That the natural environment is a key determinant of health is unquestioned. A report published by the World Health Organization (Prüss-Üstün and Corvalán, 2006 p. 6) claims that ‘approximately one-quarter of the global disease burden, and more than one-third of the burden among children, is due to modiﬁable environmental factors’. However, even in its attempt to quantify the environmental burden of disease, WHO has focused on environmental degradation: ‘the amount of death and disease caused by factors such as unsafe drinking-water and sanitation, and indoor and outdoor air pollution’ (Prüss-Üstün and Corvalán, 2006 p. 6), paying little if any attention to the impacts of environmental deprivation. The same focus is reﬂected more broadly within ‘environmental health’ as a discipline and a profession.
Despite the prevailing attitude in society that humans are separate from, outside of, or above nature (Martin, 1996; Suzuki, 1990), as human understanding of the natural environment has developed, and the massive destruction that human activities can have on natural systems has been observed, a more enlightened view has emerged. This view recognises that plants and animals (including humans) do not exist as independent entities as was once thought, but instead are parts of complex and interconnected ecosystems on which they are entirely dependent, and of which they are fundamentally a part (Driver et al., 1996). In the Foreword to its Millennium Ecosystem Assessment report ‘Ecosystems and Human Well-being: Health Synthesis’, the World Health Organisation (2005 p. iii) stated:
Nature’s goods and services are the ultimate foundations of life and health, even though in modern societies this fundamental dependency may be indirect, displaced in space and time, and therefore poorly recognised.
The human relationship with the natural world is deeply intertwined with the human conscious and subconscious mind and is therefore not easy to access for analysis. Nonetheless, in recent years, there have been concerted attempts, particularly in the disciplines of ecology, biology, environmental psychology, and psychiatry, to empirically examine the human relationship with the natural world.
Many researchers have come to the conclusion that humans are dependent on nature not only for material needs (food, water, shelter, etc) but perhaps more importantly for psychological, emotional and spiritual needs (Wilson, 2001; Frumkin, 2001; Roszak et al., 1995; Friedmann and Thomas, 1995; Katcher and Beck, 1987; Wilson, 1984). Just how dependent on nature humans are, and exactly what beneﬁts can be gained from interacting with nature are issues that have only just begun to be investigated. Findings so far, however, indicate that parks and other natural environments play a vital role in human health and wellbeing through providing access to nature. This is likely to change the way parks and nature are currently viewed and managed by governments and the wider community.
The idea that contact with nature is good for human health and wellbeing is the subject of research in diverse disciplines such as environmental psychology, environmental health, psychiatry, biology, ecology, landscape preferences, horticulture, leisure and recreation, wilderness, and of course public health policy and medicine. Driving these divergent streams is the central notion that contact with nature is beneﬁcial, perhaps even essential, to human health and wellbeing. While the strength of the evidence for this assertion varies, due in part to ‘methodological limitations of [some of] the research’, and the mechanisms by which nature inﬂuences health outcomes is generally unknown, nevertheless acceptance of the association of nature with human wellbeing is increasing (Health Council of the Netherlands and Dutch Advisory Council for Research on Spatial Planning, Nature and Environment, 2005 p. 81).
In the last few hundred years, however, there has been an extraordinary disengagement of humans from the natural environment (Beck and Katcher, 1996; Axelrod and Suedfeld, 1995; Katcher and Beck, 1987). This is mostly due to the enormous shift of people away from rural areas into cities (Katcher and Beck, 1987). Here, contact with nature is often only available via parks. Never have humans spent so little time in physical contact with animals and plants and the consequences are unknown (Katcher and Beck, 1987). Further to this, modern society, by its very essence, insulates people from outdoor environmental stimuli (Stilgoe, 2001) and regular contact with nature (Katcher and Beck, 1987). Some researchers believe that too much artiﬁcial stimulation and an existence spent in purely human environments may cause exhaustion, or produce a loss of vitality and health (Stilgoe, 2001; Katcher and Beck, 1987) A subject that has attracted some concern is the lack of opportunities for nurturing in urban environments. Nurturing living organisms, such as animals and plants, could be an essential part of human development that if denied could have adverse effects on the health, and perhaps even the long-term survival, of the human species (Kellert, 1997; Bustad, 1996; Wilson, 1993; Lewis, 1992; Katcher and Beck, 1987). Katcher and Beck (1987) state that there is a critical need for continued exploration of the emotional and health value of nurturing living things; they believe it will reveal a human health requirement equal in importance to exercise and touch (Katcher and Beck, 1987).
