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Landscape and Urban Planning 81 (2007) 167–178


Promoting ecosystem and human health in urban areas
using Green Infrastructure: A literature review
Konstantinos Tzoulas a , Kalevi Korpela b , Stephen Venn c , Vesa Yli-Pelkonen c ,
Aleksandra Ka´zmierczak a , Jari Niemela c , Philip James a,∗

The Research Institute for the Built & Human Environment, The University of Salford, Peel Building, Greater Manchester M5 4WT, UK
b Department of Psychology, University of Tampere, FIN-33014, Finland
c Department of Biological and Environmental Sciences, University of Helsinki, P.O. Box 65, FI-00014, Finland
Received 17 March 2006; received in revised form 3 February 2007; accepted 6 February 2007
Available online 6 March 2007

Europe is a highly urbanised continent. The consequent loss and degradation of urban and peri-urban green space could adversely affect
ecosystems as well as human health and well-being. The aim of this paper is to formulate a conceptual framework of associations between urban
green space, and ecosystem and human health. Through an interdisciplinary literature review the concepts of Green Infrastructure, ecosystem health,
and human health and well-being are discussed. The possible contributions of urban and peri-urban green space systems, or Green Infrastructure,
on both ecosystem and human health are critically reviewed. Finally, based on a synthesis of the literature a conceptual framework is presented. The
proposed conceptual framework highlights many dynamic factors, and their complex interactions, affecting ecosystem health and human health
in urban areas. This framework forms the context into which extant and new research can be placed. In this way it forms the basis for a new
interdisciplinary research agenda.
© 2007 Elsevier B.V. All rights reserved.
Keywords: Public health; Human well-being; Green Infrastructure; Urban ecosystem; Ecosystem health


Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Aim and objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Green Infrastructure and ecosystem health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Green Infrastructure and human health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.1. Epidemiological studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.2. Experimental studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.3. Survey studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.4. Conceptual models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Corresponding author. Tel.: +44 161 295 2133; fax: +44 161 295 2138.
E-mail addresses: (K. Tzoulas), (K. Korpela), (S. Venn), (V. Yli-Pelkonen), (A. Ka´zmierczak), (J. Niemela), (P. James).
0169-2046/$ – see front matter © 2007 Elsevier B.V. All rights reserved.


. Ecosystem Health. . . .e. . . 1995. 2005.. . like that of human health. But. epidemiological studies have provided evidence of a positive relationship between longevity and access to green space (Takano et al. . . . . the concept of ecosystem health. different academic traditions and research methods. . . . . 1998. Kinzig and Grove. . . . Environment and Behaviour. .. . . . . . 1998. . . . The World Health Organization defines human health as “a state of complete physical.. economic and political factors. . . . . (b) undertaking a critical review of the literature on associations between Green Infrastructure components and ecological and human health. . . . . . . . . Aim and objectives The aim of the paper is to integrate literature on the concepts of Green Infrastructure and ecosystem health with that on human health. . and Preventative Medicine. . . 1992. . . 1. . Tanaka et al. The British Medical Journal. Lu and Li. 1998. . . 1998). . 2000. . . . . . . . and between green space and self-reported health (de Vries et al. . . . . . 2001. Furthermore. . . . . . Devuyst et al. . . . Haeuber and Ringold. . . . Using the keywords of Green Infrastructure. . . . . . . . .. . References . . how is it possible to conceptualize the integration of socio-ecological systems in urban areas? The importance of considering human-social systems when studying urban ecological systems has been emphasised (Groffman and Likens. and help in formulating new research questions regarding ecosystem and human health. . . . . . . . . . . . . . . . . . . 2002. specialised language (Massa. . . Web of Knowledge. Zipperer et al. . . . . . . . ecosystem and human health . . 1992). . . . . . . . are complex and 173 175 175 176 176 constitute a major obstacle to interdisciplinary studies. . . . . . . . . The issues associated with integrating socio-ecological systems. .. . human health. . 8. . . . . by altering cities and the surrounding countryside. . . . psychological and social. relevant articles from these journals were identified. . . . The articles were critically evaluated by conducting a strengths and weaknesses analysis of the study design and interpretations. . . . . . . The Journal of Environmental Psychology. . . . . . . . . ecosystem health and human health. i. . . . . . . . . environmental psychology and public health. . . social and other sciences to provide a better understanding of the challenges of land use planning and management (Massa. . . . 2005). . . Nonetheless. . . . . . Yli-Pelkonen and Kohl. / Landscape and Urban Planning 81 (2007) 167–178 Conceptual framework linking Green Infrastructure. . Urban growth. . . . . . compared to 75% in 2000. well-being and conceptual models. . 2001. . . Therefore. .. . This definition implies that to fully understand and describe the concept of health a wide array of related factors ought to be considered including. . . such approaches are necessary if the challenges faced by those involved in land use planning and management are to be addressed fully. 2001. . . 2003). . . . . Introduction The United Nations (2001) estimated that the level of urbanisation in Europe will increase to almost 80% by 2015. . . . . . . 1948). . presents numerous challenges for the maintenance of urban green space. .e.. . . . . . . . . . This conceptual framework will help organise existing and new insights. . . . . At this stage only peer reviewed publications were selected for the subsequent selection of articles. . 1997. . . . . 