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Cultural ecosystem services and their effects on human health and well-being
- A cross-disciplinary methodological review

Article · July 2015

DOI: 10.1016/j.jort.2015.07.004

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Cultural Ecosystem services and their effects on human health and
well-being – A cross-disciplinary methodological review
Ulrike Pröbstl-Haider

1. Introduction
The concept of ecosystem services, based on the Millennium Ecosystem Assessment (MEA 2005), led
to new approaches in research but it also initiated a new thinking in land use related decision
making, land use policy and in the associated trade-offs. In current applications of the ecosystem
service concept, the so-called cultural services, which include outdoor recreation, are perceived as
underrepresented compared to the economically more relevant supporting, provisioning and
regulating services (Daniel et al. 2012, Chan et al. 2012). Against this background, a special issue on
this subject in the Journal of Outdoor Recreation and Tourism is not only timely, but it seems that this
area of research is in need of a cross-disciplinary review to stimulate research, to enhance the
discussion and to provide insights into how cultural ecosystem services can be better included into
decision making.

This special issue also addresses the outcomes of cultural ecosystem services, looking at their effects
on human health and well-being. Over the past few years, the benefits of exposure to nature and
outdoor recreation activities for public health have become increasingly prominent in the public
health debate – hence a better understanding of these benefits is timely. Beyond the immediate
public health and management debate, aspects of human health and well-being are research topics
in many different academic fields, which apply different theories and a wide range of methods and
concepts. This special issue compiles eight such studies on human health and well-being, and this
introduction will provide an overview and synopsis of the topic at hand, with the intent to position
the respective articles in their various research traditions.

This synoptic essay draws on an extended literature review undertaken by an European research
cooperation (COST ACTION IS1204) on “Tourism, Well-being and Ecosystem Services”, which
provided an initial database with relevant publications. From this starting point we identified
different methodological approaches within the existing research on ecosystem services, health and
well-being (see Martinez-Juarez, Chiabai, Taylor, Quiroga Gómez, 2015, in this issue).

This editorial provides a brief understanding of cultural ecosystem services, health and well-being
and the methodological challenges for research, as well as of main trends to be addressed in future
research.

2. Background
The concept of ecosystem services was originally developed to assess and investigate effects of
ecosystem and biodiversity loss on human well-being globally (MEA 2005). The overall framework
combines ecosystem functions with the capacity of ecosystem components and processes to provide
goods and services that satisfy human needs directly and indirectly (de Groot 1992). While several
definitions of ecosystem services have been proposed over the years, Haines-Young and Potschin
(2010) observe that, regardless of the definition, one must carefully distinguish between functions,
services and benefits or values. Daily (1997) describes ecosystem services as “conditions and
processes through which species …, sustain and fulfil human life”, while Costanza et al. (1997) focus

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more on “ecosystem functions”. The most recent definitions in the Millenium Ecosystem Assessment
(MEA 2005) and the Economics of Ecosystems and Biodiversity process (TEEB 2009) are in favour of a
broader definition of ecosystem services, such as the “benefits people derive from ecosystems”
(MEA 2005) or the ecosystem services providing ”direct and indirect contributions of ecosystems to
human and wellbeing” (TEEB 2009).

Cultural services are defined as the nonmaterial benefits people obtain from ecosystems through
spiritual enrichment, cognitive development, reflection, recreation and aesthetic experiences
(MEA:58,59). They include cultural diversity, which is often linked to specific ecosystems, spiritual
and religious values, educational values and cultural knowledge systems. Chan et al. (2011:206)
defined cultural ecosystem services as the “ecosystems’ contribution to the nonmaterial benefits
(e.g. experiences, capabilities) that people derive from human-ecological relations”. In the context of
health and well-being, the provision of inspiration, aesthetic values, the “sense of place” that is
associated with recognised features of an environment or the maintenance of historically significant
cultural landscapes or ecosystem elements are supposed to be relevant. Ecosystems are also
regarded as valuable places for physical and mental restoration and recreation.
While the MEA (2005) includes “ecotourism” in their list of cultural ecosystem services, current
research into ecosystem services (de Groot 2013) does not consider tourism of any kind as a service
but as an outcome. Other publications, such as Daniel (2012 et al.) include “tourism” in its entirety as
a part of the cultural ecosystem services. Although Daniel et al. (2012) are cognisant of the impacts
tourism may have on ecosystems, they do not distinguish the various forms of tourism activities
and/or the fundamental differences between tourism and outdoor recreation.

In the context of ecosystem services and their effects on human health and well-being, global
assessments and analyses currently focus on the Human Development Index (HDI) which considers
GDP per capita, childhood survival and education (World Resources Institute 2009). Although the HDI
captures only a few indicators of human well-being, current research shows that these indicators
correlate strongly with other important indicators of health and well-being such as life expectancy,
adult and youth literacy, and gender equality (McGillivray 2005). Furthermore, the indicator
“happiness”, which is part of the World Values Survey (EWVS 2006) shows a significant correlation
with the HDI (Leigh and Wolfers 2006, Bjornskov 2003). In the context of ecosystem services, health
and well-being, several studies also focused on personal security as one further significant
dimension, including natural disaster-related mortality (Mack 2005, IPCC 2007).

However, other important aspects have been studied less, such as psychological heath, or the
influence of social solidarity or cultural change (Raudsepp-Hearne et al. 2010). These authors also
stated that “although there is research on the economic value of cultural ecosystem services linked
to tourism, there is less understanding of their broader impacts on human health and wellbeing”
(Raudsepp-Hearne et al. 2010:586). They highlight that further research on ecosystem services
should consider and integrate more strongly the role of human infrastructure, culture and values
(Raudsepp-Hearne et al. 2010, Norgaard 2010).

In the context of research on ecosystem services, health and well-being, differences in the HDI-Index
as well as security aspects are both less important within Europe, while other aspects such as culture
and values are more relevant. Knoll et al. (2005) argue that psychological and social dimensions are

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crucial across Europe. As in other developed countries, research on health and well-being in Europe
is mainly prompted by

• a significant increase of chronic degenerative diseases, which are now replacing the main
infectious diseases (i.e. tuberculosis) as the most significant causes of illness and mortality;
• research findings showing that behavioural patterns significantly influence the appearance
and course of diseases;
• the significant increase of costs in all health and health insurance systems in Europe,
mirroring the ageing population but also the chronic diseases mentioned above.

Overall, new research on health and well-being frequently investigates the relationships between the
biological, psychological and social dimensions (Engel 1980, Knoll et al. 2005) (Figure 1).

Biological Dimension Psychological Dimension Social Dimension

such as such as such as

• genetic disposition • behaviour • socio-economic status
• influence of a virus • attitudes • working conditions
• influence of a • stress • ethnical group
bacterium
Figure 1 Bio-psycho-social concept, after Engel (1980)

This concept assumes that each individual is to some extent responsible for his or her health and
well-being, under consideration of its respective societal background. This understanding focuses
therefore on the individual work-life balance, the preferred way to recover, to recreate and to spend
leisure time. Outdoor recreation and tourism can contribute positively to the recovering processes of
ill and injured individuals, and to health and well-being in general. In this context, health does not
merely relate to the absence of illness but more generally to a positive functional status based on a
balanced bio-psychological situation (Quaas 1994).

For recovery from work as well as for recreation and relaxation, the presence and accessibility of a
green environment such as forests, diverse landscapes, parks or gardens is now regarded as crucial.
The term “cultural ecosystem services” covers all these positive effects. Many research findings also
distinguish between direct and indirect positive health effects from exposure to the natural
environment (e.g. Cervinka et al. 2014, Brown and Bell 2007, Kearns and Gessler 1998, Sherman et al.
2005, Ulrich et al. 1991, Li 2010), while at the same time many therapeutic approaches have been
developed to put these findings into practise (see Ecotherapy.org.uk; therapeutic gardening).

However, Chan et al. (2012:745) still perceive a great gap in the methods for valuing cultural
ecosystem services. They report that, in most frameworks for ecosystem service-related research,
market-oriented valuations are dominant. This primacy is often defended by stating that “many
cultural ecosystem services could likely never be appropriately represented” by such valuations
(Chan et al. 2012:746).

Figure 2 summarises the concept of ecosystem services in its relationship to human well-being, and
shows that the relationship between cultural ecosystem services and health and well-being is
seriously under-researched compared to the other connections. The links in Figure 2 between
cultural ecosystem services and the components of well-being are all of medium or weak intensity.
To highlight this underrepresented relationship, this special issue aims to address these links in

3
particular. This introductory paper gives an overview of the various methods used to analyse these
links in the various disciplines.

Fig. 2 Ecosystem services and the links to health and well-being (MEA 2005). The link between
cultural ecosystem services and health is circled.

While Daniel et al. (2012) provide a selective review of work in landscape aesthetics, cultural
heritage, outdoor recreation and spiritual significance, demonstrating opportunities for operationally
defining cultural ecosystem services, this special issue tries to go further by describing and discussing
the effects of cultural ecosystem services on humans regarding health and wellbeing.

As highlighted in Figure 2, this issue explores the links from cultural ecosystem services to health as
an important basic feature of well-being, but in developed countries only. This limitation has to be
emphasised because the majority of research studies has been undertaken in industrialised
countries, in North America, Europe or Japan. This article will also introduce the contributions in this
special issue and discuss possible approaches to this complex thematic field. The main task of this
article is not to describe reported health effects, but

• to review and summarise the various methodological approaches for describing the effect of
cultural ecosystem services on health and well-being, and
• to identify knowledge and research gaps and to highlight the need for further cross-
disciplinary cooperation.

