Therapeutic landscapes, restorative environments, place attachment, and well-being

Evidence of declining well-being and increasing rates of depression and other mental illnesses has been linked with modern humans’ separation from nature. Landscapes become therapeutic when physical and built environments, social conditions, and human perceptions combine. Highlighting the contextual factors underpinning this separation from nature, this chapter outlines three Australian case studies to illustrate the links between therapeutic landscapes, restorative environments, place attachment, and well-being. Case study 1, a quantitative study of 452 park users near Melbourne, Victoria, focuses on place attachment and explored the links between pro-environmental behaviour and psychological well-being. Case study 2, a small pilot mixed-methods study in a rural area of Victoria, explores the restorative potential of hands-on nature-based activities for people suffering depression, anxiety, and social isolation. Case study 3, a qualitative study of users’ experiences of accessing hospital gardens in Melbourne, highlights improved emotional states and social connections.

Setting the scene and how to read the book

Human health depends on nature. This is a basic statement on which the fundaments of this book rest. Functional and diverse ecosystems, from which we derive fresh air and water, soil to grow food, timber to build houses, settings for play and recreation, are a prerequisite for human health and survival. The latest centuries’ unprecedented speed in societal and environmental changes has come to threaten the health of natural environments and by this threatening our own health. While we cannot, and should not, reverse the trend of sound development, we need to find better and healthier ways to interact with nature—in urban as well as in non-urban areas. This chapter will give a background to this book’s development and put the topic of nature and public health into a broad, outreaching context. It also presents an overview of the book’s full content, giving a brief description of each chapter.

Healthy Islands

Small Island Developing States (SIDS) form a special setting where nature and (population) health become intimately connected. This chapter outlines the nature of such small states, their development and health challenges, and a common health solution that has been advanced in the Pacific. The Yanuca Declaration established a Healthy Island programme in 1995. It is a specific example of a ‘healthy settings’ approach (Nutbeam, 1996). Healthy Islands form an integrated element of the Pacific development agenda and explicitly pursue a comprehensive agenda at the interface of nature, health, and development. Examples of this agenda are provided in two case studies. First, the WHO-led ‘Healthy Island Recognition’ programme, and second, the commitments among Pacific islands to the Framework Convention on Tobacco Control.

The healthy settings approach: Healthy Cities and environmental health indicators

‘Healthy Cities’ is a global movement in urban health that grew from a Canadian initiative in the mid-1980s to a World Health Organization programme. Healthy Cities are characterized by a strong commitment to values such as sustainability, solidarity, justice, and participation embedded in a vision that embraces ecological and community perspectives. The movement comes in different manifestations around the world; this chapter focuses mostly on the European evidence base and discusses efforts that have been made over three decades to establish validated sets of indicators to measure and assess urban health and Healthy Cities. True to the nature of the movement, indicators are both socioecological and biomedical, qualitative, and quantitative. This presents challenges to validity and applicability across urban environments.

The health impact of natural disasters

The complex and multifaceted nature of health risks secondary to natural disasters will require innovative, holistic, and problem-oriented approaches to risk and disaster management. The Hyogo Framework for Action 2005–2015 (HFA), the goal of which is to strengthen the resilience of nations and communities to natural disasters, is the inspiration for much of the current knowledge, practice, implementation, experience, and the science for natural disaster risk reduction. Natural disaster risk reduction offers a comprehensive framework where stakeholders can take coherent and complementary actions through political, social, technological, economic, and humanitarian processes to build resilience. The aim of the recent Hyogo initiative is to globally increase resilience and reduce vulnerability. This chapter will describe the current state of knowledge of the health consequences of natural disasters, the implications of these consequences for policy, and conclude with recommendations for action.

Allergenic pollen emissions from vegetation—threats and prevention

Allergic diseases are caused by hypersensitivity of the immune system to a certain environmental exposure. Many different agents may induce an allergic reaction. This chapter concerns reactions to pollen. Although allergies to animals, for example dogs and cats, may be considered as part of nature-induced allergy, the focus here is on vegetation. Allergic reactions to pollen depend on the type of pollen, biological properties, location, and individual factors. Changes in our immune systems, our living environments and lifestyles, and climate change may play a role in the increasing prevalence of pollen allergies. This chapter contains three major sections: first, the basics of pollen biology are outlined; secondly, pollen’s impact on human health are introduced; and finally, the chapter includes a section on how practitioners and policymakers can plan our cities to be green, and yet limited in allergenic exposure.

Technological nature and human well-being

In terms of physical and psychological well-being, does it matter that on a worldwide level we are replacing interactions with actual nature with technological nature—technologies that mediate, simulate, and augment the natural word? Research from three forms of technological nature are reviewed: a technological nature window, robot pets, and a telegarden. Results suggest that while interacting with technological nature is better than nothing, it is not as good as interacting with real nature. A concern with accepting technological nature is that it can shift the baseline downward for what counts as optimal well-being, as people across generations lose experiences with healthy baselines, a process referred to as environmental generational amnesia. One result is that we ask too little of the idea of urban sustainability, confusing biological living with human flourishing.

Unifying mechanisms: nature deficiency, chronic stress, and inflammation

Disconnection from nature seems to increase the risk of chronic stress. This is followed by a range of deleterious influences on our bodily systems. Many of these changes are related to chronic inflammation. This chapter evolves around the premise that natural environments are prerequisites for resilience to the various stressors of our daily lives. If our resilience and coping mechanisms are insufficient, we are at risk of entering a vicious circle of negative organ reactions and feedback loops. As stress is prolonged, stress hormones and poor health behaviour are followed by alterations in the gut microbiota and an increase in visceral fat. These reactions lead to damage of the cells’ mitochondria from oxidative stress and release of reactive oxidative species. Finally, the results of oxidative damage and chronic inflammation lead to the shortening of telomeres, the DNA-proteins which protect the chromosomes. Shorter telomeres are associated with accelerated ageing and disease.

The physiology of stress and stress recovery

Stress (i.e. the state of threatened homeostasis), is normally associated with adaptive physical and behavioural changes that promote individual survival. Successful maintenance of homeostasis leads to the state of eustasis, which represents health. The prolonged, excessive, or deficient response of the stress system to stress, however, may lead to a state of dyshomeostasis or cacostasis, which may lead to physical and mental health problems. Although research has focused on the detrimental effects of stress, only a few studies have been done on positive stress exposure adaptations. Increased resilience, post-traumatic psychological growth, and increased empathy may benefit chronically stressed individuals, enhancing their abilities to cope with distress. Therapeutic efforts in the treatment of short- or long-term stress aims at reducing its effect on neuroendocrine responses, behaviour changes, and so on. Community investments and interventions should focus on reducing threats and promoting positive adaptation during and after traumatic stress exposures.

Similarities, disparities, and synergies with other complex interventions—stress as a common pathway

Both internal and external stimuli can cause stress, and suboptimal stress management is a major driver of ill health. There are several complex interventions, such as contemplative practices and cultural activities, which facilitate the process of becoming aware of and handling such stimuli. Participation in such activities can facilitate the connection with one’s emotions and values, and the integration of those in everyday coping. One contemplative practice is mindfulness, which involves bringing one’s complete attention to the present experience on a moment-to-moment basis, non-judgementally. Among cultural interventions we find, for example, dance and music therapy and combinations thereof. It is plausible that the health effects of nature, and contemplative and cultural activities share a mechanistic background. Several theoretical principles are similar and the same kinds of condition benefit from these interventions, all with a certain effect on stress and mental fatigue. There could be synergistic effects of the various approaches.