Evidence

EVIDENCE OF BENEFITS

There is mounting research evidence which backs up the case that the NHS Forest will help sites to realise the following, proven health, social, environmental and financial benefits:

ACCELERATED PATIENT RECOVERY

Research has shown that patient recovery rates improve even if they can only view trees from their hospital window.

Studies of cholecystectomy patients in hospital found that they recovered more quickly with a view of trees and nature from their windows. Ulrich, R.S. (1984). ‘View through a window may influence recovery from GP practice.’ Science 224, 420-421

Hospital gardens can provide the following:
- Facilitate stress reduction which helps the body reach a more balanced state
- Help a patient summon up their own inner healing resources
- Help a patient come to terms with an incurable medical condition
- Provide a setting where staff can conduct physical therapy, horticultural therapy, with patients
- Provide staff with a needed retreat from the stress of work
- Provide a relaxed setting for patient/visitor interaction away from the hospital interior
Cooper, M. C. 2005: Healing Gardens in Hospitals, The Interdisciplinary Design and Research e- Publication, 1(1), 1-27. cabeurl.com/6w.

‘Future health – Sustainable places for health and well-being’, CABE 2009

•Pain in its environmental context; implications for desiging environments to enhance pain control. Malenbaum, S., Keefe, F.J., Williams, A.C., Ulrich, R., and Somers, T.J (2008) Pain 134-244.

IMPROVED COMMUNITY HEALTH

Royal College of Physicians president, speaking at a conference in April, cited an accumulating body of evidence that supports the link between urban green space. Find out more on the BBC news website.

 

The health of patients, staff and local communities can be dramatically improved by providing opportunities to exercise outdoors and access green spaces including woodlands but less than 10% of the population have access to local woodland within 500m of their home.

Medical research from around the world, collated by the University of Exeter in 2014, demonstrates that a Green Prescription can deliver physiological and psychological benefits for patients, even if the exact mechanisms by which these accrue are not yet fully understood. The evidence also shows that doctors are ready and willing to give Green Prescriptions, and that an effective partnership with other providers is required.

Researchers from the Universities of Bristol and East Anglia found that people living closer to green spaces were more physically active, and were less likely to be overweight or obese, and people who lived furthest from public parks were 27% more likely to be overweight or obese. E. Coombs, A. Jones, & M. Hillsdon (in press)’ Objectively measured green space access, green space use, physical activity and overweight.’

Morbidity is related to a green living. Maas J, Verheij RA, de Vries S, Spreeuwenberg P, Schellevis FG and Groenewegen PP (2009) 
environment. Journal of Epidemiology and Community Health 63: 967–97

 Preference for nature in urbanised societies: Stress, restoration and the pursuit of sustainability. van den Berg, A.E., Hartig, T. & Staats, H. (2007)  Journal of Social Issues, 63, 79–96.

•Bowler, D., Buyung-Ali, L., Knight, T. & Pullin, A.S. 2010. The importance of nature for health: is there a specific benefit of contact with green space? Environmental Evidence: www.environmentalevidence.org/SR40.html

Greater opportunities for exercise provided by close proximity to a park reduced weight gain in teenagers by five kilograms over a two year period. ‘Neighborhood Greenness and 2-Year Changes in Body Mass Index of Children and Youth’: Janice F. Bell, PhD, MPH, Jeffrey S. Wilson, PhD, Gilbert C. Liu, MD, MS. Am J Prev Med 2008;35(6):547–553)

A University of Glasgow study found that, for England as a whole, people living closer to green space had lower death rates and less heart disease. Amongst lower income groups, 1,300 extra deaths occurred each year in areas where the provision of green space was poor. Mitchell R, Popham F. ‘Effect of exposure to natural environment on health inequalities: an observational population study.’ Lancet 2008; 372: 1655-1660

Regular physical activity contributes to the prevention of more than 20 conditions including coronary heart disease, diabetes, certain types of cancer, mental ill-health and obesity. Department of Health 2005: ‘Choosing Activity: a physical activity action plan’, Cm 6374, London, Department of Health. cabeurl.com/2o

Trees and woods can have a restorative and therapeutic effect on the mind. Hartig, T., Evans G.W., Jamner L.D., Davis D.S., and Gärling T. (2003). ‘Tracking restoration in natural and urban field settings.’ Journal of Environmental Psychology 23, 109-123.