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3. Methodological concepts for research on cultural ecosystem services,
health and wellbeing
Overall, research on ecosystem services, health and well-being has been undertaken by rather
different research fields. Each of these fields has its own hermeneutics and research traditions, which
certainly overlap between the various applications, especially with regard to research methods. For
the categorisation of research in this overview paper, the main areas of research will be described
along with methodological criteria, but not exclusively so. Each concept will be described briefly, and
at least one typical example of research will be provided to illustrate the characteristic approach and
the types of outcome which can be expected in the respective niche. Clearly, this classification has
numerous limitations, as plenty of conceptual and methodological overlaps exist.

3.1 Concepts and methods based on medical evidence

Studies in this research field typically measure physiological response using mainly clinical diagnostic
methods. Health effects due to natural environments are evaluated based on the measurement of
several medical indicators such as blood pressure, heart rate, stress hormones (e.g. cortisol) or brain
wave activities (e.g. Faber et al. 1992, Lee et al. 2011, Li et al. 2011). Research findings often include
a comparison with a control group in urban environments and the influence of activities while being
in nature.
This research focus, which was dominated by research in Japan (on Shinrin Yoko, literally “forest
bathing”) is currently also adopted by European researchers (Karjalainen et al. 2010). Different
studies have found increased presence of “natural killer cells” in the blood of people who spent time
in natural environments. Natural killer cells (NKCs) are a part of the body’s response to invading
pathogens like viruses and bacteria (Li et al. 2008a, Li et al. 2008 b). New findings also show
increased numbers of anti-cancer proteins in the body after time spent in nature (Li et al. 2006, Li
2010). Overall, typical findings of this methodological approach describing improved physical health
by being in nature are:
• a stabilised heart rate (Lee et al. 2011, Li et al. 2008a);
• a reduced production of stress hormones (Lee et al. 2011);
• a reduced blood pressure, heart rate, and stress hormones, such as urinary adrenaline and
noradrenaline and salivary cortisol (Li 2010);
• an increased activity of parasympathetic and reduced activity of sympathetic nervous system
(Li 2010);
• increased levels of serum adiponectin and dehydroepiandrosterone sulfate (Li 2010); and
• an increased human natural killer (NK) activity, number of NK cells, and intracellular levels of
anti-cancer proteins, suggesting a preventive effect on cancers (Li et al. 2008a; Li et al.
2008b, Li 2010).
These concepts based on medical evidence often also apply psychological methods alongside the
physiological measurements (see section 3.3 and the case study below).

Representative case study:

Effect of forest bathing on physiological and psychological responses in young Japanese male
subjects. (Lee et al. 2011)

This study examined the effect of “forest bathing” on participants engaged in a 3-day, 2-night field
experiment in which they travelled to a forest environment where they underwent several
physiological and psychological tests. Compared with baseline data collected in an urban

5
environment, the men exhibited reduced salivary cortisol (stress) levels and a reduction in heart rate
variability. The participants’ responses to stimuli were also altered in the forest environment, with
positive responses to stimuli being magnified and negative responses being reduced. The authors
conclude that being in a forest reduces physiological stress, improves mood and improves responses
to stimuli.

A second group of publications applying similar methods does not measure the effects of exposure to
nature in itself but includes the effects of specific physical outdoor activities such as hiking into their
research design (for an overview on the effects of different outdoor recreation activities on health,
see Kux and Haider 2014). For example, Li et al. (2011) examined the cardiovascular and metabolic
effects associated with time spent walking in a forest environment. They found that blood pressure
and noradrenaline levels were significantly reduced following time spent walking in a forest
environment. Many articles in this field come from sport or preventive medicine. Some also include
the possible effect of nature-based tourism, when applying these activities in nature over several
days or longer periods (deVoe et al. 2009, Huonker et al. 1997, Lee et al. 2004 Schobersberger et al.
2010). Examples of their findings are:
• a 50% reduction in the risk of coronary artery disease (Hakim et al. 1999).
• improved heart function to a degree that is comparable to a moderate intensity workout on
a stationary bike (Huonker et al. 1997).
• improved insulin sensitivity (Lee et al., 2004; Schobersberger et al. 2010).
• an accumulation of lean body mass (Lee et al. 2004).
• reduced heart rate and blood pressure (Schobersberger et al. 2010).
• increase in the number of naturally generated stem cells in the blood of adults
(Schobersberger et al. 2010).
• reduction in blood-bound “bad cholesterol” (low-density lipoproteins) (Faber et al. 1992).
• improvement in the perceived health of participants (Strauss-Blanche et al. 2004).

Representative case study:

Vacation at moderate and low altitude improves perceived health in individuals with metabolic
syndrome. (Strauss-Blasche et al. 2004).

This study examined the effect of hiking vacations on symptoms of metabolic syndrome in 72
overweight men. Participants were assigned to 3-week vacation scenarios at either high (1,700m) or
low (200m) altitude. They engaged in four 3-4 hour hikes each week. Perceived health was reported
2 weeks before the vacation, at the beginning and end of the vacation, and seven weeks afterwards.
Fitness, recreational ability, positive and negative mood, and social activities all showed significant
improvements over the course of the vacations. These perceived improvements to health were
maintained in the follow-up examinations. They occurred irrespective of altitude and other factors,
suggesting that a person does not need to engage in overly strenuous activity to reap the benefits
associated with hiking.

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3.2 Psychological concepts and methods
The authors of these studies usually have their background in environmental psychology or health
psychology. They share common roots in psychological theory of the 1980s, such as the theory of
reasoned action (TRA) (Ajzen and Fishbein 1980, Fishbein and Ajzen 1975) and the theory of planned
behaviour (TPB), (Ajzen 1985; 1991). Over the past two decades, each of these fields has developed
its own niches with separate theories and surprisingly little cross-fertilization. Therefore, the two
approaches will be presented separately below.

The focus of health psychology

The intention of health related psychological models has been to predict behaviour and to identify
triggers of behavioural changes with the aim of enabling individuals to lead a healthier lifestyle or to
prevent them from doing certain actions. This research field distinguishes between static and
dynamic models to understand behaviour and behavioural changes.
The static predictive models include:
• the Social-Cognitive Theory (Bandura 1986),
• the Health-Belief Model (HBM) (Becker 1974, Rosenstock 1966),
• the Theory of Reasoned Action (TRA) (Ajzen and Fishbein 1980, Fishbein and Ajzen 1975),
• the Theory of Planned Behaviour (TPB) (Ajzen 1985,1991) and
• the Protection Motivation Theory (PMT) (Rogers 1975,1983).
The dynamic predictive models include:
• the Health Action Process Approach (HAPA) (Schwarzer 1992),
• the Trans-Theoretical model (TTM) (Prochaska and DiClemente 1983),
• the Precaution Adoption Process Model (PAPM) (Weinstein and Sandman 1992).

The Theory of Planned Behaviour (TBP) (Ajzen 1985, 1991) has been applied widely. It is based on the
premise that several attitudinal components, i.e. attitudes towards the intended behaviour,
subjective norms and perceived behavioural control, explain intended behaviour and may also be
used to build predictive models – typically using multiple regressions or structural equation
modelling. In this context, an attitude is a favourable or unfavourable predisposition to respond in a
consistent way towards an object. While the TPB is still in use, review papers and meta-analyses are
increasingly noting deficiencies (Knoll et al. 2005, Sheeran 2002). Cooke and Sheeran 2004 identified
seven cognitive properties (accessibility, cognition consistency over time, direct experience,
involvement, certainty about cognition, attitudinal ambivalence and affective-cognitive consistency)
that moderate the relationship between intention and behaviour. According to Bilic (2005), several
applications in health psychology showed that the TPB would require factors that describe more
precisely the affective (emotional volitional, motivational) antecedents that can account for the
disparity between intention and behaviour. In addition, Knoll et al. (2005) and Johnson et al. (2004)
argued that intention and perceived behavioural control might not necessarily be an independent
predictor of health behaviour.

This discussion may also explain why new models concentrate on the crucial step from strong
intention to real action, typically based on planning. Good intentions are more likely to be translated
into action when individuals plan when, where and how to perform the desired behaviour (Milne et
al. 2002, Sniehotta et al. 2005). New dynamic models have emerged around this line of thought, such
as the TTM and PAPM, which distinguish several crucial stages between intention and actual
behaviour. These models analyse behavioural changes, e.g. from unhealthier behaviour to healthier

7
behaviour, and divide them into 5 and 7 steps, respectively. However, the definition and / or the
duration of these steps are still an issue for discussion.

This research focus could also be included in the research on ecosystem services, health and well-
being. If green spaces and facilities in natural environment support outdoor recreation activities, it is
also important to understand why some people do not make use of them and how this behaviour
could be changed. This research has identified constraints, barriers and key reasons why people
abandon activities or do not engage in physical outdoor recreation activities (Rosqvist et al. 2009,
Withall et al. 2011):

- Past exercise behaviour

- Perceived self-efficacy
- Cost
- Lack of leisure time
- Social support
- Self-confidence
- Access to facilities
- Physical environment (perceived and objective environmental characteristics)
o Commute (transportation)
o Leisure (recreational)
o Safety
o Accessibility
- Gender and socio-economic status
- Knowledge of what is available
- Poor mental health
o Poor health
o Fear and negative experiences
o Lack of knowledge

Hughey et al. (2015, in this issue), whose work comes from the public health paradigm which
typically focusses on health promotion, education and behaviour, highlights that still more research
is needed to specifically examine why green infrastructure in close proximity to residential areas is
not used very widely. Such information would be crucial for developing target intervention strategies
or promotional campaigns to maximise the health-promotion potential of green infrastructure in
communities.

