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Medical Hypotheses 76 (2011) 877880

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Medical Hypotheses
journal homepage: www.elsevier.com/locate/mehy

Does biodiversity improve mental health in urban settings?


Julie Dean a,, Kate van Dooren a, Philip Weinstein a,b
a
b

School of Population Health, University of Queensland, Australia


Graduate Studies Centre, University of South Australia, Australia

a r t i c l e

i n f o

Article history:
Received 15 December 2010
Accepted 22 February 2011

a b s t r a c t
Background: Globally, the human and economic burdens of mental illness are increasing. As the prevalence and costs associated with mental illness rise, we are progressively more aware that environmental
issues such as climate change and biodiversity loss impact on human health.
Hypothesis: This paper hypothesises that increased biodiversity in urban environments is associated with
improved mental health and wellbeing. It proposes the ecological mechanism through which the association may exist, and explores the extant literature to determine the extent of empirical evidence to support our hypothesis.
Evidence: While there is a substantial literature investigating the impact of green space and contact with
nature on mental health, we identied only one original research paper that directly investigated the link
between biodiversity and mental health. This suggests that the extant evidence considers only one part
of the story, providing an evidence base which is inadequate to inform policy on biodiversity conservation and public health.
Implications: Our hypothesised relationship between environmental change and mental health proposes
conservation and restoration of biodiversity in urban environments as a form of intervention for improving human health. It also highlights the need for a better evidence base to demonstrate the synergistic
benets of increased biodiversity and mental health to decision makers. Well-designed quantitative epidemiological research is needed to establish the strength of any such causal relationship.
2011 Elsevier Ltd. All rights reserved.

Introduction
Globally, the human and economic burdens of mental illness are
increasing. Mental illness has been estimated to affect over
450 million people internationally [1]. In 2001, unipolar depressive
disorders were responsible for 5.6% of global disability adjusted life
years (DALYs) in high-income countries alone [2]. In Australia in
2010, mental disorders accounted for 13% of total DALYs, and anxiety and depression is, and will remain, one of the countrys top
ve leading causes of disease burden over the next decade [3].
As the prevalence and costs associated with mental illness increase, we are becoming progressively more aware that environmental issues such as climate change and biodiversity loss
impact on human health. Recent studies have demonstrated the
negative effect of environment degradation [47] and environmental disasters [8] on mental health outcomes. However, nature can
also impact positively on mental health and wellbeing, and we
know that contact with natural environments such as forests and
vegetation can improve outcomes across a broad range of human
Corresponding author. Address: School of Population Health, Public Health
Building, Herston Road, Herston Qld 4006, Australia. Tel.: +61 7 3346 4628; fax: +61
7 3365 5442.
E-mail address: j.dean@sph.uq.edu.au (J. Dean).
0306-9877/$ - see front matter 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.mehy.2011.02.040

health indicators [9]. In urban environments, physical, and even visual, contact with green spaces any piece of land covered with
vegetation, including green corridors, woods, parks, elds, or easily
accessible countryside [10,11] is associated with better mental
health outcomes [12,13]. However, while this literature has contributed to an important evidence base for public health interventions in urban settings, many of the green spaces investigated in
these studies (for examples parks and small gardens) do not necessarily improve urban ecosystem health or promote biodiversity
per se.
Hypothesis
This paper hypothesises that increased biodiversity in cities is
associated with improved mental health and wellbeing. It proposes
the ecological mechanism through which the association may exist, and explores the extant literature to determine the extent of
empirical evidence to support our hypothesis.
Biodiversity, or biological diversity is the variability among
living organisms from all sources including, interalia, terrestrial,
marine and other aquatic ecosystems and the ecological complexes
of which they form part; this includes diversity within species,
between species and of ecosystems [14]. Table 1 presents a model
of the ecological linkage mechanism connecting urban

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J. Dean et al. / Medical Hypotheses 76 (2011) 877880

Table 1
A model of the ecological linkage mechanism connecting urban environmental
change with mental health.

environmental change with mental health, and is described in detail below.