Recent studies have looked at the beneficial effects of natural surroundings on children with Attention Deficit Hyperactivity Disorder. Taylor, AF et al (2001) ‘Coping with ADD, The Surprising Connection to Green Play Setting’, Environment and Behaviour, Vol. 33, January 2001, pp 54-77

Trees have been found to enhance mood, improve self esteem and lower blood pressure. Research in the Netherlands and Japan indicated that people were more likely to walk or cycle to work if the streets were lined with trees and live longer and feel better as a result. Van den Berg, A.E., Koole S.L., and van der Wulp N.Y. (2003). ’Environmental preferences and restoration: (how) are they related?’ Journal of Environmental Psychology 23, 135-146.

Two reports, sponsored by RSPB, published in 2004 and 2007 outlined the benefits to physical and mental health arising from contact with the natural environment. These included the reductions in obesity, heart disease, diabetes, cancer, stress, ADHD, aggression and criminal activity, amongst others. Bird, W (2004) ‘Natural Fit’, RSPB - www.rspb.org.uk/Images/natural_fit_full_version_tcm9-133055.pdfBird, W (2007) ‘Natural Thinking’, RSPB - www.rspb.org.uk/Images/naturalthinking_tcm9-161856.pdf

Environmental volunteering, including tree planting, can be as effective as aerobics in improving fitness. Independent evaluation of BTCV’s Green Gym concluded that overall the physical health status of volunteers significantly improved, with 99% of participants reporting enhanced health and confidence. Yerrell, P. (2008) ‘National Evaluation of BTCV’s Green Gym.’ Oxford Brookes University www2.btcv.org.uk/display/greengym_research

• National Ecosystem Assessment report:The NHS Forest is discussed as a key sustainability initative through its focus on both tree planting, community engagement and the health benefits of the green space in the UK National Ecosystems Assessment. Our project is mentioned in Chapter 8 with a box 8.3 detailing the NHS Forest. http://uknea.unep-wcmc.org/Resources/tabid/82/Default.aspx

Ian Higgins MA Dissertation identifying the feasibility of the NHS Forest and the healing properties of the creating of greenspace on NHS Estates. The NHS Forest Dissertation

•Regular exercise in greenspace can boost immune system! http://info.evergreen.ca/en/blog/entry/green-time-just-what-the-doctor-ordered?utm_source=Canadian+Green+Health+Care+Digest+Issue+%2378+-+March+27%2C+2013&utm_campaign=Green+Digest+%2378&utm_medium=email

Conference Proceedings from the 2011 ICF - Trees, people and the built environment. Sections on Promoting green networks and human wellbeing, management of the urban forest and the value of communities in successful urban greening among other chapters are relevant to the NHS Forest.

•Sustainable Health and Social Care: Connecting Environmental and Finanacial performance. This document produced by the Kings Fund provides an overview of the environmental impacts of health and social care and examins the evidence available. www.kingsfund.org.uk/sustainability

•Forests, Trees and Human Health Nilsson, K.; Sangster, M.; Gallis, C; Hartig, T,; de Vries, S.; Seeland, K; Schipperijn, J. (Eds.) 2011. Springer

•Trees and Woodlands, Nature's Health Service. Liz O'Brien (2005) Forest Research

Why Nature should not be seen as an expensive add on! A good article relating to the Ecosystems Assessment report in the Guardian. http://www.guardian.co.uk/sustainable-business/nature-heart-economic-soc...

Mind has demonstrated that: Ecotherapy would contribute to three of the government’s six key priorities set out in its Public Health White Paper: increase exercise, improve mental health and reduce obesity. The report provides evidence of studies confirming that participating in green exercise activities provides substantial benefits for health and well-being. Ecotherapy could contribute to reducing the £338 million that antidepressant prescription costs the public health service.