Representative case study:

Everybody Active Every Day in Exeter, Public Health Behaviour Change Scoping Report:
A Social Marketing Approach. (Devon County Council (Ed.) 2015).

Given the fact that 88% of residents in the city of Exeter (GB) are not sufficiently active to derive
health benefits from these activities, the Exeter Health and Well-being Board started a research-
based project to get more people involved in physical activities and a healthier lifestyle. In order to
achieve long lasting changes, the typical barriers were identified. The concept for behaviour change
applied in this case is the Trans-theoretical Model of Behaviour Change (Prochaska and DiClemente,
1983), which looks at behaviour change as a dynamic process. The theory argues that individuals
move through a number of ”stages” of readiness to change the behaviour in question. The
implementation is based on a segmentation identifying the most inactive segments of the local
population. The TTM could also serve as a tool to monitor behavioural changes.

8
(http://www.devonhealthandwellbeing.org.uk/wp-content/uploads/2015/02/Everybody-Active-
Every-Day-in-Exeter.pdf)

The focus of environmental psychology

Environmental psychology emerged during the 1970s to examine the interrelationship between
environments and human action, cognition and behaviour (Bechtel & Churchman, 2002). This field
has always been concerned with both built and natural environments. Environmental psychology
develops, and empirically validates, practical intervention strategies regardless of where the
foundational science resides. Therefore, environmental psychology is also characterised by
contributions from different research fields beside psychology, such as geography, landscape
planning, sociology or anthropology.

In contrast to health psychology, in environmental psychology, the static predictive models such as
the theory of planned behaviour are still in use. Research on tourism and outdoor recreation
planning and management also follows this static approach (Pröbstl-Haider and Haider 2013).
However, dynamic predictive models have so far not been considered in health and nature oriented
studies. The methodological concepts developed by environmental psychology started with the same
behavioural concepts, but given their somewhat different focus, evolved in other directions. With its
focus on ecosystem services, health and well-being, this research field contributed significantly to
exploring the effect of environmental stress on human performance, the characteristics of
restorative environments, understanding the social dimension of nature, human information
processing, and the promotion of durable conservation behaviour. Many studies in this context focus
on the social dimension and place-related theories. Place attachment studies can be described as a
psychometric approach that reveals relationships between place attachment, behavioural and
psychological variables. Examples for specific research in this field are “Place attachment” (e.g.
Korpela 1989, Altmann and Low 1992), “Place identity” (e.g. Proshansky et al. 1983, Twigger-Ross
and Uzzell 1996), “Familiarity” (e.g. Hammitt 1981), “Sense of place” (e.g. Jorgensen and Stedman
2001), “Typicality” (Purcell 1987, 1992). This specific research is useful for understanding cultural
ecosystem services in detail.

In the context of health and well-being, several theories explain the benefits derived from time spent
in a natural setting or green spaces. These are
• the Stress Reduction Theory (SRT), and
• the Attention Restoration Theory (ART).
SRT was first described by Ulrich in 1983 and suggests that experiencing the sights and sounds of
nature elicits activation of the parasympathetic nervous system, thus leading to relaxation and
psychophysiological stress recovery (Ulrich 1983). Moderate depth, moderate complexity, the
presence of a focal point, structural qualities and natural contents such as vegetation and water can
evoke positive emotions, sustain non-vigilant attention, restrict negative thoughts and so aid a return
of autonomic arousal to more moderate levels (Hartig et al. 2003 ). While SRT views humans as
biologically prepared to respond positively to a natural environmental and experience restorative
responses from nature, ART complements analyses of overload in urban environments by proposing
factors that work towards a renewal of depleted attention capacity.

9
According to ART, restoration from directed attention fatigue occurs with psychological distance
from routine mental contents (being away), in conjunction with effortless, interest-driven attention
(fascination), sustained in coherently ordered environments of substantial scope (extent) when the
person’s inclinations match the demands imposed by the environment as well as the environmental
supports for intended activities (compatibility). Kaplan and Kaplan (1989) argue that these four
factors commonly are provided by natural environments. Kaplan (1995) studied the restorative
effects of nature, analysing the time spent in a natural setting and the implications for human
effectiveness, particularly pertaining to attention. The reduction of physiological stress responses has
a positive impact on the ability of research participants to complete tasks requiring mental focus,
forming the cornerstone of ART (Kaplan 1995).

Von Lindern (2015, in this issue) presents a state-of-the-art application of ART, analysing the
restorative effects of a wilderness park in Switzerland. His findings show that the same
environmental setting leads to different self-reported restorative outcomes among different visitors,
who are influenced by the perceived sense of being away, by their fascination with the area, as well
as by its coherence or the perceived setting interdependencies between the park and usual
demanding and stressful settings. Also Buchecker (2015 in this issue) looks at the restorative effects
of urban green spaces in Switzerland. He analyzed the effects of urban inhabitants' nearby outdoor
recreation on their well-being and their psychological resilience.

Furthermore, the people one meets when engaging in recreation in natural areas can lead to new
friendships and the satisfaction of one’s need for social contact (Takano et al. 2002, de Vries et al.
2003, Knecht 2004, Maas et al. 2006). Strong interpersonal relationships subsequently lead to
improved confidence and energy in day-to-day tasks, improving an individual’s overall productivity.

Representative case study:

Alone or with a friend: A social context for psychological restoration and environmental preferences.
(Staats and Hartig 2004)

This study explored the significance of being alone or in company for the appreciation of two
different environments for psychological restoration. ART (Kaplan 1995) was used to compare the
psychological restoration between urban and natural locations. Results from 106 student participants
showed that the natural environment is preferred over the urban environment, and that this
difference is about twice as large for those people seeing themselves as ”attentionally fatigued”.
Company proves to be important in both environments, but for different reasons. Being in company
enhances the pleasure of walking in an urban environment, but not because it enhances restoration.
The absence of a general effect of company in the natural environment owes to two opposed effects:
Company enables restoration by providing a sense of safety, but, when safety is not a concern,
restoration is enhanced by the absence of company.

3.3 Evidence and observation based concepts and methods

Research in this category is based on observation and evidence of a certain exposure to nature on
health and well-being.
The methodological approaches in this field differ in their use of data sources such as
• Medical databases,
• Spatial databases, or
• Large databases using public surveys, census data, license data or visitor monitoring data.

10
These data bases are not necessarily used exclusively as medical and spatial databases have been
combined in order to analyse public health. Of course the same also applies for the large visitor
monitoring data and spatial data, and for all these reasons they are combined in one section.

An example for an observational approach using medical database studies is provided by Tzsoulas et
al. 2007. Ulrich’s (1984) famous study also falls into this category as it analyses whether a view of
nature through a hospital window had an influence on recovery from surgery (see representative
case study). Other typical examples are the findings of Faber-Taylor et al. (2001) and Wells (2000).
Faber-Taylor et al. (2001) found that, according to parents’ assessments, 7–12-year-old children with
attention deficit disorder functioned better than usual following activities in green settings. The
greener a child’s play area was, the less severe his or her attention deficit symptoms were.
Based on statistical evidence, Wells (2000) analysed the impact of natural views on cognitive
functioning. She studied 7–12-year-old low-income, urban children in the US before and after
relocation. Both before and after relocation, objective measures of naturalness were employed along
with a standardized instrument measuring the children’s cognitive functioning. Her findings show
that, whilst the change in the overall housing quality was not a significant predictor of ability to focus
attention, children whose homes improved the most in terms of natural views tended to have the
highest levels of improved attention capacity.

Representative case study:

View through a window may influence recovery from surgery. (Ulrich 1984).
The restorative effect of natural views on surgical patients was examined in a suburban Pennsylvania
hospital (200 beds). The sample consisted exclusively of patients who had undergone
cholecystectomy, a common type of gall bladder surgery. Pairs of patients were matched based on
sex, age (within 5 years), being a smoker or non-smoker, being obese or within normal weight limits,
and general nature of previous hospitalisation. One member of each pair had a view of trees while
the other viewed a brick wall. The healing process was analysed based on recovery data and the
length of hospitalisation from 1972 through 1981, but only for the time when the trees had foliage.
Overall, 46 patients grouped into 23 pairs were analysed. In summary, in comparison with the wall-
view group, the patients with a tree-view had shorter postoperative hospital stays, fewer negative
evaluative comments from nurses, took fewer moderate and strong analgesic doses, and had slightly
lower scores for minor postsurgical complications.

Studies using spatial databases

Health benefits, both physiological and psychological, may only occur if a person is able to visit areas
which provide restorative scenery or has access infrastructure or facilities to improve physical health
by enhancing outdoor recreation activities. In the opposite case, living in a built environment may
constrain physical activity and may lead to an unhealthier lifestyle. In landscape and urban planning
as well as in outdoor recreation research and public health, accessibility of and short distances to
green spaces are known to be a significant factors in determining likelihood of being outdoors and of
participating in outdoor recreation activities (e.g. Brabyn and Sutton 2013, Manning 2010, Sandell
and Fredman 2010, Hall and Higham 2005, Bell et al. 2009). Both urban planners and health
promoters describe a dense network of easily accessible green spaces with suitable infrastructure for
different age and gender groups as effective means of promoting active and healthier lifestyles.

11
Green spaces are perceived as being restorative if they contribute to the health and well-being of
individuals, including physical, mental, emotional and social health (Campbell and Wiesen 2009).
Health benefits are expected of designed elements such as parks, gardens or urban farms, as well as
of semi-natural areas such as urban forests, pastures, natural shorelines or vacant lots with natural
succession.