1991. . . maintains its organisation and autonomy over time and is resilient to stress (Costanza. integrates numerous ecological. biological. . (c) constructing a conceptual framework of the interface between these disciplines. . . . . . . 1997. .g. . Additionally. . . . . . . . . The link between an individual’s socio-economic position and their health is well-established (e. . . . . . . 1991) and the lack of common theories (Moss. . . . Collins et al. Discussion. 2003).. . . . . . These themes and relationships were used to construct a conceptual framework. . . . . . . . . 1998. . . . . 2002). . Costanza et al. 2000. Brussard et al. . . . . . 1996). Yli-Pelkonen and Niemel¨a. . . . . . . . 1994. . . . Kinzig and Grove. . . . . . . . 1997. . . Rapport et al. . . . . . . . .168 7. . . . . . . . . . . social. . Mageau et al. and to formulate a conceptual framework based on the resultant new understanding. . . . . This review is an important step in stimulating debate on integrating urban Green Infrastructure components and planning in public health promotion. . . . . . . amongst others. . . To do this it is necessary to develop and use interdisciplinary approaches that integrate biological. . . . . . . . . . . . . 3. . . . 2. . . Some authors have pointed out that defining ecosystem health depends on human-social values and desires (Lackey. . . 2000).. . .. . . 2000. . . . . . . . . . . . . ecosystem health. . . The themes were summarised and classified into seven thematic groups each one . . . . . . . . Ecosystem health is generally defined as the occurrence of normal ecosystem processes and functions (Costanza. Tzoulas et al. . . 9.. . . . . . . Grimm et al. . K. . . . . . . . . . . . . Davey-Smith et al. . . . . Brunner. . . . . . mental and social well-being and not merely the absence of disease or infirmity” (WHO. Since causal relationships between Green Infrastructure components and human health are difficult to establish and quantify this critical literature review covered studies that focussed on association rather than causation. . . . Bartley et al. . . . . . landmark book publications where included in the literature review. Berkes and Folke. . . . . This is achieved through addressing three objectives: (a) constructing a set of definitions. . . . . . . . . . . .. . . . . . Ehrlich. The literature reviewed revealed a number of themes and relationships that relate to Green Infrastructure. . . Acknowledgements . . . . . . . and consequently also for human health and well-being. A healthy ecosystem is thought of as one that is free from distress and degradation. . Methods Electronic journal databases (i. . . . . 1998. . . . . Science @ Direct and Infotrac—Health & Wellness Resource Centre) were first searched by journal name to identify journals in urban nature conservation. . . . . . . . . . . .. . . . . The journals included in the literature review were Landscape and Urban Planning. . . . . . Conclusion . . . . . . . . . . 1990). ecosystem health. . . . .

according to associations that have been empirically evaluated by published studies.e. If a Green Infrastructure is proactively planned. Such a planned approach would offer many opportunities for integration between urban development. organization index Ecosystem viability or health = current utility. 2000. containment. Macintyre et al. Flores Table 1 Studies defining ecosystem health Author Type of study Keywords Lu and Li (2003) Brussard et al. that are characterised by system integrity and exhibit properties of a self-organising. de Vries et al. 2000. 2003). Medical science and epidemiology have traditionally focused on biological and individual-level factors affecting health and well-being. The term well-being is used in the WHO (1948) definition of health. On this basis.. Schrijnen. around and between urban areas. Dunn and Hayes. 1985. resilience Ecological health = ecological integrity. A key concept within public health is that of well-being. van der Ryn and Cowan. However. productivity and autonomy over time (Costanza. the dynamic nature of relationships between Green Infrastructure. psychological and psychosocial variables (Rioux. resilience . 2003. Since the 1990s there has been an increase in multilevel studies exploring the role of socio-economic and environmental factors in public health (e. The concept of health in ecology generally refers to habitats. 5. 1997. social epidemiology can contribute to a better understanding of socioeconomic and environmental determinants of health. future potential. thus contributing to conservation of biological diversity (Bratton. 2002). 1999. 1993. stress and degradation. 1998. open systems with dynamic interrelationships). 1997). Nonetheless. This was achieved by organising the themes and relationships. complex systems (Rapport and Whitford. 1992. Rapport et al. multilevel studies have not been readily accepted within epidemiology (Zielhuis and Kiemeney. 1995). ecosystem health and human health were illustrated. Within research well-being has been variously defined by socio-economic. loosely defined assemblages with only weak evolutionary relationships to one another (Levin. resilience index. 2003) as well as to the dominance of conceptual and political individualism in epidemiology (Macintyre et al..g. in the conceptual framework. environmental. 1998). and for not emphasising that ecological communities are open. good social relations and physical health (Millennium Assessment. economical. whether managed or pristine. 1986). Multilevel approaches (e. as well as by the feelings of connectedness to nature (Mayer and McPhersonFrantz. The WHO (1948) defines health as being a state of complete physical. 2006. and the importance of interconnections between habitats (van der Ryn and Cowan. Odum. developed. Lu and Li (2003) see modelling of ecosystem health as an organising framework for protecting and sustaining environmental quality and human well-being.. models of ecosystem health ought to be constructed under the new ecological paradigm (i. / Landscape and Urban Planning 81 (2007) 167–178 comprising a number of elements. 1996. cultural and political factors. The Millennium Ecosystem Assessment adopted a broad definition of “well-being” that includes material security. This has been attributed to the lack of theoretical foundations and unresolved methodological issues (O’Campo. and maintained it has the potential to guide urban development by providing a framework for economic growth and nature conservation (Walmsley.. Nonetheless. personal freedoms.. nature conservation and public health promotion. semi-natural and artificial). 