Populations living in greener environments have lower levels of income related health inequality. R.Mitchell, F. Popham (2008) Effect of exposure to natural environment on health inequalities: anobservational population study. The Lancet, 372 (9650). pp 1655-1660

• Australian researchers found that members of land conservation groups experience higher levels of health and well-being than non-members. The positive health benefits derived from participating in conservation activities include improvements to physical health and general mood and, in addition, to enhanced social capital. Moore M, Townsend M and Oldroyd J. 2006. Linking human and ecosystem health: the benefits of community involvement in conservation groups. EcoHealth 3(4) 255-261

Participation in a range of green exercise activities leads to significant health and social benefits. Self-esteem levels are significantly improved and feelings of anger, confusion, depression and tension all significantly improve post-activity.Pretty J, Griffin M, Peacock J, Hine R, Sellens M and South N. 2005.

A countryside for health and well-being; the physical and mental health benefits of green exercise. Countryside Recreation Network, Sheffield. Pretty J, Peacock J, Hine R, Sellens M, South N and Griffin M. 2007. Green Exercise in the UK Countryside: Effects on Health and Psychological Well-Being, and Implications for Policy and Planning. J. Environ. Planning and Manage. 50(2) 211-231

•Great Outdoors:How Our Natural Health Service Uses Green Space To Improve Wellbeing
An action report by the Faculty of Public Health http://www.fph.org.uk/uploads/r_great_outdoors.pdf

•Direct and Indirect health benefits of urban parks: http://www.ifpra.org/images/park-benefits.pdf 

Benefits for staff of greenspace/ plants within your office http://metro.co.uk/2013/09/16/sick-building-syndrome-get-some-air-4019902/

what is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Barton,J. & Pretty, J. (2010)  Environ. Sci. Technol. 2010, 44, 3947–3955

Returning urban parks to their public health roots. C. Philip Wheater et al (2008). Manchester University and John Moores University.

A compararative study of the Characteristics of EEG when observing a hedge or a concrete block fence.Nakamura R, Fujii E,  J of theJapanese Institute of landscape architects. 55 pp139-144

Stress recovery during exposure to Natural and Urban environments.Ulrich RS, Simons RF, Losito E, Fiorito E, Miles MA, Zelson M,  J of Environmental Psychology 11, 201-230

•Sustain's growing for health report demonstrating the benefits of gardening and food growing for health http://www.sustainweb.org/publications/?id=293

•Natural England's report "on the benefits of green space for tackling health inequalities" - http://www.instituteofhealthequity.org/projects/natural-solutions-to-tac...

GREATER SOCIAL COHESION

Trees and woods can enhance social cohesion between the NHS Estates and local communities through joint involvement in planting, maintenance and enjoyment of trees and woodland.

Numerous studies on green space and particularly woodland have shown that they are highly valued by communities. MORI, 2002, ‘The Environment: Who cares?

Access to woodland is not only important for health benefits through exercise but also makes visitors feel ‘happy’, ‘relaxed’ and ‘close to nature’ Coles R.W. and Bussey S.C. 2000, ‘Urban forest landscapes in the UK - progressing the social agenda.’ Landscape and Urban Planning 52, pp181- 8

IMPROVED AIR QUALITY
Trees and woodland have a measureable impact on air quality, in particular by adsorbing pollutants such as sulphur dioxide and ozone, intercepting harmful particulates from smoke, pollen and dust and releasing oxygen through photosynthesis, thus reducing the incidence of diseases exacerbated by air borne pollutants. The negative effects of air pollutants are proportionately greater in urban areas, where trees are close to sources of pollution and nearer to people who might be affected – yet tree cover in urban areas is under threat.

The UK already has one of the world’s highest rates of childhood asthma, with about 15 per cent of children affected, and research by the British Lung Foundation suggests that one in every seven people in the UK is affected by lung disease – almost 8 million people. The predicted rise in air pollution will increase attributable deaths and hospital admissions, with as many as 1,500 additional deaths and hospital admissions each year (‘Future health - Sustainable places for health and well-being’, CABE 2009).

Columbia University researchers found asthma rates among children aged four and five fell by a quarter for every additional 343 trees per square kilometre. Lovasi, G., Quinn, J., Neckerman, K., Perzanowski, M. & Rundle, A. (2008) ‘Children living in areas with more street trees have lower prevalence of asthma.’ Journal of Epidemiology & Community Health, 62(7), pp. 647-649.

