Throughout the UK, a wide variety of programmes and projects are helping people to receive the mental and physical health benefits on offer from outdoor spaces. On 30th November 2012, the Ecosystems Knowledge Network held a webinar featuring three nature-based projects that have made progress in delivering health benefits:
- Health Benefits from Green Infrastructure in Liverpool – Paul Nolan (The Mersey Forest) and Sarah Dewar (Liverpool Primary Care Trust)
- Dudley Healthy Towns Initiative – presented by Dean Hill (Dudley Primary Care Trust)
- Branching Out - presented by Kirsty Cathrine (Forestry Commission Scotland)
A short summary of the webinar was published in Issue 3 of Ecosystems News (cover theme 'An Environment for Health'). A separate webpage lists links to resources to help nature-based projects deliver health benefits.
Documents referred to in the webinar
In his introductory and concluding remarks, Dave Stone referred to:
- National Institute of Clinical Excellence (NICE) Guidance on Walking and Cycling
- Baseline data for the Public Health Outcomes Framework (England)
- Walking for Health (England)*
- Green Gyms
- The National Planning Policy Framework
* Equivalent schemes available elsewhere in the UK are listed here. In their presentation on health benefits from green infrastructure in Liverpool, Paul Nolan and Sarah Dewar referred to:
- Liverpool Decade of Health and Well Being
- Liverpool Green Infrastructure Strategy
- NHS Heatwave Plan for England*
- The report of the Marmot Review, 'Fair Society Healthy Lives' (2010)
In his presentation of the Dudley Healthy Towns Initiative, Dean Hill referred to:
- The report of the Marmot Review, 'Fair Society Healthy Lives' (2010)
- Change for Life Campaign
- Programme Evaluation for the Dudley Healthy Towns Initiative (this will also be made available on the Department of Health website in the New Year). This document is the executive summary. Please contact firstname.lastname@example.org for the full report.
In her presentation of the Branching Out programme, Kirsty Cathrine referred to:
- Mind Report (2006). Ecotherapy. The green agenda for mental health
- Equally Well: Report of the Ministerial Task Force on Health Inequalities (2008)
- Evaluation of Branching Out
Questions specific to the presentation by the Mersey Forest and Liverpool PCT
Q: Jacqui Stearn (Natural England): Where is the £8 billion [asset value for green infrastructure] reported? Q: James Taylor: How was the £8 billion figure calculated?
A: Paul Nolan (Mersey Forest Partnership). The £8 billion is reported in the Liverpool Green Infrastructure Strategy. The calculation was made using the Green Infrastructure Valuation Toolkit. Users of the toolkit need to exercise care when deploying it. It was, however, considered to be the best calculation method available at the time.
Q: Jo Sampson (Greater Thames Futurescape): Is the methodology for determining need in the Liverpool case study available?
A: Paul Nolan. This is also set out in the Liverpool Green Infrastructure Strategy.
Q: William Moreno (Kent County Council): Paul mentioned "funding the programme not the park". Please would you clarify this?
A: Paul Nolan. I was trying to highlight that the focus of the project, the intent and the commitment of the project manager has to be health focussed - not health funding as a way to do other things such as look after the park. The latter follows if the project is successful, but is almost a by-product (but a good one!). I may be wrong but I think that successful projects will be the ones that show a real and deep commitment to health outcomes.
Question specific to Branching Out
Q: Jacklyn Johnston (Nature Consult Ltd): Are there any early indications of the cost/benefit of an individual referral to Branching Out (for the NHS)? A: Kirsty Cathrine: The Branching Out economic study is currently in the data collection stage, so we do not have any results to share yet. However, there is lots of other information about the project, including our initial project evaluation report, on the Forestry Commission website at www.forestry.gov.uk/branchingout.
Q: Zoe Kemp (Scottish Natural Heritage): Did the successful projects look to change behaviour and use of green spaces, not just increasing availability?
A: Dean Hill (Dudley Primary Care Trust): Reference to site in North of Borough where there had been challenges with vandalism. However, this was now the most successful project site. Behavioural change occurs at different levels. It also occurs at a corporate and population level as well. Behaviour change is captured in the evaluation. A: Paul Nolan (Mersey Forest): Natural Choices was definitely about changing attitude to green spaces to see them as a health resource/asset in their own right and a venue for a range of interventions.
Q: Hilary Phillips (Oxfordshire Nature Conservation Forum): What did they [the presenters] do/are they doing to engage with the health and wellbeing boards and Clinical Commissioning Groups?
A: Dean Hill. Dean referred to his experience of presenting to the Dudley Health and Well Being Board and NHS Dudley Clinical Commissioning Group (CCG). He noted that the CCG has already granted some finances to the local authority. A Health and Wellbeing Strategy is being presented to the Health and Well Being Board, which contains a range of stakeholders. This strategy (currently in draft form) refers to a need for green space for both physical and mental health improvement. Also note that Assistant Directors of public health are represented on the Boards. A: Paul Nolan. Our work on “Natural Health Service” is an attempt to coordinate a range of potential providers of health products that use the natural environment to deliver health outcomes and provide this as package to CCG and present to Health and Wellbeing Boards if possible.