2003). Karr et al. sociological. It can be considered to comprise of all natural. Suter. 1997.K. Ross. 2002). The concept of Green Infrastructure emphasises the quality as well as quantity of urban and peri-urban green spaces (Turner. organization. mental and social well-being. The concept of ecosystem health has been variously defined (Table 1) and the definitions have been closely allied with the concepts of stress ecology (Barrett and Rosenberg. 169 social epidemiology) are important in identifying a varied range of socio-economic and environmental factors affecting public health. and maintains its organisation.. an ecosystem can be considered as healthy when it is free from. 2001). It has been criticised for creating a metaphor of “ecosystem as organism” (Rapport et al. 4. Urban and peri-urban habitats increase the overall vegetation cover (natural. Definitions The concept of Green Infrastructure has been introduced to upgrade urban green space systems as a coherent planning entity Sandstr¨om (2002). Brussard et al. at all spatial scales. 1992). for focusing on equilibrium theories (de Leo and Levin. 1993). semi-natural and artificial networks of multifunctional ecological systems within. Wicklum and Davies. 1992. Rudlin and Falk.g. 1981. 1998.. 1989). 2004). Rapport. or resilient to. 1992). Diez-Roux et al. Further work is needed in testing theoretical assumptions and developing rigorous methodological approaches in order to advance the field (O’Campo. 2005). Tzoulas et al. 1999). However. 2000. which encompasses a wide array of biological. Green Infrastructure and ecosystem health The elements and components of a complete Green Infrastructure could contribute to ecosystem health in various ways. 1996).. 1996). Then. their multifunctional role (Sandstr¨om. The concept of ecosystem health is not unanimously accepted (Calow. (1998) Model of ecosystem health Discussion of ecosystem management Lackey (1998) Discussion of ecosystem management Costanza (1992) Model of ecosystem health Vigour index. need to define the desired state to achieve desired social benefits Vigour.

although large (N = 10197). Haddad and Tewsbury. Lu and Li. Regarding social outcomes of green space Kim and Kaplan (2004) suggested that natural features and open spaces in a ... 1999). a Green Infrastructure maintains the integrity of habitat systems and may provide the physical basis for ecological networks. Bolund and Hunhammar. 2003) and the European Ministerial Conferences on the Environment and Health Process recognised that poverty and social factors are the main determinants of human health... 2001).170 K. This makes biodiversity conservation an integral part of sustainable landscapes (Opdam et al. sex and education level (Booth et al. or vigour. Cultural. Tanaka et al. species-rich ecosystems are considered to maintain their organisation better than less diverse ones. in a non-exhaustive list. 1999. protection or maintenance of goods and benefits that humans obtain from ecosystem functions (Millennium Assessment. sex. it is commonly hypothesised that species-rich communities are more resistant to invasion than species-poor communities.. 1990). (1998) saw that linking ecosystem health to the provision of ecosystem services. Simberloff et al. de Groot et al. Macintyre et al. Davey-Smith et al. 2003). 2002. de Groot et al. An accumulating set of studies provide evidence. increas- ing ecological stress leading to a reduction in both the quality and quantity of ecological services (Cairns and Pratt. identified no less than 32 ecosystem services including biological. Ross. There is a close relationship between ecosystem health and ecosystem services: i. Dunn and Hayes. psychological and other non-material benefits that humans obtain from contact with ecosystems contribute in particular to human health in urban settings (Butler and Oluoch-Kosura.. recreational and cultural. 2002). a Green Infrastructure could have an influence on urban and peri-urban ecosystem health by contributing to ecosystem resilience. organisation and vigour. Takano et al. 1998. when controlled for socio-economic and demographic characteristics and for level of urbanity. 1992. The link between ecosystem health and public health is the set of ecosystem services provided by the Green Infrastructure... ecological networks have become a popular element of urban planning (Jongman and Pungetti. ecological functions and ecosystem services derived from a Green Infrastructure contribute to ecosystem health and to public health.. 1993. marital and socio-economic status.. the functionality of corridors in ecological networks remains contested (Noss. especially in relation to lifestyle that may be prevalent in communities near parks. Epidemiological studies The links between socio-economic status and health are wellestablished (e. 2004. 2003). In contrast. physical. 1998). 1997. 1997.. Therefore. 2002. 2006). 2003. Pikora et al. respectively. Also. presents major challenges at the interface of health. aesthetic. because they use the available resources more efficiently (Loreau et al. Therefore. 2006). However. Payne et al. provision. Evidence of the association between levels of physical activity and proximity of green areas in the neighbourhood have been provided in studies which have controlled for age. 2002.. Furthermore... From these fundamental ecosystem functions. 2005).. The elements of a Green Infrastructure can be seen as preserving and enhancing diversity within ecosystems in terms of habitats... 1997). 1998. bio-chemical and abiotic processes.. The term “ecosystem service” refers to the delivery. Tilman. The EU Strategy on Environment and Health (EC. 1998).. controlled for age. and determining how an ecosystems’ health (or alternatively dysfunction) related to these services. So. (1998) found that park users reported better general perceived health. on the positive relationship between well-being. within and between ecosystems (Turner et al. 2003). the possibility of confounding factors is impossible to exclude. Furthermore. (2002). 1996). Therefore...e. there is a rapidly accumulating body of theoretical (Humpel et al. 1995). / Landscape and Urban Planning 81 (2007) 167–178 et al.g.. 6. Hobbs. 