It has been estimated that doubling the tree cover in the West Midlands alone would reduce mortality as a result of poor air quality from particulates by 140 people per year. Stewart, H., Owen S., Donovan R., MacKenzie R., and Hewitt N. (2002). ‘Trees and Sustainable Urban Air Quality’. Centre for Ecology and Hydrology, Lancaster University

REDUCTION IN NOISE

Trees can reduce urban noise through sound deflection and absorption and this can in turn improve the environment for patients and staff.

High noise levels have been found to increase perceived stress levels in staff, and bring about anxiety and sleeplessness in patients. Ulrich, R. 2000: ‘Effects of healthcare environmental design on medical outcomes’, ‘Design & Health: The Therapeutic Benefits of Design’. Proceedings of 2nd International Congress on Design and Health, Karolinska Institute, Stockholm, Sweden, pp. 51, 52

HELP REDUCE THE IMPACT OF GLOBAL TEMPERATURE RISES

Trees and woods can reduce the impact of the ‘urban heat island effect’ which occurs when hard surfaces in summer act as giant storage heaters, absorbing heat during the day and releasing it at night. Dramatic summer temperature differences of as much as 10 degrees C between London and its surrounding areas have been recorded, which in turn exacerbate the symptoms of chronic respiratory conditions. Projections suggest this problem will get markedly worse. The cooling benefits of trees can also help in heat waves, which are also projected to become more frequent. The very old, chronically ill and poor are most susceptible to heat-related illnesses. By 2012, there will be a 1 in 40 chance that the South-East of England will experience a serious heat wave causing over 3,000 immediate heat-related deaths and 6,350 further heat-related deaths soon afterwards (DH, 2008a).

A study by the University of Manchester has shown that increasing tree cover in urban areas by 10 per cent can reduce urban surface temperatures by as much as 4°C. Handley, J and Carter, J (2006) ‘Adaptation strategies for climate change in the urban environment’, Draft final report to the National Steering Group, Centre for urban and regional ecology, University of Manchester www.sed.manchester.ac.uk/research/cure/downloads/asccue_final_report_nat...

LESS SURFACE WATER FLOODING

Throughout the UK winter is predicted to be wetter and summers drier and there is also a
predicted increase in the frequency of very heavy rainfall. Trees can reduce the likelihood of surface water flooding, when rain water overwhelms the local drainage system, by regulating the rate at which rainfall reaches the ground and contributes to run off. Slowing the flow increases the possibility of infiltration and the ability of engineered drains to take away any excess water. This is particularly the case with large crowned trees.

Research by the University of Manchester has shown that increasing tree cover in urban areas by 10 per cenet reduces surface water run-off by almost 6 per cent. ‘Using green infrastructure to alleviate flood risk’, Sustainable Cities –www.sustainablecities.org.uk/water/surface-water/using-gi/

REDUCED CARBON EMISSIONS

Trees can help mitigate climate change and thus reduce the NHS carbon footprint by absorbing carbon dioxide from the atmosphere and reducing the amount of energy used in heating and cooling a building. It is estimated that the NHS Forest could directly absorb up to 260,000 tonnes of CO2.

Research in the USA suggests a per tree saving in carbon emissions for shade and shelter trees as a result reduced building energy use of around 10-11kg per year. Akbari, H. (2002) ‘Shade trees reduce building energy use and CO2 emissions from power plants’, Environmental Pollution, Volume 116, Supplement 1, pp.119-126

ECONOMIC BENEFITS:

There are numerous economic benefits to be gained from the provision of high quality green space and wooded areas. These include:

REDUCED COSTS THROUGH HEALTH PREVENTION:

If just 1% of the 2.5 million people on incapacity benefit in Britain could be helped back into the workplace through active lifestyles encouraged by a better environment, it would save the country £67million a year. Speech by Andy Burnham MP, Secretary of State for Health, 13 August 2009, ‘Fit for the future – can we build a more active Britain?’ Department of Health - www.dh.gov.uk/en/News/Speeches/DH_104324)

