Proximity to blue space – such as rivers, lakes or sea – has been found to produce many of the same health and wellbeing benefits as green space, according to research caried out by the European Centre for the Environment and Human Health (ECEHH). There are indications, too, that these health benefits are greater in more deprived communities.

Living on the coast isn’t an option for everyone, of course. However, the presence of even small areas of water in urban environments, such as fountains or ponds, can have positive results. In a 2010 study led by researchers at the University of Exeter, participants responded most positively to images of landscapes containing water, even in built up environments, and these spaces had “higher perceived restorativeness.” The effect that water has on the quality of ambient light and sound was suggested as one possible cause for this favourable response.

Intriguingly, images of ‘built’ environments containing water were generally rated just as positively as natural ‘green’ space.

Blue Space: The importance of water for preferences, affect and restorativeness ratings of natural and built scenes, 2010

ECEHH has also been researching whether a view of water from a window can be beneficial, or even the introduction of fish tanks in healthcare settings and care homes. Early results suggest this has a positive effect on heart rate, blood pressure and mood.

How to use blue spaces within healthcare

Southmead Hospital was designed and built with sustainability and nature in mind. This included the installation of sustainable drainage systems (SuDS), which incorporate 4,900m2 of attenuation ponds on the north Bristol site. These are permanent wetland features, fed by runoff from the car parks which passes through swales to clean it before it flows into the reed-filled ponds.

The ponds are an important wildlife habitat, and biodiversity surveys have revealed high numbers of invertebrates living here. Southmead encourages patients, staff and visitors to engage with these blue spaces: the hospital’s Explorer Map shows walking routes around the grounds, which pass through multiple green spaces as well as past the ponds. The drainage system has reduced rainwater runoff and has significantly reduced costs for the hospital.

The SuDS attenuation ponds are amazing! We’re integrating these into green walks around the hospital with an Explorer Map showing walking and running routes as well as ‘Routes to Recovery’ for patients.

Tricia Down North Bristol NHS Trust

It may not be practical for a healthcare site to establish water features on their land, but nearby blue spaces can be used as a focus for health walks and social prescribing, producing wide-reaching health and wellbeing benefits amongst patients and community members.

Pond at Guild Lodge, Lancashire
Pond at Guild Lodge, Lancashire. Photo: Miriam Dobson / Centre for Sustainable Healthcare 2021. Attribution 4.0 International (CC BY 4.0).
Queen Elizabeth Hospital pond
Queen Elizabeth Hospital pond. All rights reserved.

The NHS Forest’s Green Health Routes are one such way that blue spaces have been incorporated into healthcare. These walking routes help patients and the wider community to access local green and blue spaces, with maps, leaflets and regular walking groups to increase participation. They can also be offered as a green prescription. The Marston Green Health Route for example, just outside Oxford, follows Peasmoor Brook, and takes in small parks and nature reserve containing ponds that support wildflowers and attract butterflies and bees.

There can be risks associated with blue spaces, of course; in the creation of wetlands and attenuation ponds, consultations are important to ensure that there is a minimal risk of infection. And even the smallest ponds, streams and fountains can pose a threat to small children, so the siting and adequate signage of these should be considered.