2000. social and natural sciences. albeit still rather weak. Bartley et al. Only a few empirical studies have shown the successful role of ecological corridors as conduits for wildlife (e.. 1996. and may also lead to people spending a greater amount of time outdoors and being more physically active. 1995). Epidemiological studies. Tanaka et al. in the absence of alternative strategies for addressing the ecological impact of fragmentation. de Vries et al. numerous ecosystem services can be provided. but environmental threats are recognised too. higher levels of activity and the ability to relax faster. have provided evidence of a positive relationship between senior citizens’ longevity and green space (Takano et al. Tzoulas et al.1. 2000. 1997). healthy ecosystems have the capacity to provide a comprehensive range of ecosystem services (Costanza et al.g. was drawn from people visiting primary care facilities. Humpel et al. positive relationships have been revealed between green space and self-reported health (de Vries et al. Green areas in one’s living environment may ameliorate air pollution. 1997. Species-rich heterogeneous habitats are considered to be more resilient than homogenous habitats (Bengtsson et al. Takano et al. Brussard et al. and the urban heat island effect (Whitford et al. Green Infrastructure and human health 6. 1995). 2004). 2002). 2002). 2000. 1996). 2003. The possibility of selection bias remains with the de Vries et al.. A possible mechanism explaining the relationship between the amount of green space. Beier and Noss. Additionally. species-rich ecosystems have higher productivity. The development of ecological networks has been advocated as a means of alleviating the ecological impacts of habitat fragmentation. Brunner. 1993. Diversity is one of the most important indicators of ecosystem health (Rapport. 2003.. Ecosystem functions include biotic. Indeed. 1997. 2005. health and green space (de Vries et al. (2003) study as the sample. Rapport et al. Diez-Roux et al. The benefits of biodiversity for human well-being are generally determined by the diversity of habitats and species in and around urban areas (Tilman. 2002) and empirical evidence of the importance of physical environmental influences on neighbourhood walking and physical activity.. well-being and health has been hypothesized (cf. than simpler ecosystems (Naeem et al. species and genes. Even though these studies were controlled for socio-economic factors..

2001. 1993). vegetation or water) after exposure to a stressor video. Experimental studies A second mechanism explaining the relationship between the amount of green space. Korpela. and their interactions with other residents.3. low-income. A decrease in negative feelings and a commensurate increase in positive feelings have characterized visits to natural favourite places in particular (Korpela et al. and emotional gains (Hartig et al. based on psycho-evolutionary reasoning. This assertion is based on the speculation that environmentally induced changes in physiological.. 1993). Table 2). has also been found in controlled field experiments where subjects were randomly assigned to a slow walk in either urban or natural environments. 2003) in natural settings. (2001) found that. causal relationships are not easy to establish. facing matters on one’s mind. Future research will show whether it is possible to quantify environmental influences and subsequent positive or negative health outcomes from different types and configurations of urban Green Infrastructure. 1989. 1992). mainly natural settings. 1998. 1996) such as forgetting worries. natural places constituted 50–60% of their stated favourite places (Korpela and Hartig. Wells (2000) studied American 7–12-year-old. urban children before and after relocation. 2001) studies have suggested . 6.. Further research is also required to establish different possible health responses to natural. For example. Additionally. Favourite places afford emotional release and also restorative experiences (Korpela and Hartig. 1996. such as sport. 1997). or mediate. despite accumulating evidence on the relationships between components of the Green Infrastructure and health. 2006). Even passive viewing of natural environments after negative antecedent conditions. changes in well-being and health. Tzoulas et al. Stokols et al.. 2001). it is reported that the greener a child’s play area was. These studies suggest that a complete Green Infrastructure may have a considerable potential for improving the health of urban residents. 1991). Experimental research has also begun to investigate the effect of natural versus urban environments on restoration gained through running (Bodin and Hartig. suggests that certain aspects of biodiversity elicit fear and avoidance. These studies used statistical mediator variable analysis to demonstrate the relationship between green elements and psychological variables. produces stress-ameliorating effects which may ultimately confer health benefits (Ulrich.. Evidence also indicates that adults with high negative mood scores (Korpela. It is stipulated in this hypothesis that contact with nature is fundamental to psychological well-being and personal fulfilment (Kellert and Wilson. well-being and health can be hypothesized. 2006). Korpela et al. Newell. The biophilia hypothesis suggests a biologically based.. commercial or community service settings. 1993). Hence. according to parents’ assessments. are more likely to choose favorite places dominated by vegetation than other favorite places. Nearby trees and grass visible from apartment buildings have been shown to enhance residents’ effectiveness in facing their major life issues and to lessen intra-family aggression by reducing mental fatigue (Kuo. This was indicated by lowered blood pressure. clearing away random thoughts. 1991) as well as lowered blood pressure (Hartig et al. Faber-Taylor et al. the positive benefits of green space cannot be generalised. 2004) and West Nile Virus (Zielinski-Gutierrez and Hayden. / Landscape and Urban Planning 81 (2007) 167–178 residential area play an important role in residents’ feelings of attachment towards the community. Also. 1984). recovering attention focus. due to association with danger (Ulrich. 2001. and relaxation (Korpela et al... 2003. as well as those reporting a higher incidence of health complaints (Korpela and Yl´en. Similarly. Although there is no direct empirical evidence for either hypothesis. 