Column A refers to impacts of urbanisation on biodiversity. Rapid growth in cities across the globe has led to more than half of
the worlds population living in cities, with a worldwide urban
growth rate of 2% from 2005 to 2010 [15]. Three-quarters of the
population of people in more developed regions live in urban areas
[16] with 89% of Australians in urban centres [15]. An emerging
planning framework to help reduce impacts on the ecosystems
that support cities is the concept of green infrastructure, which
refers to networks of multifunctional ecological systems that address urban development and nature conservation goals, including
enhancement of biodiversity in cities [17].
Column B outlines the proposed ecological linkage mechanism
connecting urban biodiversity to improved mental health. Biodiversity is a critical factor in ecosystem health, linked to indicators
such as resilience (the capacity of a system to absorb stressors such
as extreme weather events or accumulation of toxic substances),
organisation (the diversity and number of interactions between
different parts of the system, for example high biodiversity in native animals or plants), and vigour (related to the activity and productivity of an area, such as soil fertility) [18].
Column C points to the services provided to humans by healthy
ecosystems and associated linkages with mental health. An urban
areas ecological footprint can be reduced by capitalising on ecosystem services which provide benets to humans [19,20]. Examples of ecosystem services include provisioning services (such as
locally produced food and fresh water), regulating services (such
as improvements in urban hydrology, air quality, temperature
regulation, and carbon sequestration) and culturally enriching
services (such as recreational environments, educational opportunities, aesthetic values and cultural heritage) [20,21]. Supporting
services such as soil formation, nutrient cycling and primary
production underpin all of the above services.
By maintaining ecosystem health, the impact of human populations on the surrounding environment is reduced. This impact can
be measured in terms of the ecological footprint of a city [22], or
the amount of land and water area a city needs to produce the
material consumed by citizens and absorb the waste. The area of
land required to provide a city with the necessary resources to
function and assimilate its waste is far beyond the boundaries of
the city itself.
There is evidence that the mental health of citizens is directly
impacted by each of these service types. The literature investigat-

ing the links between contact with nature and mental well-being is
particularly oriented to the culturally enriching services of
ecosystems, with emphasis on psychosocial benets such as recovery from stress and self-regulation of emotions [23], restoration of
attention fatigue [10,24,25], enhanced sense of community [26]
and settings for physical activity [27,28]. In proposing our
hypothesis we also point to the evidence regarding the relevance
of other ecosystem service types on mental health. The impacts
from diminished regulating services is clearly seen in the link between post traumatic stress and natural disasters such as major
ooding or bushres, and the psychological consequences of environmental stressors such as drought and heat exposure [5,7]. Physical health problems linked to loss of biodiversity and associated
environmental degradation [29] are also associated with mental
health problems through causal and reciprocal relationships
[7,30]. The mental health impacts of impaired provisioning services is seen via a less direct causal pathway through psychological stress experienced due to loss of livelihood, and associated
impacts from life changes in areas such as employment and place
of residence. In short, the capacity of ecosystems to provide sufcient resources and a supportive habitable environment for humans has an important protective function for human mental
health.

Evaluation of the idea in current literature


Previous studies have proposed mechanisms through which
ecosystem health might impact upon human health. In particular,
Tzoulas et al. [17] proposes a comprehensive framework explaining the association between ecosystem and human health based
on a detailed narrative review of the literature. While this framework successfully integrates and represents the evidence base, it
does so without necessarily representing the specic pathway
through which a conservation biology approach to biodiversity
might also improve human mental health outcomes. We aim to
build on and enhance this framework: rather than integrating literature on this topic, we start with a public health hypothesis
grounded in conservation biology and test whether research has
considered our proposed pathway. In doing so, we also aim to evaluate whether the literature has moved beyond integration of current understandings around ecosystem and human health to
empirically test mechanisms that have been proposed by existing
reviews (see also [31,32]).
In other words, we aimed to assess whether the extant literature has established the proposed ecological linkage mechanisms
as measured by indicators across each step in Table 1. To do so,
we conducted a systematic review of the extant literature to identify empirical, narrative and review papers that investigated the
relationship between biodiversity and mental health in urban settings. A combination of search terms relating to biodiversity
(including but not limited to, biological diversity, biodiversity,
species richness, ecosystem quality, ecological footprint) and
mental health (including but not limited to, psychological distress, resilience, mental illness, mental health) were used to
search seven online databases for eligible titles. We also systematically searched reference lists of relevant titles. Studies were excluded if the outcome measure was not related to mental health,
or if the exposure was unrelated to biodiversity, as dened above.
All eligible abstracts were independently reviewed by two authors.
A detailed search protocol is available from the authors upon
request.
Based upon this review, we identied only one original research
paper that directly investigated the link between biodiversity per
se and mental health [33]. Although small (n = 312 people) and
with limitations in clearly demonstrating causality, this UK based

J. Dean et al. / Medical Hypotheses 76 (2011) 877880

study of the psychological benets gained by people using greenspaces in the city of Shefeld demonstrated a positive association
between species richness and psychological well-being. In relation
to our hypothesised ecological mechanism, this study addressed
columns (A) and (C), allowing the authors to specically argue that
their results indicate that successful management of urban green
spaces should emphasise biological complexity to enhance human
well-being in addition to biodiversity conservation ([33, p. 390]).