Size, spatial distribution, walking distance from home, the environmental character and the provided
infrastructure are known to be relevant indicators for spatially explicit analyses. Spatial analyses are
mostly based on geographical information systems (GIS). In addition to maps, the data sources also
include new technology such as tracking information based on apps or information provided by web-
based interactive maps (participatory GIS) (Schaupenlehner 2012, Brown 2013).

Spatially explicit findings are also developed in combination with medical data or surveys. The study
by Bell et al. (2008), for example, revealed a significant correlation between an increasing body mass
index BMI and the amount of green spaces for children. The study includes data of 3842 children in
the US (Indianapolis) with an average age of about 9 years. The data were collected over a period of
two years’ time and were provided by a hospital network. The population density had no influence,
only the amount of urban greening.

However, an extended literature review by Lee and Maheswaran (2010) on health related studies
showed that, in this research field, the applied methodological concepts are dominated by rather
simplistic approaches. Most of the research findings are based on spatial data in combination with
statistical data or behavioural studies.

Representative case study:

Availability of Recreational Resources and Physical Activity in Adults

(Diez-Roux et al. 2007)

Based on data from a multi-ethnic sample of 2723 adult participants living in the North-eastern
United States (New York City, Baltimore and Forsyth County), the study examined whether or not
the availability of recreational resources was a factor in adult physical activity levels. For that
purpose, the individual data were linked to the location of recreational resources. The researchers
measured the availability (density) of resources within 0.5 miles (0.8 km), 1, 2, and 5 miles of each
participant’s residence and used binomial regression to investigate associations of density with
physical activity based on a questionnaire. Participants in the areas with the highest density of
resources were significantly more active physically. These associations were slightly stronger among
minority and low-income residents. The findings suggest that making resources available may be one
of several environmental factors that influence individuals’ physical activity behaviour.

A similar study was conducted by Maas, Verheij, Groenewegen, de Vries and Spreeuwenberg (2006),
analysing the relation between urban green spaces and health. Their study included 250782 people
in the Netherlands. The health effect of green spaces was studied by linking the percentage of green
space within a one kilometre and three kilometre radius around the postal code coordinates for each
household with the respective information on perceived general health. Their main findings show
that the percentage of green space in people's living environment has a positive association with the

12
perceived general health. They underline that the development of green space should be allocated a
more central position in spatial planning policy.

Studies using large databases

Social science methods are part of many approaches. Here, I want to draw attention to large
inventories and large national surveys on recreation which provide an excellent basis for the
valuation of cultural ecosystem services but also for health related research, strategic planning and
the consideration of environmental assessments and/or land use trade-offs.

The potential of these studies for various analyses is illustrated by the National Survey on Recreation
and the Environment (NSRE) in the United States (US). This series of national surveys was started in
1960 by the congressionally created Outdoor Recreation Resources Review Commission (ORRRC) and
has since been conducted periodically (from 1960 until 2011). Financed by the National Forest
Service and the US Department of Agriculture, the purpose of the survey is to collect data on
participation in outdoor recreational activities, as well as on related behaviour and attitudes of
individuals ages 16 years and older in the US. The survey also includes questions related to diet and
physical activity practices within the household, participation in indoor active and passive
recreational activities, as well as to perceived barriers to outdoor activity, such as safety concerns. In
the first two decades, the outcomes of the NSRE only recognised social, economic, and
environmental benefits of recreation (Godbey 2009), but little attention was paid to human health
benefits. Since then, however, research has confirmed a link between outdoor physical activity and
positive health outcomes, and also an association between an indoor, sedentary lifestyle and
negative health consequences. Cordell et al. (2008) looked in detail at the outdoor recreation
patterns by children. Godbey (2009) criticised that this database would offer much greater potential
for analysis, because most health-related recreational surveys tend to cover only a short period of
time while this survey could be used to analyse societal trends over decades.

However, the figures since the late 1980s show negative trends: the annual number of recreation
visits to National Park Service sites has declined and visits to national forests have dropped as well.
At the same time, the data show an increase in participation in nature-based recreation as well as an
increase of motorised activities (Cordell et al. 2008, 8). Further analyses illustrate remaining
challenges such as significant differences between ethnic groups. This analyses would offer great
opportunities to address these problems with governance concepts, and to link them to health data
(Godbey 2009).

Looking at Europe, only a few countries have followed the North American example (Bell et al. 2009)
and conducted national surveys. The history of the NSRE also shows that the added value, here the
long term influence on health, has only been analysed lately.The example provided by Lankia,
Kopperoinen, Pouta and Neuvonen (2015, in this issue) shows the integrated kind of analysis possible
with such data sets. Statistics Finland implemented their national survey on outdoor recreation for
the second time in 2009 and 2010. Data collection was performed three times per year – in winter,
spring, and fall – for a total of six survey rounds. A random sample of Finns aged 15 to 74 years was
drawn from the Census of Finland. In each round, 4000 respondents (24 000 in total) were contacted.
The data were collected using a web-based survey supported by a mail questionnaire (mixed-mode
method). In this paper, the authors show how these national survey data can be used to learn more

13
about national lifestyle differences, recreational preferences and their health effects. Their
contribution is an excellent example for new trends in the research of cultural ecosystem services,
health and wellbeing from a methodological point of view. They integrate the Finnish National
Outdoor Recreation Demand Inventory, spatial data and economic valuation methods to analyse
recreational benefits and to provide information for spatial development and strategic recreational
management. Their study underlines the significant benefits a national survey can provide not only
for the adequate consideration of cultural ecosystem services but also as an analytical tool in support
of a national health strategy.

In times where the state is looking for economic savings, data collection for monitoring purposes is
often seen as a good opportunity to save money. The case studies show how important for the
evaluation of public health these databases are and which added value these data have. Investment
in this type of monitoring is obviously of increasing relevance.

Representative case study:

Health and Well-being from Finnish National Parks – A Study of Benefits Perceived by Visitors.

(Kaikkonen et al. 2014)

The Finish forest service “Metsähallitus” conducted a survey on health and well-being provided by
national parks. The survey is linked to the permanent visitor monitoring. The main aim of the survey
was first to gain new information to verify and monitor the overall effectiveness of parks in providing
health and well-being benefits, and second to understand the connections between the attributes of
protected areas, their users and various dimensions of health. The on-site questionnaire in four parks
was complemented with an extended online survey. A total of 871 visitors participated in both
surveys. Park visitors perceived an increase in social, psychological and physical well-being according
to the on-site survey. Respondents who spent a night in the park, and those who described their
state of health positively, perceived more benefits. Long lasting benefits were achieved for
psychological well-being in particular, especially by long-distance visitors and by women. Increase in
physical well-being was connected to normal weight, compliance with fitness recommendations,
distances hiked and overnight stays. The type of activity and the number of visits had no influence on
the findings.

3.4 Economic concepts and methods

Since the concept of ecosystem services and the integration of cultural ecosystem services into
decision making was mainly shaped by economists, they compiled many guidelines and
methodological recommendations. The methodological discussion started back in the 1990s (e.g.
Kopp and Smith 1993, Costanza et al. 1997, Goulder and Kennedy 1997, Daily 1999, Farber, Costanza
and Wilson 2002). A synthesis paper by Milcu, Hanspach, Abson, Fischer (2013) analysed 114
scientific publications on cultural ecosystem service concerning the research method (applied or
proposed) for valuing these services. According to that study, within the group of economic
techniques contingent valuation was the most frequently applied method, followed by market price
approaches and the travel cost method. Other methods such as hedonic pricing, benefits transfer,
the choice experiment and deliberative economic valuation were considered significantly less often.

14
When valuing cultural ecosystem services, direct use values, the option values and the non-use
values are of particular importance (see figure 3).

Figure 3 The valuation of cultural ecosystem services (after Hein et al. 2006)

Most of the economic guidelines and synthesis papers ( Figure 2) distinguish first between market
based valuation and non-market valuation methods and secondly between direct and indirect use. In
the context of cultural ecosystem services, the separation between market and non-market types of
uses poses an ever present challenge for tourism and outdoor recreation, as depending on context
the same type of outdoor activity may be either. In the case of direct use, for recreational products
such as guided mountain-bike tours or kayaking trips, a direct market value can be calculated. In
these cases the market price can be integrated in the valuation of the cultural ecosystem services.
Direct use values may also be attained by a valuation of what a society would be willing and able to
pay (WTP) for the use of a recreation area, or what a society would be willing to accept (WTA) as
compensation for a recreation area which would no longer be accessible.

The option value describes the value of preserving natural resources so that they might be available
for use in the future, e.g. a currently unused lake that might become a water recreation resource in
the future. In recreation research, the option value can also describe the value that current non-
users are willing to pay to ensure continued availability of a service or transport facility. Even those
presently not using an existing cable car up a mountain could view this infrastructure as an important
option that ought to be available and might be useful in the future. From a methodological point of
view, the same methodological approaches (WTP, WTA) apply for the option value.

However, cultural ecosystem services are often characterised by non-use values, like the existence
value. Here non-commercial outdoor recreation activities (e.g. mountain-biking without a guide),
spiritual, the relevance for inspiration and aesthetic experiences or cultural heritage values must be
considered. Therefore, non-market-valuation methods are required in this case. Figure 4 provides an
overview highlighting the most frequently applied economic valuation methods.

15
Figure 4 Overview of important economic valuation methods

Several economic guidelines and overview papers recommend the methods summarised in Table 1 to
valuate cultural ecosystem services.