1989) or psycho-physiological stress (Ulrich. for regulation of their feelings (Korpela. there is compelling logical reasoning for them (Pretty et al. green spaces that are perceived to be overgrown or unmanaged may have a negative effect on peoples’ well-being by increasing anxiety caused by fear of crime (Kuo et al. 6. urban and peri-urban ecological changes can affect the geographical range of diseases such as Lyme disease (Patz and Norris. produced significant recovery from stress within 4–7 min. Moreover. In adult samples from different countries. 2003). sufficient evidence prevails to draw the conclusion that a Green Infrastructure is a significant public health factor (St Leger.. semi-natural or artificial habitats.. the biophobia hypothesis. 2001). However. Interestingly. 1984). Even those studies with the best controls for socio-economic factors cannot compensate for the array of personal.K. A mechanism to explain human affiliation or aversion towards biodiversity has been expressed in the biophilia and biophobia hypotheses. emotional and cognitive processes may induce. Although subjective effects have been found more studies are needed to objectively quantify health benefits from Green Infrastructure. temporal and cultural factors that also affect human health. 2001). some biodiversity (Horwitz et al. self-report studies on people’s favourite places indicate that people visit particular neighbourhood places. inherent human need to affiliate with life and lifelike processes (Kellert and Wilson. He found that whilst the change in the overall housing quality was not a significant predictor of ability to focus attention. Survey studies Studies on self-regulation of mood complement epidemiological and experimental studies by emphasising the active role of individuals in the use and choice of green settings. muscle tension and skin conductance in a study where subjects were randomly assigned to urban or natural video conditions (Ulrich et al. children whose homes improved 171 the most in terms of natural views tended to have the highest levels of attention capacity. 2001). such as attention fatigue (Kaplan and Kaplan. Evidence of improved attention functioning. 1997). 2003). On the other hand. Bixler and Floyd. For example.. 2003.2. Kuo and Sullivan. 2001) and environmental health (Wilson. 2003). On the other hand. the less severe his or her attention deficit symptoms were (Faber-Taylor et al. Hence. a 10 min video exposure to an everyday nature view (dominated by trees.. 7–12-year-old children with attention deficit disorder functioned better than usual following participating in activities in green settings.

often natural settings. (2003) Payne et al. The two interconnected parts of this framework are (1) the human-social system – which includes social institutions. and (2) the resource system – which consists of cultural and socio-economic resources. environmental. However. Ulrich et al. ecosystem services were grouped into four categories (provisioning. Tanaka et al. (2005). chronic stress and high blood pressure. Conceptual models With the great variety of benefits attributable to Green Infrastructure in relation to the urban ecosystem and human health and well-being. as well as people’s attachment to such places. Kuo and Sullivan (2001) Experimental Korpela (1989. community. Korpela and Hartig (1996). Both the original human ecosystem model (Pickett et al. Newell (1997) Kim and Kaplan (2004) Survey Innate need to be in contact with biodiversity for psychological well-being and personal fulfilment Urban green space users have greater longevity Urban green space users had better self-reported health Urban park users reported better general perceived health. supporting and cultural) and human well-being into five categories (security. 1992). access to basic resources. 2003).e. more physical activity and relaxation Natural views restore attention fatigue. health. Millennium Assessment.. increased positive self-reported emotions. and ecosystem structure and processes (Pickett et al. 1997). (2001).. The Millennium Ecosystem Assessment developed a conceptual framework linking ecosystem services and human well-being through socio-economic factors. 1998). and the interactions between Green Infrastructure and urban social systems. The settings approach to public health is characterised by its emphasis on the integration between social. integrated the arch of health with organisational development principles and systems theory. Grimm et al. and the subsequent modified versions (Pickett et al. 2001)... biological and physical complexes. (1991. may prove to be important to the study of these phenomena.172 K. The human ecosystem framework is an integrated analytical framework for analyzing urban systems as social. (2001) Experimental Kuo (2001). Wells (2000) Ulrich (1984). cultural. 2000).. / Landscape and Urban Planning 81 (2007) 167–178 Table 2 Studies exploring the contributions of green spaces and nature to human health Author Type of study Human health aspect Kellert and Wilson (1993) Interdisciplinary studies synthesis Takano et al.4. good social relations and freedom of choice. for studying social–ecological systems in urban areas. to promote the settings approach within organisations. Another integrative framework for factors affecting public health is the arch of health (WHO. via intermediate vectors. 2003). 2001. (2002). with their consequent health implications. working and living conditions.. This modified scheme highlights the essential variables. via a second set of intermediate vectors. and recovery from stress Children with attention deficit disorder who are active in green spaces show reduced symptoms Green views increase the effectiveness of people in facing major crises. Although the well-being categories of the Millennium Ecosystem Assessment Conceptual Framework include broad social and environmental factors. restorative environments and favourite places in nature). (1998) Epidemiological Epidemiological Questionnaire and diary survey Kaplan and Kaplan (1989). they . This is a public health model illustrating the environmental. The human ecosystem framework was modified with respect to the interactions of ecological and social systems in urban areas by Grimm et al. environmental stress can lead to chronic anxiety. affect the nervous system and this is manifested. they do not clearly articulate the relationships between ecosystems and public health. 