Consequences and discussion


It is increasingly recognised that human health relies upon
the ecosystems that support us. This understanding has led to
consideration of interventions that provide concurrent benets
for both humans and the environment [34]. Our paper hypothesises that biodiversity can improve mental health outcomes in urban settings, through outlining an ecological linkage mechanism
that directly connects ecosystem health with its associated services to humans. We conducted a systematic review to examine
the evidence for such linkages, nding only one empirical paper
that employed indictors measuring both biodiversity and mental
health outcomes.
Nonetheless there is a well-developed body of evidence supporting the premise that contact with nature provides a range
of health benets for humans [32,35]. This literature draws particular attention to the culturally enriching services of ecosystems such as psychological restoration, settings for physical
activity and aesthetic preferences. The implication from our
model is that such services are only the tip of the iceberg. Other
types of ecosystem services such as the provisioning of human
resources and regulation of ecological processes impact on mental health outcomes via environmental stressors or protective effects. There is also the possibility that biodiverse urban
environments have an increased capacity to provide culturally
enriching services in comparison to merely green settings that
harbour less species diversity. For example, many urban parks
and golf courses provide contact with green spaces but do not
necessarily support biodiversity or ecosystem health. Several
authors have called for further research on the quality of the
green space as measured by for example biodiversity richness,
and associated benets to health or well-being [31,35]. The single paper uncovered in our systematic review hypothesised that
there are psychological benets associated with enhanced species richness in urban greenspaces [33].
This hypothesised relationship has implications for the interdisciplinary eld of conservation biology as a form of intervention to protect and enhance human health. The potential for
relatively simple, effective, publically valued and cost effective
interventions is evident when considering theoretical principles
from both public health and urban planning elds. A seminal
concept in public health is that simple mass approaches to interventions that target entire populations have the potential to lead
to greater benets at the population level than do approaches
targeting a small number of people at higher risk of a health
problem [36]. In the urban planning eld, the complex interlinkages between systems in cities means that a relatively small
change addressing a single issue has the potential to stimulate
changes in many interlinked dimensions related to sustainability
a concept coined the urban sustainability multiplier [22].
With recent evidence that green spaces have a role in moderating health inequalities [12], there is also the potential for systematic interventions to restore or improve ecosystems in
disadvantaged areas as one step in mitigating health inequalities.
An powerful example of an intervention that has the potential
to magnify an effect far beyond the initial activity is urban creek

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regeneration, an area of growing interest in Australian cities that


involves local community members and organisations such as
schools and neighbourhood groups [37]. Psychological benets
from culturally enriching services include the social engagement,
physical activity, restorative experiences, educational and ethical/
stewardship values for participants and others who access these
areas [21], given that walking and bicycle paths are often located
adjacent to urban waterways. Benets from regulating services
of urban waterways include reduced ooding and storm damage,
mitigation of thermal heat from urban infrastructure, reduced air
pollution and carbon emissions through uptake of toxins by
vegetation [20,38]. Each of these processes has the potential to
reduce both psychological and physical and stressors to humans
[3941]. Urban waterways also contribute to ecosystem provisioning through increased quality of sh stocks in nearby rivers
and seas through reduced pollution and improved quality of
spawning grounds [42]. Finally, in Australia, there is growing
interest in indigenous foods (bush tucker) the availability
of which is enhanced by restoration of native vegetation. This
potential to contribute to urban agriculture [43] also strengthens
connections with Aboriginal cultural practices and wellbeing
[44].
The critical next step in this agenda for research and action is
the generation of high quality evidence of the concurrent benets
from such interventions to both human health and ecosystem
health. Such evidence would provide an invaluable planning tool
to enable policy-makers, decision-makers and funders to prioritise
planning for urban biodiversity. To strengthen the requisite evidence base will require well-designed epidemiological research
using carefully selected mental health and biodiversity indicators
to investigate the nature and extent of causal relationships between these variables. One interesting possibility for trans-disciplinary research is the systematic study of demonstration
projects in urban developments that aim to harness the synergies
between ecosystem health and human well-being.
Conict of interest statement
The rst author is a member of several environmental organisations including the Australian Conservation Foundation.
Acknowledgments
We thank the School of Population Health, University of
Queensland, for a seeding grant to support this multidisciplinary
research, and numerous colleagues for stimulating discussion.
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