Table 1 Overview of recommended methods to valuate cultural ecosystem services (after Farber
2006, Pagiola et al. 2004, Bell et al. 2009)

Proposed methods for evaluation Amenability

for economic
Ecosystem Contingent Choice Travel cost Hedonic valuation
service valuation experiment pricing
Service demand Service demand Service demand Service demand
may be elicited by may be elicited may require travel, may be reflected in
posing hypothetical based on the the costs of which the process people
scenarios that ranking, rating or can reflect the will pay for
involve some selecting of implied value of the associated goods,
valuation of alternative choice- service (e.g. such as housing
alternatives, e.g. sets which have recreation areas for prices near
willingness to pay different distant visitors who attractive green
combination are willing to pay spaces
attributes for the journey)
Recreation x x x x High
Aesthetics x x x x High
Education - - - - Low
Spiritual x x - Low

The contribution by Lankia, Kopperoinen, Pouta and Neuvonen (2015, in this issue) serves as one
example for the research on cultural ecosystem services, health and wellbeing from a methodological
point of view. They integrate the Finnish National Outdoor Recreation Demand Inventory and spatial
data with economic valuation methods (travel cost) to analyze recreational benefits and to provide
information for spatial development and strategic recreational management.

Representative Case study

Looking below the surface: The cultural ecosystem service values of UK marine protected areas
(Jobstvogt, Watson, Kenter, 2014)

16
This study was selected because it integrates various economic valuation methods to add to the
evidence base on marine cultural ecosystem service values, to improve understanding about marine
use and non-use values, and to provide evidence that this approach can be used in decision-making
on marine protected areas in the United Kingdom. To achieve these objectives, the authors used a
stated preference valuation method that linked a travel-cost choice experiment (CE) with an
attribute-based contingent valuation method (CVM). The CE elicited direct and indirect use values for
recreational visits to marine sites. The CVM elicited non-use and option values for protecting marine
sites. Attribute-based CVM in combination with a travel-cost CE is a sophisticated approach to
valuing ecosystem services. The application of a place-based approach, and the innovative
combination of multiple valuation tools revealed a high average willingness-to-pay to protect marine
sites against future harm. An understanding of key stakeholders’ cultural ecosystem service values
can improve marine management concepts, especially for decisions involving trade-offs between
marine protection and opportunity costs of the blue economy. The health effect, however, is only
indirectly included by considering recreational activities.

3.5 Cultural-anthropological and ethnographic approach

Anthropological and ethnographic research methods focus on the understanding of “culture”. Here
the definition of “culture” includes behavioural patterns or the way of life of a respective group of
people. Crucial elements of culture, therefore, are common habits, customs, traditions, histories and
other attributes connecting members of the “culture” or defining them. Ethnographic research
usually involves observing target users in their natural, real-world settings. The aim is to gather
insight into how people live, what they do, how they use things or what they need in their everyday
or professional lives. The ethnographic approach is characterised by inductive, interactive and
recursive data collection methods to build local cultural theories, using both qualitative and
quantitative data (LeCompte and Schensul 2010, Whitehead 2005). The overall goal is to describe
human behaviour within its context using the concept of culture as a lens through which to interpret
study results.

Ethnographic research methods are well established in health related research, with studies
analysing issues such as the patient–nurse relationship, the understanding of instructions, diabetic
care or the “culture“ within a hospital (Garro, 1982, Goodson and Vassar 2011). The reason for
applying this research method is the experience that health behaviour and differences in healthcare
delivery are not necessarily detected in a quantitative study. The use of ethnography allows to
provide the decision maker a better understanding of the patient and of the healthcare delivery team
(Goodson and Vassar 2011).

Compared to other methodological concepts, ethnographical approaches alone have not been widely
used to study the link between the cultural ecosystem services, health and well-being context.
However, several multidisciplinary studies have used the ethnographic approach when analysing
health effects and the access to green space (Burls 2007, Kessel et al. 2009). The findings of Burls
(2007) showed that some people may seek personal recovery through stewardship of green spaces,
and she argues that this added social value has not been previously considered as an important
dimension in people's well‐being and recovery from ill health or social exclusion. Burls (2007)
emphasizes that such outcomes emerge from the idea of green spaces becoming a ‘product’

17
delivered to the community by people whose pursuit of personal recovery also directly contributes to
improved public mental health.

O’Brien and Varley (2012) analysed ethnographic approaches to study health experiences in relation
to natural landscapes. They found that methods such as autoethnography can add value to nature
and health studies by providing opportunities for researchers to be self-critical. In addition they
report that the different forms of research, such as accompanied visits and visual ethnography,
provide rich data about physical movement, facial expressions and journeys, as well as dialogues
associated with the significance of nature for health.

Representative case study:

Developing a forest-based wellbeing tourism product together with customers – An ethnographic

approach. (Konu 2015)

The study is part of a wider tourism development project aiming to develop forest-based well-being
tourism products in Finland. The results, based on an ethnographic approach, show that it not only
provides information about the environment, infrastructure and service quality but also about the
perceived atmosphere, feelings and emotions of the participants. For the development of a forest-
based wellbeing tourism product, this information was crucial. The method is perceived as very
appropriate to study complex experiential new services in health and well-being.

4. Discussion and concluding remarks

Based on the above presentation of the conceptual and methodological research directions on
cultural ecosystem services, I would now like to discuss their future implications for research on
cultural ecosystem services overall, as well as the link between perceived health improvement and
conservation and finally presenting trends across the various research field.

Consideration of cultural ecosystem services

In Europe and in most other industrialised countries, and especially in their urban areas, societies
value cultural ecosystem services ahead of other ecosystem services (Quétier et al. 2010, Tielbörger
et al. 2010, Palomo et al. 2011). Methodological challenges, the dominant influence of economic
concepts and perceived constraints in environmental decision making have often been mentioned by
researchers and decision makers as reasons why cultural ecosystem services are not treated
according to their supposed perceived value (de Groot et al. 2010). Too often they are omitted
because of a lack of relevant data and their arduous collection. Therefore, Milcu et al. (2013) see a
further deepening of the discrepancy between those services which matter to people and those
which are easy to measure.

Additionally, many developed countries are facing significant problems with so-called lifestyle
diseases, including coronary heart disease, obesity, hypertension or type 2 diabetes. Medical and
scientific evidence, as presented in this issue, would warrant a more thorough consideration of these
services.

After the intensive methodological discussion on how to measure ecosystem services in general and
cultural ecosystem services in particular properly over the last decade, research should now

18
emphasise the expected outcomes more, such as well-being and health improvement. Services
should not be measured simply for the sake of measuring services or to prepare decisions, but these
measures should be used equally to evaluate and monitor the consequences of decisions and the
influence of the ecosystem service approach. The methodological overview presented above should
be helpful when deciding on the valuation and measuring of cultural ecosystem services, for decision
making and for the evaluation of health benefits.

Willis (2015 in this issue) argues that the concept of ecosystem services can contribute significantly
to an understanding of the relevance of nature for well-being in tourism. She argues that a closer
alignment of the concepts of cultural ecosystem services and psychological well-being can clarify how
natural resources provide the conditions for nature tourism, from which enhancements in
psychological well-being emerge. Her empirical findings from visitors to the Jurassic Coast in Great
Britain, illustrate how psychological benefits arise from interactions there, and how the cultural
ecosystem services framework assists in this context. She identified the following advantages
accruing from the application of the framework:

• A deeper appreciation of tourist motivation and levels of satisfaction by tourism

management practices
• An improved inclusion of cultural ecosystem services and their benefits into decision making
• An improved consideration of psychological experiences; and
• A more systematic consideration of less tangible aspects and therefore more holistic tourism
planning and management.

The effect of perceived health benefits on biodiversity

The links between cultural ecosystem services on the one side, and health and well-being on the
other, illustrated by medium and thin arrows in Figure 2, are not only rather weak but also point in
one direction only. Various studies covering socio-cultural values show that perceived health benefits
are able to stimulate an engagement for the conservation of biodiversity (e.g. Khan et al. 2008,
Haslett et al. 2010, Everard and Kataria 2011). The discussion on when and how detailed cultural
ecosystem services should be integrated could also be influenced by this positive feedback loop.
Jobstvogt et al. (2014) show, that the value of cultural ecosystem services of marine sites, in
combination with ecological conservation evidence, is likely to be a stronger argument for protection
than the conservation of biodiversity alone.

Research diversity and research trends

The diversity of research methods on cultural ecosystem services on the one hand, and on health
effects on the other, indicates scientific dynamism but, at the same time, a lack of common
terminology and understanding. Martinez-Juarez et al. (2015, in this issue) voice this critique when
they suggest that “exposure” to natural environments or green spaces could serve as an important
link and organising principle to analyse the relationship between ecosystem services and health and
wellbeing, and to organize the increasing amount of literature in this field. They expect that such an
organization would increase the comparability and transparency of the various methodological
approaches.

19
However, the editorial shows that research on cultural ecosystem services, health and well-being
asks for diverse elicitation and valuation methods across disciplines. This interaction offers further
opportunities for exchange of ideas and innovation. Strictly separated research fields also seem to be
vanishing over time. In current research there is a visible trend and tendency to bridge and integrate
different research fields and take advantage of these new insights. Several papers in this issue
underline this new trend. An excellent example is the contribution by Pietilä et al. (2015, in this
issue). In an innovative manner, they analyse the association of exposure to urban green spaces,
physical activity and self-rated health:

Pietilä et al. (2015) explores whether the surrounding landscape types and their respective
availability affect recreational and commuting opportunities, and thereby human health and well-
being. They combine several of the aforementioned methodological approaches. They used the
Finnish national dataset on outdoors activities to integrate information on physical outdoor
recreation activities, with the number of outdoor recreation visits to green spaces close to home and
the self-rated health status to investigate the relationship between recreation. Opportunities and
perceived health effects. The survey data were supplemented with a GIS-based spatial analysis
revealing the exposure to green spaces by the respondents. The results support the positive health
effects of safe and easily accessible green infrastructure.

