People and green spaces: promoting public health and mental well-being through ecotherapy

T here is growing evidence that the quality of our relationship with nature impacts on our mental health. More than 80% of people in the UK live in urban areas (DEFRA, 2004), and there is evidence that ‘less green nature means reduced mental well-being, or at least less opportunity to recover from mental stress’ (Pretty et al, 2005a; p2). This evidence does not, however, seem to have greatly influenced town and country planners; nor has it predisposed the establishment of public health policies that are inclusive of nature. This situation seems to require a concerted effort and more broad-spectrum solutions (English Nature, 2003a). John Sorrell, chair of the Commission for Architecture and the Built Environment (CABE), affirms that ‘a positive and creative relationship between all concerned is of critical importance’, and that this would ‘enable agencies, organisations and individuals with different objectives… to work together to a common and successful end’ (Sorrell, 2006; p254). Morris et al (2006) assert the need for a more strategic public health approach. They highlight that ‘in Western societies, the relevance of the environment to health has become obscured… [and] even when this is not the case, the perspective is usually narrow, centring on specific toxic, infectious or allergenic agents in particular environmental compartments’ (p889). They emphasise the need for shared concerns across disciplines and sectors. Barton and Grant (2006) have presented an updated version of the World Health Organization (WHO) health map, introducing the global ecosystem, natural environment and biodiversity to the range of determinants of health and well-being in our neighbourhoods. They state that concerns about physical and mental health problems and Keywords ecohealth ecotherapy biophilia social capital natural capital 25 journal of public mental health vol 6 • issue 3 © Pavilion Journals (Brighton) Ltd People and green spaces: promoting public health and mental well-being through ecotherapy inequalities have forced town planning to take account of factors previously divorced from health agendas. The map (figure 1) was designed to be a ‘dynamic tool’ to ‘provide a focus for collaboration across practitioner professions and across topics’ (p253) directly related to sustainable development of healthy neighbourhoods. National and international policy supports the inclusion of the natural environment in holistic health promotion. For example, the WHO Twenty Steps for Developing Healthy Cities Projects (WHO, 1997) document sets out a multipronged planning strategy based on intersectorial action, alongside health awareness and healthy public policy, community participation and innovation. Similarly, the WHO Health Impact Assessment Toolkit for Cities (WHO, 2005a) offers a means to quantify the benefits of green spaces in terms of: ● greater involvement in the processes of making policy and decisions ● potential to extend the democratic process, especially to excluded groups in society ● empowerment ● the development of skills ● consideration of how to reduce sources of disadvantage or inequality ● the development and provision of services that better meet the needs of local people. These actions would pave the way towards more comprehensive public mental health policies. However, they would be served well by the inclusion of the concept of ecohealth. The concept of ecohealth Ecological perspectives have played a part in health promotion models and constructs of health (Hancock & Perkins, 1985; Kickbusch, 1989). These have informed the development of health promotion strategies and practices such as healthy cities, schools and work places. But St Leger (2003) remarks that even these holistic frameworks put more emphasis on health promotion as a way of addressing specific mortality and morbidity outcomes, and that there is generally a tendency to work with the immediate problems of the individual. Specific actions are aimed at creating change in behaviours and life styles, but rarely include the bringing about of tangible change in the natural world around us. Figure 1: The determinants of health and well-being in our neighbourhoods (Barton &