Q: James Taylor (Linking Environment and Farming): How do the new Local Nature Partnerships link to the Health and Wellbeing Boards? A: Penny Rachel (Natural England): NEWP Commitment 54 encourages good links: ‘Local Nature Partnerships and the Health and Wellbeing Boards should actively seek to engage each other in their work. Forthcoming guidance will make clear that the wider determinants of health, including the natural environment, will be a crucial consideration in developing joint strategic needs assessments and joint health and wellbeing strategies’. Guidance and links are available on Page 9 of Defra’s Overview of the LNP Role.
Q: Caroline Drewett (Kent County Council): we have been working through [the] Naturally Active [Project to] support[ing] specific groups in increasing mental wellbeing. We shifted from a service through to a supported scheme to develop a more sustainable approach. How have you tackled this?
A: Kirsty Cathrine (Forestry Commission Scotland): When Branching Out started it was a service provided directly by Forestry Commission Scotland as a stand-alone project in the NHS Greater Glasgow and Clyde area. Over the last five years we have expanded into six more NHS areas and so have had to develop a more sustainable approach. By providing training and support to organisations already involved in community greenspace activities, such as local authority ranger services, we have been able to reduce costs while increasing provision. As the number of partners involved in the project has grown we have also been able to offer more local opportunities, reducing transport requirements. We are also currently looking at options to help train up mental health service staff to assist with activities on some of our Branching Out groups with community mental health services.
A: Dean Hill: Dudley Healthy Towns did this by starting with a large consultation base to identify wants and needs for longer term by in, promotion and marketing to help change behaviour and build demand, and then the supply of a supportive environment to sustain the behaviour change.
Q: Matt Smith (Joint Nature Conservation Committee): How can you control for the fact that areas with lower [access to] green infrastructure are likely to be less-affluent areas, therefore there is a plethora of other socio-economic factors that are affecting health and well-being regardless of access to green infrastructure? A: Paul Nolan. We can’t - others may be able to do so. We are not saying that there is a causal relationship. There is an association (the correct statistical term, I think) and similar R squared values are refrerred to as 'moderate' association s in documents such as Health is Wealth. We are however able to comment on the inequality of GI [green infrastructure] and that in places where there is need for GI in order to deliver health benefit it is lacking.
A: Dean Hill. Normally within the evidence base, [socio-economic factors] are balanced as much as possible to leave the green space argument more isolated. Furthermore there is evidence to show that, even within those groups that are most deprived and suffer from other socio-economic factors, illness etc, that it is less prevalent than those with less green space but in otherwise the same circumstances.
Q: Jacqui Stearn (Natural England): Is there evidence that using outdoor gyms is or is not preferable to indoor?
A: Paul Nolan: You may be interested in a systematic review of this topic by Thompson Coon et al. A: Dean Hill: Yes, lots of evidence over the years. This tends to focus on adherence (how long people were on the programmes and their activity levels at 6 or 12 month follow ups) as much as physiological outcomes. The most recent is the Outdoor Fitness Classes Report, Is it Better Outside?
Q: Jo Sampson (Greater Thames Futurescape): Is there a specific role or function for biodiversity/nature in public health outcomes? A: Paul Nolan: If the question is about a rich biodiverse landscape being a better setting for these types of project then there is some evidence to support that – linked to Biophyllia. However I think that that projects that have their primary focus on biodiversity will struggle to engage the health commissioners - only because the primary focus has to be the health outcome. You can/should get biodiversity benefits of course – but as a by-product! We have been suggesting that Natural Choices is a PES project – the projects are often delivering biodiversity benefits - but the payment is for health benefits and the trick is for clever project managers to get as many benefits they can as by-products of the health outcomes you are asked to deliver.
A: Dean Hill: Yes, definitely. This includes the provision supportive environments, quiet spaces for relaxation and mental health promotion, open spaces for fun and physical activity, most of which are free and accessible to lessen the impact of financial inequalities.
Jo Sampson (Greater Thames Futurescape): It would be great if the Ecosystems Knowledge Network [website] could have an area specifically dedicated to public health outcomes as part of "connecting people and nature" (Response: Bruce Howard (Ecosystems Knowledge Network): At present we have a page that direct Network members to on-line resources that help in this process. Suggestions for developing this page, or initiating others would be welcome.) Rachel Penny (Natural England): [In England] Many Health and Wellbeing Boards are publishing Health and Well Being Strategies and Joint Strategic needs Assessments, so these consultations can be a way in. See kings Fund website for contact list for all Health and Wellbeing Boards [In England].
View the flyer for this event.