The methodological discussion across research disciplines in the field of cultural ecosystem services,
health and well-being also showed that each research field is scurrently in a dynamic state and
subject to change. In the following, some of these perceived trends and changes are summarised and
will hopefully serve to stimulate further research and/or discussion.

• Beside self-reported health benefits one can observe an increasing interest in measurable,
“real”, medically approved or statistically valid health benefits. Studies combining self-
reported health benefits and medical measurements are also part of this trend.
• While research to date has mostly focused on the actual health benefits by exposure to
nature, the interest in long term health effects is also increasing.
• Current research design in cultural ecosystem service often perceives behavioural intention
and the valuation of nature as stable. The exchange with health psychology and its focus on
behavioural change may stimulate new research concepts and new thinking in the future.
• Many technical innovations offer new research opportunities. For example to use of a web-
based GIS allows the combination of spatial analyses and new participatory types of data
collection, such as self-reported, location specific health benefits.
• A bridging of economic and psychological approaches could lead to new applications in
stated-preferences research, predicting behaviour and health benefits concomitantly.

Acknowledgements

Special thanks go to Liiza Tyrväinen and Working Group 2 of the EU COST Action TObeWELL (Tourism,
Wellbeing and Ecosystem services, 2012-2016, COST Action IS1204) for discussing the draft paper
and their valuable recommendations.

References

20
Ajzen, I. (1985): From intentions to actions: A theory of planned behavior. In: Kuhl, J., Beckman, J.
(Eds.): Action-control: From cognition to behavior. Heidelberg: Springer, 11-39.

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision
Processes 50, 179-211.

Ajzen, I., Fishbein, M. (1980): Understanding Attitudes and Predicting Social Behavior. Englewood
Cliffs, NJ: Prentice-Hall.

Altman, I., Low, S. (Eds.) (1992): Place Attachment. New York: Plenum Press.

Bandura, A. (1986): Social foundations of thought and action: A social cognitive theory. Englewood
Cliffs, NJ: Prentice-Hall.

Becker, M.H. (1974): The Health Belief Model and Personal Health Behavior. Health Education
Monographs 2(4), 336-353.

Bell, S., Simpson, M., Tyrväinen, L., Sievänen, T., Pröbstl, U. (Eds.) (2009): European Forest Recreation
and Tourism. A Handbook.Taylor and Francis, London.

Bell, J.F., Wilson, J.S., Liu, G.C. (2008): Neighborhood greenness and 2-year changes in body mass
index of children and youth. American Journal of Preventive Medicine 25(6), 547-553.

Bilic, B. (2005): The theory of planned behaviour and health behaviours: critical analysis of
methodological and theoretical issues. Hellenic Journal of Psychology2, 243-259.

Bjornskov C. (2003): The happy few: Cross-country evidence on social capital and life satisfaction.
Kyklos 56, 3-16.

Brabyn, L., Sutton, S. (2013): A population based assessment of the geographical accessibility of
outdoor recreation opportunities in New Zealand. Applied Geography 41, 124-131.

Brown, T., Bell, M. (2007): Off the couch and on the move: global public health and the
medicalisation of nature. Social Science & Medicine 64(6), 1343-1354.

Brown, G. (2013): The relationship between social values for ecosystem services and global land
cover: An empirical analysis. Ecosystem Services. http://dx.doi.org/10.1016/j.ecoser.2013.06.004
Burls, A. (2007): People and green spaces: promoting public health and mental well‐being through
ecotherapy. Journal of Public Mental Health (6)3, 24-39.

Buchecker, M., (2015): The effects of urban inhabitants' nearby outdoor recreation on their well-
being and their psychological resilience, Journal of Outdoor Recreation and Tourism 2/2015.(in this
issue)

Campbell, L., Wiesen, A., (Eds) (2009): Restorative Commons: Creating Health and well-being through
Urban landscapes, published by the USDA Forest Service, General Technical Report NRS-P-39, 278p.

Chan, K. M. A., Goldstein, J., Satterfield, T., Hannahs, N., Kikiloi, K., Naidoo, R., Vadeboncoeur, N.,
Woodside, U. (2011): Cultural services and non-use values. In: Kareiva, P., Tallis, H., Ricketts, T. H.,
Daily, G.C., Polasky, S. (Eds.): Natural capital: theory and practice of mapping ecosystem services.
Oxford University Press, Oxford, UK, 206-228.

21
Chan, K. M. A., Satterfield, T., Goldstein, J. (2012): Rethinking ecosystem services to better address
and navigate cultural values. Ecological Economics 74, 8-18.Cervinka, R., Höltge, J., Pirgie, L., Schwab,
M., Sudkamp, J., Haluza, D., Arnberger, A., Eder, R., Ebenberger, M. (2014): Zur Gesundheitswirkung
von Waldlandschaften. BFW-Berichte 147/2014, 85. Bundesforschungs- und Ausbildungszentrum für
Wald, Naturgefahren und Landschaft, Wien. Available online:
http://bfw.ac.at/050/pdf/BFW_Bericht147_2014_GreenPublicHealth.pdf

Cooke, R. Sheeran, P. (2004): Moderation of ccognition-intention and cognition behaviour relations: a

meta-analysis of properties of variables from the theory of planned behaviour. Journal of Personality
and Social Psychology 43, 159-186.

Cordell, H.K., Betz, C.J. & Green, G.T. (2008) Nature-based outdoor recreation trends and wilderness.
International Journal of Wilderness 14(2), 7-13.

Costanza, R., d’Arge, R., de Groot, R., Farber, S., Grasso, M., Hannon, B., Limburg, K., Naeem, S.,
O’Neill, R.V., Paruelo, J., Raskin, R.G., Sutton, P., van den Belt, M. (1997): The value of the world's
ecosystem services and natural capital. Nature 387, 253-260.

Daily G.C. (Ed.) (1997): Nature’s Services: Societal Dependence on Natural Ecosystems. Island Press,
Washington, DC.

Daily, G.C. (1999): Developing a scientific basis for managing earth’s life support systems.
Conservation Ecology 3(2), 14.

Daniel, C. D., Muhar, A., Arnberger, A. Aznar, O., Boyd, J.W., Chan, K.M.A., Costanza, R., Elmqvist, T.,
Flint, C.G., Gobster, P.H., Grêt-Regamey, A., Lave, R., Muhar, S., Penker, M., Riben, R.G.
Schauppenlehner, T., Sikoro, T., Soloviyp, I., Spierenburg, M., Taczanowska, K., Tame, J., von der
Dunk, A. (2012): Contributions of cultural services to the ecosystem services agenda. Proceedings of
the National Academy of Sciences 109(23), 8812-8819.

de Groot, R.S. (1992): Functions of Nature: Evaluation of Nature in Environmental Planning,

Management, and Decision Making. Wolters-Noordhoff, Groningen, 315 pp.

de Groot, R.S. (2013): Ecosystem Services (and Tourism), Keynote at ToBeWell-Conference, 3 August
2013, Wageningen

de Groot, R.S., Fisher, B., Christie, M., Aronson, J., Braat, L., Haines-Young, R., Gowdy, J., Maltby, E.,
Neuville, A., Polasky, S., Portela, R., Ring, I. (2010): Integrating the ecological and economic
dimensions in biodiversity and ecosystem service valuation. In: Kumar, P. (Ed.): The Economics of
Ecosystems and Biodiversity: Ecological and Economic Foundations. Earthscan, London.

DeVoe, D., Israel, R. G., Lipsey, T., & Voyles, W. (2009): A long-duration (118-day) backpacking trip
(2669 km) normalizes lipids without medication: A case study. Wilderness & Environmental Medicine
20(4), 347-352.

Devon County Council (Ed.) (2015): Everybody Active Every Day in Exeter. Public Health Behaviour
Change Scoping Report: A Social Marketing Approach.

22
De Vries, S., Verheij, R. A., Groenewegen, P. P. and Spreeuwenberg, P. (2003): Natural environments -
- healthy environments? An exploratory analysis of the relationship between greenspace and health.
Environment and Planning A 35, 1717-31.

Engel, G.L. (1980): The clinical application of the biopsychosocial model. Am J Psychiatry 137, 535-
544.

European and World Values Surveys (EWVS) (2006): European and World Values Surveys Four-wave
Integrated Data File 1981-2004, vol. 20060423. European Values Study Group and World Values
Survey Association.

Everard, M., Kataria, G. (2011): Recreational angling markets to advance the conservation of a reach
of the Western Ramganga River, India. Aquatic Conservation: Marine and Freshwater Ecosystems
21(1), 101-108.

Faber, M., Benade, A., Celliers, C., Marais, M. (1992): Changes in plasma-lipoprotein levels during a
hiking expedition in South-America. International Journal of Sports Medicine 13(4), 279-284.

Faber-Taylor, A., Kuo, F.E., Sullivan, W.C. (2001): Coping with ADD. The surprising connection to
green play settings. Environ. Behav 33, 54-77.

Farber, S., Costanza, R., Childers, D. L., Erickson, J., Gross, K., Grove, M., Hopkinson, C. S., Kahn, J.,
Pincetl, S., Troy, A., Warren, P., Wilson, M. (2006): Linking ecology and economics for ecosystem
management. Bioscience 56(2), 121-133.