If every household in England were provided with good access to quality green space it could save an estimated £2.1 billion in health care costs. Our Natural Health Service – ‘The role of the natural environment in maintaining healthy lives’, Natural England 2009 – www.naturalengland.org.uk/publications

People who live within 500 metres of accessible green space are 24 per cent more likely to meet recommended levels of physical activity. Coombes, E. G., Jones, A. P., Hillsdon, M (2009). ‘The relationship of physical activity and overweight to objectively measured green space accessibility and use.’ Social Science and Medicine, under review

Reducing the sedentary population by just one per cent could reduce morbidity and mortality rates that have been valued at £1.44 billion for the UK. 2005 CJC Consulting, Willis, K., Osman, L., 2005. ‘Economic benefits of accessible green spaces for physical and mental health: scoping study’. Forestry Commission

The overall costs to the economy of physical inactivity in England are estimated to be £8.2 billion per year. Allender, S. Foster, C. Scarborugh, P. Rayener, M. 2007, ‘The burden of physical activity-related ill health in the UK’. J. Epidemiol Community Health, 2007, 61:344 – 348(‘No charge? Valuing the natural environment’, Natural England 2009 - www.naturalengland.org.uk/publications)

The benefit of air pollution absorption by woodland greater than two hectares has been estimated at around £900,000 per year. However, the health benefits from air pollution absorption within smaller woodland (less than two hectares) are not included and are likely to be much greater. Many of these woods and trees are located closer to urban populations and to sources of pollution. CJC Consulting (2009), ‘The Value of Benefits Arising from Trees and Woodland in the UK’

The Corporate back-40 Employee benefits of wildlife enhancement efforts on corporate land. Kaplan R., Barwell, L. V., Ford H. A., Kaplan, S. (1996) Human Dimensions of Wildlife Vol 1. Issue 2.

Psychological Benefits of greenspace. A longitudinal study has been carried out by ECEHH following the same people over 17 years and has enabled them to compare the benefits of greenspace against other factors:

http://www.ecehh.org/publication/would-you-be-happier-living-greener-urban-area

Economic benefits of Ecominds http://www.mind.org.uk/media/338566/The-Economic-Benefits-of-Ecominds-re...

 

REDUCED COSTS LINKED TO FLOOD PREVENTION:

The insurance cost of the 2007 flooding was thought to have been around £3 billion (Newratings, 24th June 2007, UK floods likely to cost £3bn in insurance - www.newratings.com/en/main/company_headline.m?&id=1577047) but the Environment Agency expect the regular annual cost of damage to property alone to be in excess of £1 billion. When the cost of further disruption, damage to infrastructure and loss of business is added this increases to £2.5 billion and could rise to £4 billion by 2035. Environment Agency, ‘New reports highlight GBP20Bn investment over 25 years is needed to protect England from flooding’ www.environment-agency.gov.uk/news/108705.aspx

REDUCED ENERGY COSTS:

By providing shade and shelter trees can contribute to a reduction in a building’s energy budgets. Deciduous trees in particular provide shading during hot summer months, reducing the need for air conditioning, whilst allowing solar gain to buildings during the winter, reducing the need for heating. UK Government (2009), ‘The UK low carbon transition plan – national strategy for climate and energy’, The Stationery Office

REDUCED SITE MAINTENANCE COSTS:

In general woodlands are considerably cheaper to manage than mown grassland. Large simple areas of gang mown grass are as cheap (but no cheaper) to manage than woodland but contribute little to urban environmental quality. Urban woodlands provide more interesting landscapes for people to enjoy than open grassland and they make valuable contribution to the overall woodland resource in the UK. They also offer an achievable alternative to close mown grassland, at no extra management cost ‘Trees or Turf: Best value in managing urban greenspace’, National Urban Forestry Unit, 1998

VALUE FROM LEISURE USE:

Woodland is an important leisure resource. Benefits from public access were estimated in 2003 to be £392m per year in GB (£447m at 2007/08 prices). CJC Consulting (2009), ‘The Value of Benefits Arising from Trees and Woodland in the UK’

The Forestry Commission has produced this useful document aimed at urban planners outlining the importance of trees: www.forestry.gov.uk/forestry/INFD-87YEK2