Guest post by Marjani Orchery

Since the publication of the Marmot Review over a decade ago there has been an increasing awareness of the social and ecological determinants of health.

Green spaces provide some of the richest areas of natural biodiversity in Britain, and there is considerable evidence of their health benefits for communities. These include the reduction of stress hormones, such as cortisol; improvements to the digestive and immune systems, and increased energy levels. Access to green space is related to lower mortality from cardiovascular disease, lower rates of obesity and lower levels of Type 2 diabetes. Studies have found that the more green space there is in a 1km radius, the lower the prevalence of disease. People moving to greener areas go on to have better mental health and higher levels of wellbeing

These health benefits arise partly because green space promotes physical activity, but are also linked to other factors. Natural environments have relaxing and restorative effects. Urban green spaces, such as parks, provide opportunities for social interaction and social inclusion, which are likely to be especially important for more marginalised groups. A variety of potential pathways are discussed here.

A game of football beneath the tower blocks in Burgess Park, South London. Photo: Axel Drainville
Urban green spaces are used by a wide variety of communities. Above: A game of football beneath the tower blocks in Burgess Park, South London. Photo: Axel Drainville via Flickr. Attribution-NonCommercial-NoDerivs 2.0 International (CC BY 2.0).
A dance class at Lambeth Country Show in Brockwell Park, South London. Photo: Sabrina Dallot-Seguro
They are a space for people to come together, learn and be active. Above: A dance class at Lambeth Country Show in Brockwell Park, London. Photo: Sabrina Dallot-Seguro via Flickr. Attribution-NonCommercial-NoDerivs 2.0 International (CC BY 2.0).

The most affluent 20% of wards in England have five times the amount of green space compared to the most deprived 10% of wards. A landmark study that looked at the relationship between proximity to green space and both all-cause disease mortality and circulatory disease mortality found that across all incomes, groups with greater exposure to green space have lower rates of mortality. But it also found that where people have greater access to green space, income-related health inequalities are narrower and that access to green space offers a degree of protection against health inequalities related to income. 

Systemic inequalities in the age of Covid

Black British and Asian British communities experienced significantly higher rates of mortality during the Covid-19 pandemic, and the way in which communities were differently affected by the virus suggested not only disparities in access to healthcare, but also systemic inequalities in social, environmental and economic factors. 

The pandemic has thrown a spotlight on the link between human health and the environment. In cities, it has highlighted the importance of green space for wellbeing, the huge public appetite for getting out into fresh air, and the systemic inequality of access. 

The UK government report, ‘Ethnic minority experiences of COVID-19’, demonstrates the mechanisms through which communities of colour were disproportionately affected by a lack of access to green spaces. The ‘lockdown’ policy implemented in March 2020 and the subsequent physical restrictions were undoubtedly difficult for all communities in the UK. However, the report suggests that minority ethnic communities were impacted severely; particularly in limitations to their access to ‘social, familial and environmental resources’. One anonymous participant wrote, ‘I’m going to be a prisoner in my house’, a sentiment expressed as a reaction to the restrictions.

The access to public green space during the pandemic was often subject to influence from external bodies. There was evidence of closures of public green spaces due to overcrowding. Such enforcements may have been necessary to prevent further spread of the virus yet left many individuals without any alternative access to green spaces, whether public or private. Minority ethnic and lower socio-economic communities in urban areas were disproportionately affected by such closures.

A game of chess in London's Holland Park during the pandemic. Photo: Sanshiro Kubota
A game of chess in London’s Holland Park during the pandemic. Photo: Sanshiro Kubota via Flickr. Attribution-NonCommercial-NoDerivs 2.0 International (CC BY 2.0).

The isolation precipitated by the restrictions of Covid-19, when compounded with historical incidents of both housing disparities and higher levels of poverty, further impacted communities of colour and health outcomes during a particularly difficult period.

Lower socio-economic groups in Britain are also significantly impacted by environmental inequalities, irrespective of their racial or ethnic demographic. However, individuals and specific populations who are doubly marginalised by ethnicity and socio-economic status are more likely to experience a higher burden of disease, relative to the other groups in society. Individuals in semi-skilled or unskilled manual occupations are almost three times as likely to be without a garden, when compared to those in managerial or professional occupations. 

Spaces for culture to flourish

The value of green space extends beyond the physical or mental health of individuals to wider social and communal benefits. ‘Sowing Roots: Caribbean Garden heritage in South London’ documents the socio-historical heritage of the Windrush generation’s management of green spaces. These post-World War II immigrants and their descendants were restricted to overcrowded, poor quality housing located far from parks and gardens. Many of them brought native plants and horticultural practices from the Islands, forming networks of Caribbean-owned allotments in British cities. In those spaces, new migrants were able to cultivate their own foods, whilst simultaneously providing sanctuary and respite from social discrimination and racism. In addition to their value for health, these green spaces provide a cultural legacy.

A volunteer gardens at King's Hospital's Jennie Lee Garden, part of Lambeth GP Food Co-op
A volunteer gardens at King’s Hospital’s Jennie Lee Garden, part of Lambeth GP Food Co-op. Photo: Vicki Brown / Centre for Sustainable Healthcare 2021. Attribution 4.0 International (CC BY 4.0).

Such benefits may include both the direct usage of healing plants and the subsequent integration of plant folklore and mythology – providing a method of reasserting cultural histories and practices. Transplanted plants like christophene (chayote) are well known as potent antioxidants and the opened ackee fruit was traditionally associated with smiling and well-being. Jamaica’s national dish is ackee and saltfish and this remains highly popular amongst diasporan communities.

How can healthcare sites support equality of access?

The consequences of environmental health inequalities, particularly among ethnic minority groups are only beginning to be recognised. In the absence of a systemic response, an increasing number of healthcare sites are developing their own green space projects to mitigate against the historic and contemporary lack of access to nature. The NHS Forest supports collaborative efforts between healthcare sites and local communities to access green spaces. A range of facilities, based in diverse settings, allows NHS staff and communities to experience the therapeutic physiological and social benefits of nature, as a significant resource and tool for healing. 

One example is the Lambeth GP Food Co-op, a collective of doctors, patients and residents growing food together in one of the most deprived and ethnically diverse areas of London. The co-op builds gardens in the land around urban GP surgeries to support their patients and residents.

In Leicester, Glenfield Hospital has recovered and restored its ‘Secret Garden’. This thriving space supports staff and patients, but is also open to the local community, and has become a popular and accessible green space within this very diverse city. Staff have requested to grow ingredients used in South Indian cuisine in its vegetable beds, and a local Asian women’s walking group regularly include the garden on their route.

For many marginalised groups, these kinds of initiatives may be the only salient green space available within their local area. Direct collaboration with NHS organisations can allow for greater connectivity with local communities and healthcare professionals. Additionally, these processes enable healthcare principles to be administered to local communities beyond the boundaries of clinical settings, such as hospitals or general practice surgeries.

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Marjani Orchery is a final year medical student, with an interest in health equity. Dually qualified as a dentist, she has extensive clinical experience in numerous healthcare settings and seeks to improve health outcomes through sustainable endeavours.

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Banner photo: ‘Playground is closed’, Glenlake Park, Georgia, USA. Thomas Cizauskas via Flickr. Attribution-NonCommercial-NoDerivs 2.0 International (CC BY 2.0).