Farber, S., Costanza, R., Wilson, M.A. (2002): Economic and ecological concepts for valuing ecosystem
services. Ecological Economics 41, 375-392.

Fishbein, M., Ajzen, I. (1975): Belief, attitude, intention, and behavior. Reading, MA: Addison-Wesley.

Garro, L.Y. (1982): The ethnography of health care decisions. Soc Sci Med 16, 1451-1452.

Godbey, G. (2009): Outdoor Recreation, Health, and wellness: Understanding and Enhancing the
Relationship. RFF Discussion Paper 09-21, Resources for the Future, Washington, DC, USA.

Goodson, L., Vassar, M. (2011): An overview of ethnography in healthcare and medical education
research. J Educ Eval Health Prof. 8, 4.

Goulder, L.H., Kennedy, D. (1997): Valuing ecosystem services: philosophical bases and empirical
methods. In: Daily, G. (Ed.): Nature’s Services: Societal Dependence on Natural Ecosystems. Island
Press, Washington, DC, 23-48.

Haines-Young, R.H., Potschin, M.P. (2010): The links between biodiversity, ecosystem services and
human well-being. In: Raffaelli, D.G., Frid, C. L. J. (Eds.): Ecosystem Ecology: A New Synthesis.
Cambridge University Press, 110-139.

Hakim, A., Curb, J., Petrovitch, H., Rodriguez, B., Yano, K., Ross, G., White, L.R., Abbott, R. (1999):
Effects of walking on coronary heart disease in elderly men - the Honolulu heart program. Circulation
100(1), 9-13.

23
Hall, M., Higham, J. (2005): Tourism, recreation and climate change. Clevedon: Channel View
Publications.

Hammitt, W. (1981): A theoretical foundation for Tilden’s interpretive principles. Journal of

Environmental Education 12, 13-16.

Hartig, T., Evans, G.W., Jamner, L.D., Davis, D.S., Gärling, T. (2003): Tracking restoration in natural and
urban field settings. Journal of Environmental Psychology 23(2), 109–123.

Haslett, J.R., Berry, P.M., Bela, G., Jongman, R.H.G., Pataki, G., Samways, M.J., Zobel, M. (2010):
Changing conservation strategies in Europe: a framework integrating ecosystem services and
dynamics. Biodiversity and Conservation 19, 2963-2977.

Hein, L., van Koppen, K., de Groot, R.S., van Ierland, E. C. (2006): Spatial scales, stakeholders and the
valuation of ecosystem services. Ecological Economics 57(2), 209-228.

Huonker, M., Schmidt-Trucksass, A., Sorichter, S., Irmer, M., Durr, H., Lehmann, M., Keul, J. (1997):
Highland mountain hiking and coronary artery disease: Exercise tolerance and effects on left
ventricular function. Medicine and Science in Sports and Exercise 29(12), 1554-1560.

Hughey et al. (2015): Demographic differences in reported reasons for non-use of a prominent
community trail Journal of Outdoor Recreation and Tourism 2/2015.

Intergovernmental Panel on Climate change (IPCC) (2007): Climate change 2007: Impacts, adaptation
and Vulnerability. Cambridge University Press.

Jobstvogt, N., Watson, V., Kenter, J.O. (2014): Looking below the surface: The cultural ecosystem
service values of UK marine protected Areas (MPAs). Ecosystem Services 10, 97-110.

Johnson, D.W., Johnston, M., Pollard, B., Kinmonth, A.-L., Mant, D. (2004): Motivation is not enough.
Prediction of risk behavior following diagnosis of coronary heart decease from the theory of planned
behavior. Health Psychology 23, 533-538.

Jorgensen, B.S., Stedman, R. (2001): Sense of place as an attitude: lakeshore property owners’
attitudes toward their properties. Journal of Environmental Psychology 21, 233-248.

Kaikkonen, H., Virkkunen, V., Kajala, L., Erkkonen, J., Aarnio, M., Korpelainen, R. (2014): Health and
Well-being from Finnish National Parks – A Study of Benefits Perceived by Visitors. Executive
summary, Metsähallitus, Vantaa 2014. Available online:
https://www.slu.se/Documents/externwebben/centrumbildningar-projekt/centrum-for-
naturvagledning/dok/metsa.pdf

Kaplan, S. (1995): The restorative benefits of nature: Toward and integrative framework. Journal of
Environmental Psychology 15, 169-182.

Kaplan, R., Kaplan, S. (1989): The Experience of Nature: A psychological perspective. New York:
Cambridge University Press.

Karjalainen, E., Sarjala, T., Raitio, H. (2010): Promoting human health through forests: overview and
major challenges. Environmental Health and Preventive Medicine 15(1), 1-8.

24
Kearns, R.A., Gessler, W. (Eds.) (1998): Putting Health into Place: Landscape Identity and Weil-Being,
Syracuse, NY: Syracuse University Press.

Kessel, A., Multidisciplinary research in public health: A case study of research on access to green
space. Public Health, 32-38.

Khan, M. L., Khumbongmayum, A.D., Tripathi, R.S. (2008): The sacred groves and their significance in
conserving biodiversity: an overview. International Journal of Ecology and Environmental Sciences 34,
277-291.Knecht, C. (2004): Urban nature and well-being: some empirical support and design
implications. Berkeley Planning Journal 17, 82-108.

Knoll, N., Scholz, U., Riekmann, N. (2005): Einführung in die Gesundheitspsychologie, UTB, München,
Basel.

Konu, H. (2015): Developing a forest-based wellbeing tourism product together with customers - an
ethnographic approach. Tourism Management 49, 1-16.

Kopp, R., Smith, V.K. (1993): Valuing Natural Assets. Resources for the Future, Washington, DC.

Korpela, K.M. (1989): Place identity as a product of environmental self regulation. Journal of
Environmental Psychology 9, 241-256.

Kux, S., Haider, W. (2014): Health Benefits of Non-Motorized Outdoor Recreation: A Summary of
Published Findings, Prepared for the Federation of Mountain Clubs of British Columbia, School of
Resource and Environmental Management, Simon Fraser University, Burnaby, British Columbia,
March, 2014, 22p.

Lankia, Kopperoinen, Pouta and Neuvonen (2015): Journal of Outdoor Recreation and Tourism
2/2015. (in this issue)

LeCompte, M.D., Schensul, J.J. (2010): Designing and Conducting Ethnographic Research. The
Ethnographer’s Toolkit, Book 1. Lanham, MD: AltaMira Press, Rowman and Littlefield, 356p.

Lee, A.C.K., Maheswaran, R. (2010): The health benefits of urban green spaces: a review of the
evidence. Journal of Public Health(33)2, 212-222.

Lee, J., Park, B., Tsunetsugu, Y., Ohira, T., Kagawa, T., Miyazaki, Y. (2011): Effect of forest bathing on
physiological and psychological responses in young Japanese male subjects. Public Health 125(2), 93-
100.

Lee, W., Chen, J., Hunt, D., Hou, C., Lai, Y., Lin, F.,Chen, C., Lin, C., Liao, Y., Kuo, C. (2004): Effects of
hiking at altitude on body composition and insulin sensitivity in recovering drug addicts. Preventive
Medicine 39(4), 681-688.

Leigh, A., Wolfers, J. (2006): Happiness and the human development index: Australia is not a
paradox. Australian Economic Review 39, 176-184.

Li, Q., Nakadai, A., Matsushima, H., Miyazaki, Y., Krensky, A. M., Kawada, T., Morimoto, K. (2006):
Phytoncides (wood essential oils) induce human natural killer cell activity. Immunopharmacology and
Immunotoxicology 28(2), 319-333.

25
Li, Q., Morimoto, K., Kobayashi, M., Inagaki, H., Katsumata, M., Hirata, Y., Hirata, K., Shimizu, T., Li,
Y.J., Wakayama, Y., Kawada, T., Ohira, T., Takayama, N., Kagawa, T., Miyazaki, Y. (2008a): A forest
bathing trip increases human natural killer activity and expression of anti-cancer proteins in female
subjects. Journal of Biological Regulators and Homeostatic Agents, 22(1), 45-55.

Li, Q., Morimoto, K., Kobayashi, M., Inagaki, H., Katsumata, M., Hirata, Y., Hirata, K., Suzuki, H., Li, Y.J.,
Wakayama, Y., Kawada, T., Park, B.J., Ohira, T., Matsui, N., Kagawa, T., Miyazaki, Y.,Krensky, A. M.
(2008b): Visiting a forest, but not a city, increases human natural killer activity and expression of anti-
cancer proteins. International Journal of Immunopathology and Pharmacology 21(1), 117-127.

Li, Q., Otsuka, T., Kobayashi, M., Wakayama, Y., Inagaki, H., Katsumata, M., Hirata, Y., Li, Y.J., Hirata,
K., Shimizu, T., Suzuki, H., Kawada, T., Kagawa, T. (2011): Acute effects of walking in forest
environments on cardiovascular and metabolic parameters. European Journal of Applied Physiology
111(11), 2845-2853.

Li, Q (2010): Effect of forest bathing trips on human immune function. Environmenthal health and
preventive medicine, 15 (1), 9-17

Maas, J., Verheij, R. A., Groenewegen, P. P., De Vries, S, Spreeuwenberg, P. (2006): Green space,
urbanity, and health: how strong is the relation? Journal of Epidemiology and Community Health 60,
587-592.

Mack, A. (2005): The Human Security Report: War and peace in the 21th Century. Human Security
centre, University of British Columbia.

Manning, R.E. (2010): Studies in outdoor recreation: search and research for satisfaction (3rd ed.).
Oregon State University press.