2000). The psychosocial stress and health model was explained in Henwood’s (2002) review of the role of environmental and countryside agencies in promoting health. The Millennium Ecosystem Assessment was completed in 2005 and assessed global ecosystem changes and their impacts on human well-being. in mental or physical illness. Tzoulas et al. interactions and feedbacks connected to land use change (Grimm et al. socio-economic. (1991) Experimental Faber-Taylor et al. (2000). According to this model. in the healthy living and working model. for regulation of self-experience and feelings Experimental Survey that understanding the salutary effects of natural environments (i. it is not surprising that integrative frameworks have been developed to link human and ecosystem health. Natural features and open spaces in a residential area enhance sense of community Freeman (1984) suggested a model of environmental effects on mental and physical health. (1996) de Vries et al. organisational and personal factors that collectively determine human health and well-being. help in understanding the role of Green Infrastructure in urban areas. 1997). and quicken recovery of attention-demanding cognitive performances Natural views provide relaxation. lifestyle and hereditary factors of public health. One such framework is the human ecosystem framework (Pickett et al.. social cycles and order. social and cultural factors. since these models were developed from socio-ecological considerations. regulating. 2001). 6. 1997. Hartig et al. Thus. Korpela et al. and lessen aggression by reducing mental fatigue People visit favourite places. developed from the human ecosystem model (Pickett et al. This model stipulates that physical. Paton et al.

green areas do not explicitly distinguish between the biological. LW: living and working conditions. ecosystem and human health. but it does not clearly articulate the links between them. education. AS: aesthetic and spiritual. (2002) includes various environmental (e. infectious diseases. and spiritual) Health all aspects (physical. Macintyre et al. The top half (ecosystem) has three interrelated boxes and the bottom half (human health) four interrelated boxes. PE: positive emotions. as well as economic factors amongst others (van Kamp et al. EI: endocrine functions and immunity. CI: sense of community identity. The framework suggested by Macintyre et al. cemeteries and school grounds. SC: social capital. WP: water purification. socio-economic Chronic anxiety. social. / Landscape and Urban Planning 81 (2007) 167–178 173 Table 3 Models and theories linking ecosystem and human health aspects Author Model/theory Green Infrastructure aspect Human health aspect Freeman (1984) Model of Environmental Effects on Mental and Physical Health Psychosocial Stress and Health Model Physical. waste disposal. social) play of factors affecting quality of life including personal. 1. Their model illustrates the complex inter- Working and living conditions. WQ: water quality. landscapes. social relationships. and recreation) and economic (e. NP: noise pollution control. The top half of the figure Fig. . AC: attention capacity. cultural. CS: churchyards. cultural. CE: community empowerment. but did not acknowledge the importance of biodiverse habitats in contributing to these factors. 2001). Conceptual framework linking Green Infrastructure. natural and built environment. A comprehensive model of liveability and quality of life was synthesised by van Kamp et al. following their review of the concepts of liveability. The framework has two main parts separated by two-way arrows. AP: air purification. psychological and epidemiological aspects of health. D: digestive. (2002) suggested a conceptual framework on which to base measurements of environmental influences on health. 1). flora and fauna. natural resources. CC: cognitive capacity. EL: education and lifestyle. HG: housing green space and domestic gardens. health. environmental quality. OW: open standing and running water. and freedom of choice Human needs (biological. Two-way arrows indicate two-way interactions. community. (2002) Healthy Living and Working Model Links between ecosystem services and human well-being Framework based on basic human needs van Kamp et al. CL: culture. (2003) Domains of liveability and quality of life Henwood (2002) Arch of Health Environmental. (2005) Millennium Assessment (2003) Macintyre et al. social (e. C: cardiovascular. ecosystem and human health To summarise the main findings from this literature review and to promote further research in this area. a conceptual framework linking Green Infrastructure. food. IE: income and employment. (2000) WHO (1998) Human Ecosystem Framework Ecosystem structure and processes and cultural and socio-economic resources Environmental. ER: ecosystem resilience. chronic stress and high blood pressure Socio-ecological systems Paton et al. socio-economic Provisioning. Conceptual framework integrating Green Infrastructure. Based on Maslow’s hierarchy of human needs. This comprehensive model is useful in conceptualising health determinants. and protection from infections). water. regulating and cultural Air.g. quality of life and sustainability. ecosystem services. social. pollution Natural environment.K. social and cultural factors Nervous system and manifested illness Poor environment Pickett et al. personal. clean air and water. SS: soil structure. SN: soil and nutrient cycling. Key: GR: green roofs. community.g. CR: climate and radiation regulation. HP: habitat provision. R: respiratory. DL: derelict land. Tzoulas et al.g. working and transport) factors affecting health. cultural. EC: encapsulated countryside. GC: green corridors. UP: urban parks. AQ: air quality. N: nervous system. B: bone tissue. ASH: access to services and housing. ecosystem and human health and well-being was developed (Fig.. basic resources. (1997. 7. RS: relaxation from stress. lifestyle and hereditary factors Living and working conditions Security. Grimm et al. HSD: habitat and species diversity. (2003). psychological. 2003). The integrative frameworks linking ecosystem and public health are summarised in Table 3. EM: energy and material cycling. WD: waste decomposition.