The idea that isolation from the natural world may be harmful to health is not limited to scientists and researchers but is also seen in the choices of everyday people. For example, it is estimated that 42% of the American public uses some form of complementary medicine (Clark, 2000) and worldwide the use of complementary medicine has doubled in recent decades (New Scientist, 2001). A recent Australian review of the literature on the use of complementary and alternative medicines, with a particular focus on their use in treating asthma, found that ‘20-30% of adults and 50-60% of children with asthma may be using CAM at any one time’ (Slader et al. 2006 p. 386). The rise in popularity of complementary medicines may not only be due to disenchantment with modern techniques, but also the expression of a desire to take a more natural approach to health (Clark, 2000). In fact, many patients cite ‘naturalness’ as the appeal of complementary medicine, yet others are drawn by spiritualism or the emphasis on holism (New Scientist, 2001). Both of these qualities are often assigned to nature. Yet, there is still a lack of understanding in the general populace, governments and institutions about the signiﬁcance of the human connectedness with nature, and its relevance to current social problems, particularly in terms of health.
The following is a review of the potential and actual health beneﬁts of contact with nature, including but not restricted to nature in a park context. Contact with nature is deﬁned as viewing natural scenes, being in natural environments, or observing, encountering or otherwise interacting with plants and animals. Although the primary interest of this review concerns human contact with nature in a park context, we have examined the literature within the broader context of human health and nature. This has meant the inclusion of ﬁelds such as environmental psychology, psychology, psychiatry, medicine, environmental economics, biodiversity conservation, ecology, complementary and alternative medicine, landscape design and urban planning, recreation and leisure, environmental health, public health policy and health promotion, adventure and wilderness therapy, and religion and spirituality.
The emphasis on parks in this document is for the simple reason that they are the chief means of maintaining intact natural ecosystems and preserving biodiversity in a world that is becoming increasingly urbanised. Because of this, parks play an essential role in public health, as they are the most readily available (or sometimes the only) source of nature for the majority of people who live in urban areas. This review is the ﬁrst step toward collating current knowledge on this topic with the aim of undertaking further empirical research in the near future.
The ﬁrst part of the review comprises a discussion on public health and nature, as well as the current concerns of public health in Australia. This is followed by the connection between parks, nature and health, how parks can contribute to public health, and the need to reposition parks in terms of health. Next is a discussion on understanding the human-nature relationship that examines some current theories of the human place in nature, as well as in particular reference to some population groups. Evidence for the health beneﬁts of contact with nature is presented in the following section, including the beneﬁts arising from viewing nature, being in nature, contact with plants, and contact with animals. A brief discussion on some unique forms of nature based therapy follows, which is then followed by a summary on the principal health outcomes of interacting with nature on an individual or personal level, and at a community level. Finally, a brief comment on policy outcomes and triple bottom line reporting, and some key recommendations are presented. There are also a number of assertions that can be made about current knowledge of the health and wellbeing beneﬁts of the human relationship with nature. These are included in an Appendix.
Healthy parks, healthy people
The health benefits of contact with nature in a park context
A review of relevant literature
School of Health and Social Development Faculty of Health, Medicine, Nursing and Behavioural Sciences
© Deakin University and Parks Victoria 2008
Authors Dr. Cecily Maller Associate Professor Mardie Townsend Associate Professor Lawrence St Leger Dr Claire Henderson-Wilson Ms Anita Pryor Ms Lauren Prosser Dr Megan Moore