Martinez-Juarez, P., Chiabai, A., Taylor, T., Quiroga Gómez, S. (2015): The impact of ecosystems on
human health and well-being: a critical review. Journal of Outdoor Recreation and Tourism 2/2015.

McGillivray, M. (2005): Measuring Non-Economic Well-Being Achievement. Review of Income and

Wealth 51(2), 337-364.

MEA [Millenium Ecosystem Assessment] (2005): Ecosystems and Human Well-being: Synthesis. Island
Press, Washington, DC.

Milcu, A.I., Hanspach, J., Abson, D., Fischer, J. (2013): Cultural Ecosystem Services: A Literature
Review and Prospects for Future Research. Ecology and Society 18(3), 44.

Milne, S., Orbell, S., Sheeran, P. (2002): Combining motivational and volitional interventions to
promote exercise participation: Protection motivation theory and implementation intentions. British
Journal of Health Psychology 7, 163-184.

Norgaard, R., (2010): Ecosystem services: From eye-opening metaphor to complexity blinder.
Ecological Economics 69, 1219-1227.

O’Brien, L, Varley, P. (2012): Use of ethnographic approaches to the study of health experiences in
relation to natural landscapes. Perspect Public Health 132(6), 305-312.

26
Pagiola, S., von Ritter, K., Bishop, J.T. (2004): Assessing the Economic Value of Ecosystem
Conservation, TNC-IUCN-WB, Washington DC.

Palomo, I., Martín-López, B., López-Santiago, C., Montes, C. (2011): Participatory scenario planning
for protected areas management under the ecosystem services framework: the doñana social-
ecological system in southwestern spain. Ecology and Society 16(1), 23. Available online:
http://www.ecologyandsociety.org/vol16/iss1/art23/

Pietilä M.E., neivonen, M., Borodulin, K.,Korpela, K., Sievänen, T., Tyrväinen, L. (2015) The association
of exposure to urban green spaces, physical activity and self-rated health, Journal of Outdoor
Recreation and Tourism 2/2015. (in this issue)

Pröbstl-Haider, U., Haider, W. (2013): Tools for measuring the intention for adapting to climate
change by winter tourists: some thoughts on consumer behavior research and an empirical example.
Tourism Review 68(2), 44-55.

Prochaska, J.O., DiClemente, C.C. (1983): Stages and processes of self-change of smoking: Toward an
integrative model of change. Journal of Consulting and Clinical Psychology 51(3), 390-395.

Proshansky, H., Fabian, A. K., Kaminoff, R. (1983): Place-identity: Physical world socialization of the
self. Journal of Environmental Psychology 3, 57-83.

Purcell, A.T. (1987): Landscape perception, preference and schema discrepancy. Environment and
Planning B: Planning and design 14, 159-177.

Purcell, A.T. (1992): Abstract and specific physical attributes and the experience of landscape. Journal
of Environmental Management 34, 159-177.

Quaas, W. (1994): Arbeitswissenschaftlich orientierte Gesundheitsförderung in der Arbeit –

konzeptionelle Aspekte und empirische Grundlagen. In: Bergmann, B., Richter, P. (Eds.): Die
Handlungsregulationstheorie. Von der Praxis einer Theorie. Göttingen: Hogrefe, 157-197.

Quétier, F., Rivoal, F., Marty, P., Chazal, J., Thuiller, W., Lavorel, S. (2010): Social representations of an
alpine grassland landscape and socio-political discourses on rural development. Regional
Environmental Change 10, 119-130.

Raudsepp-Hearne, C, Peterson, G.D., Tengö, M., Bennett, E.M., Holland, T., Benessaiah, K.,
MacDonald, G., Pfeiffer, L. (2010): Untangling the Environmentalist’s Paradox: Why is human well-
being increasing as ecosystem services degrade? BioScience 60(8), 576-589.

Rogers, R.W. (1975): A protection motivation theory of fear appeals and attitude change. Journal of
Psychology 91, 93-114.

Rogers, R.W. (1983): Cognitive and physiological processes in fear appeals and attitude change: a
revised theory of protection motivation. In: Cacioppo, J.T., Petty, R.E. (Eds.): Social Psychophysiology:
a Source Book. New York: Guilford Press, 153-176.

Rosenstock, I.M. (1966): Why People Use Health Services. The Milbank Memorial Fund Quarterly
44(3), 99-124.

27
Rosqvist, E., Heikkinen, E., Lyyra, T.M., Hirvensalo, M., Kallinen, M., Leinonen, R., Rasionaho, M.,
Pakkala, I., Rantanen, T. (2009); Factors affecting the increased risk of physical inactivity among older
people with depressive symptoms. Scandinavian Journal of Medicine & Science in Sports 19 (3), 398-
405.

Roux, A.V.D., Evenson, K.R., McGinn, A.P., Brown, D.G., Moore, L., Brines, S., Jacobs, D.R., Jr. (2007):
Availability of recreational resources and physical activity in adults. American Journal of Public Health
97(3), 493-499.

Sandell, K., Fredman, P. (2010): The Right of Public Access: Opportunity or Obstacle for nature
Tourism in Sweden? Scandinavian Journal of Hospitality and Tourism 10(3), 291-309.

Schauppenlehner, T; Blamhofer, S; Ogris, A; Schuhmacher, C; Höglhammer, A; Eder, R; (2012):

YouthPlaces: Ein Prototyp für den Einsatz neuer Medien zur Aufnahme, Beschreibung und Bewertung
öffentlicher Freiräume. GW-Unterricht, 126, 67-75; ISSN 20771517

Schobersberger, W., Leichtfried, V., Mueck-Weymann, M., & Humpeler, E. (2010). Austrian moderate
altitude studies (AMAS): Benefits of exposure to moderate altitudes (1,500-2,500 m). Sleep and
Breathing 14(3), 201-207.

Schwarzer, R. (1992): Self-efficacy in the adoption and maintenance of health behaviors: Theoretical
approaches and a new model. In: Schwarzer, R. (Ed.): Self-efficacy: Thought control of action.
Washington, DC: Hemisphere, 217-243.

Sheeran, P. (2002): Intention-behaviour relations: A conceptual and empirical review. European

Review of Social Psychology 12, 1-36.

Sherman, S.A., Varni, J.W., Ulrich, R.S., Malcarne, V.L. (2005): Post-occupancy evaluation of healing
gardens in a pediatric cancer center. Landscape and Urban Planning 73(2-3), 167-183.

Sniehotta, F. F., Schwarzer, R., Scholz, U., & Schüz, B. (2005): Action planning and coping planning for
long-term lifestyle change: Theory and assessment. European Journal of Social Psychology 35, 565–
576.

Staats, H. Hartig, T. (2004): Alone or with a friend: A social context for psychological restoration and
environmental preferences. Journal of Environmental Psychology 24, 199–211.

Strauss-Blasche, G., Riedmann, B., Schobersberger, W., Ekmekcioglu, C., Riedmann, G., Waanders, R.,
Humpeler, E. (2004): Vacation at moderate and low altitude improves perceived health in individuals
with metabolic syndrome. Journal of Travel Medicine 11(5), 300-306.

Takano, T., Nakamura, K., Watanabe, M. (2002): Urban residential environments and senior citizens’
longevity in megacity areas, the importance of walkable green spaces. Journal of Epidemiological
Community Health 56, 913-918.

Tielbörger, K., Fleischer, A., Menzel, L., Metz, J., Sternberg, M. (2010): The aesthetics of water and
land: a promising concept for managing scarce water resources under climate change. Philosophical
Transactions of the Royal Society 368, 5323-5337.

28
 TEEB (The Economics of Ecosystems and Biodiversity (2009): The Economics of Ecosystems and
Biodiversity for National and International Policy Makers – Summary: Responding to the Value of
Nature, 2009,
http://ec.europa.eu/environment/nature/biodiversity/economics/pdf/d1_summary.pdf

Twigger-Ross, C.L., Uzzell, D.L. (1996): Place and identity processes. Journal of Environmental
Psychology 16, 205-220.

Ulrich, R.S. (1893): Aesthetic and affective response to natural environment. In: Altman, I., Wohlwill,
J. F. (Eds.): Behavior and the natural environment. New York, Plenum Press, 85-125.

Ulrich, R.S. (1984): View through a window may influence recovery from surgery. Science 224, 420-
421.

Ulrich, R.S., Simons, R.F., Losito, B.D., Fiorito, E., Miles, M.A., Zelson, M. (1991): Stress recovery
during exposure to natural and urban environments. Journal of Environmental Psychology 11(3), 201-
230.

Weinstein, N.D., Sandman, P.M. (1992): A model of the precaution adoption process: evidence from
home radon testing. Health Psychology 11, 170-180.

Wells, N.M. (2000): At home with nature: The effects of nearby nature on children’s cognitive
functioning. Environment & Behavior 32, 775-795.

Whitehead, T L. 2005. Basic classical ethnographic research methods: secondary data analysis,
fieldwork, observation/participant observation, and informal and semi-structured interviewing.
EICCARS Working Paper Series. 1-27.

Willis, C. A. (2015): The Contribution of Cultural Ecosystem Services to Understanding the Tourism-
Nature-Wellbeing Nexus, Journal of Outdoor Recreation and Tourism 2/2015. (in this issue)

Withall, J., Jago, R., Fox R, K. (2011): Why some do but most don’t. Barriers and enablers to engaging
low- income groups in physical activity programmes: a mixed methods study. BMC Public Health 11,
507.

World Resources Institute (2009) Earth trends: the environmental information portal. WRI.

29

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