2003. Pesticide use may then cause health consequences for the local people (e. also promotes health and well-being (Department of Health. 1 summarises ecosystem health. In turn. Public health is also represented at both the community level and the individual level. with human health aspects summarised in the lower half. in particular. configuration and variability of ecosystem functions and services. Local Government and the Regions (2002) has been adopted because it includes green spaces of all types of origin. if engaged in frequently. 1998) also recognises culture and lifestyle as determinants of health. This typology is inclusive and flexible enough to be applied in a variety of urban settings. ownership and function. 1998). These indices formed the basis for the elements included in box 4 of Fig. aspects of public health which encompass physical. the residential environment and workplace. . 1999. 1 are all interrelated. Mathematical modelling within and between each one of the boxes is feasible by using multivariate analysis of indicators such as habitat size and connectivity. 1989. The Green Infrastructure and its ecosystem functions and services create the urban ecosystem settings within which the socio-economic and other aspects of public health exist. based on current evidence... The typology of urban green spaces developed by the UK’s Department for Transport. In the UK. and particular species of plants could be indicators at the species scale. employment. this may lead people to select other favourite places (Horwitz et al. Ecosystem management is inevitably guided by human needs. Kaplan and Kaplan. indicators for physical or psychological illnesses could be collected at the national. 1996. From the community level of boxes 5 and 6 of Fig. the Indices of Deprivation 2004 (Office of the Deputy Prime Minister. Bouchard et al. This implies that peoples’ health can also be a factor in modifying environments. 1) also focuses at the individual level of health and. Achieving these goals would require the concerted establishment of multidisciplinary international research teams. This is why community health has also been included in the conceptual framework (Fig. Psychological aspects are considered in relation to contact with green spaces (Hartig et al. 2005. Korpela and Hartig. Community satisfaction and involvement. / Landscape and Urban Planning 81 (2007) 167–178 shows the two-way interactions (indicated by two way arrows) between Green Infrastructure. Additionally. 1.. 1998) suggest that outdoor or indoor physical activity. quantity. physical health. The Green Infrastructure and associated improvements in ecosystem health provide the environmental settings of public health. there are two-way interactions between ecosystem and human health. 2001). does not make assumptions about causality but rather demonstrates the complexity of associations between ecosystems and human health. Psychological aspects. regional. the healthy living and working model (Paton et al. economic and some environmental conditions of communities. The elements that make up the urban Green Infrastructure are outlined in box 1 of Fig.g. and the aspects of ecosystem health that these influence. Payne et al.. (2001). the ecosystem functions and services it provides. 2003. proximity to services. Such a modelling approach could be applied to discern correlations at different scales of resolution. cardiovascular and respiratory disease. social and community health.174 K. Hence lifestyle. Therefore. Westphal. A Green Infrastructure through its ecosystem functions and services creates the environmental settings for community health. This scale is appropriate for the study of ecosystem services and public health.. Kaplan. and incidence rates for depression. Box 7 (Fig. Korpela et al. as well as educational level and access to health care and other housing facilities. This framework. the presence of mosquitoes in a place favoured by the public may result in a demand to use pesticides. Hence. 1991. Community relationships also contribute significantly to the well-being of individuals (Troyer. both preventative and curative (Department of Health. The top half of Fig. city and electoral ward levels. 2002.. These environmental settings contribute to. Furthermore. The four boxes in the lower half of Fig. on psychological health. also recognise living and working conditions as determinants of public health. income. 1. 2003). ␣-diversity could be an indicator at the habitat scale. are fundamental to the social well-being of both communities and individuals. Tzoulas et al. Kuo. 1. including emotional and cognitive elements. Schrijnen. are all important determinants of public health. 1990). psychological. For example.. have been linked with each other and with the Green Infrastructure. amounts of pollutants. the model of ecosystem health developed by Lu and Li (2003) and the ecosystem services components of the framework developed by Pickett et al. In boxes 2 and 3 of Fig. respiratory irritation) and/or a change in local people’s attachment to that place. 2001).. illustrated on the model by two-way arrows between the upper and the lower halves. 1. 2004) describe the social. socio-economic factors and cultural conditions. 2004. box 5). Ulrich et al. The level of resolution of this conceptual framework is that of the landscape scale. 2000). are important components of human health. Ecosystem health relates to the quality. Epidemiological studies linking Green Infrastructure and health (Takano et al. but are also affected by (two way arrows). Sallis and Owen. 2005) and the arch of health (WHO. 1. 2001. Multidisciplinary research should be integrated into trans-national research policy if integration between human and ecosystem health is to be successfully achieved. community factors and socio-economic factors work synergistically to affect the well-being of individuals. Therefore. For instance habitat connectivity could be an indicator for Green Infrastructure at the landscape scale. the lower half of the framework comprises four boxes representing these aspects of health and the two-way interactions between them (two way arrows). 1995. Ideally each of these elements should be present in sufficient amounts and interconnected at all scales to create a contiguous Green Infrastructure (Li et al. since they are factors affecting health and well-being of both individuals and communities. 2002. Exercise is suggested to have direct health maintenance effects. box 6 deals with physical health at the individual level. physical activity and socio-economic and community health are inseparable.. as well as community identity. habitat heterogeneity. Therefore. Kuo. 2004). The arch of health (WHO.

1).K. community participation and psychological disorders. ecosystem health and public health. it is necessary to articulate the link between ecological and social systems in a way that is understood by those working in different disciplines. and public health specialists to further improve urban and peri-urban environments. The framework does not explicitly distinguish between scales but rather recognizes interacting themes that might be scale independent. Haeuber and Ringold. 1948). can be developed from the top half of the conceptual framework. undertaking longitudinal studies and ensuring that geographical units (scale) are relevant to the health outcome under investigation (Diez-Roux. or between primary and secondary factors and their relationships. Ehrlich. Urban planners. There is also clearly a need to evaluate the potential economic implications of Green Infrastructure. the identification of causal relationships between environmental factors and health. urban ecologists. The concept of human health is defined as an ideal state of socio-economic and biological being (WHO. The linkages between the Green Infrastructure. Ecosystem health is seen as a heuristic metaphor based on the concept of human health (Haila. Also. ecosystem and human health) can be precisely defined. Healthy environments can contribute to improved socio-economic benefits for those communities as well. thus providing an outline for creating an interdisciplinary research agenda within which hypotheses can be developed. Tzoulas et al. The interdisciplinary nature. Community health and psychological health issues are the remit of epidemiologists and environmental psychologists. contextual and collective explanations for environmental effects on health (Macintyre et al. 1998. as has been recommended in a number of studies (Berkes and Folke. This finding makes a strong economic case. the development and testing of hypotheses to explain how environmental factors influence health. the saving to the UK’s National Health Service would be more than £1. environmental psychologists. can be developed based on the lower half of the conceptual framework. of this framework are its main strengths.. Another strength of the framework is that it does not distinguish between what is considered to be more or less important. Most importantly. Thus. 2002). Neither of the two concepts that are central to the conceptual framework (i. and on to which political or biological boundaries may be imposed if this is required. he calculated that if 20% of the population within 2 km of an 8–20 ha green space used that space to reach a target of 30 min activity on 5 days a week. physical illness. In particular the level of detail is purposefully designed so that it might be used flexibly and adjusted to particular settings. testing of residual confounding variables. this conceptual framework presents opportunities for interdisciplinary collaboration for studying the relationships between the Green Infrastructure and ecosystem and human health. and to the issues included in boxes 4 and 6. 2000. This allows for debate and dialogue between disciplines. description and measurement of the environmental processes that affect health. and the detail. Based on a study of five major UK cities. the proposed framework elaborates the findings of the Millennium Assessment (2003) and emphasized their applicability to the urban context. The integrative conceptual framework that is proposed here contributes to the settings approach to public health by incorporating the arch of health (WHO. Conclusion Ecosystem services provided by a Green Infrastructure can provide healthy environments and physical and psychological health benefits to the people residing within them. 9. The framework proposed should facilitate interdisciplinary debate to define the conditions of pub- 175 lic health and ecosystem health. for enhancing the urban Green Infrastructure for the purpose of reducing health care expenditure. in measuring and modelling the role of Green Infrastructure and ecosystem health in maintenance of human health. Bird (2004) developed a model for calculating health care savings attributable to increased outdoor physical activity. Discussion This literature review has synthesized research carried out in a number of disciplines which has explored the role of green spaces in public health. / Landscape and Urban Planning 81 (2007) 167–178 8. 1998. It also allows for changing scientific evidence and changing social and political values to be incorporated into discussions without the whole framework having to be redesigned. Public health indicators based on socio-economic derivation. developers. as well as a strong social case. death rates.. 2001. This provides a basis for the establishment of an interdisciplinary approach to urban planning. and progress made. Kinzig and Grove. The hope and intension of this paper is to encourage the integration of information among and between the various disciplines such as the urban nature conservationists. politicians. 1) illustrates possible ways for developing associations between the concepts of Green Infrastructure. In addition. air and water quality and landscape features and form.. 2002).e. Considerable empirical research to explore the roles of environmental factors in public health is needed in order to resolve theoretical and methodological issues before any relevant policy interventions can be formulated.7 million) a year. 1998) into the discipline of urban ecology. 1998). This is an important consideration in the light of ongoing expansion and intensification of urbanisation worldwide. Devuyst et al. 2002). atmospheric and soil scientists and social scientists. In a pioneering study. 2001. Collins et al. linked to health effects and health service budgets. Ecosystem health indicators based on habitat and species indicators. Thus. ecosystem and human health and well-being presented in this paper provide a basis for such an interdisciplinary “conceptual meeting point”. It is also important to distinguish between the compositional. public health professionals will not be strangers to issues relating to pollution. If the concept of Green Infrastructure is to gain recognition as an important public health factor. this new conceptual framework illustrates clearly the relationships between ecosystem and human health systems. will be familiar with aspects of the conceptual framework (Fig. the conceptual framework (Fig. These theoretical and methodological issues include the identification. .8 million (D 2.

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