Health & Well-being benefits from Parks & Protected Areas
Practical advice on the delivery of Health & Well-being benefits from Parks & Protected Areas
What is this toolkit for?
This toolkit is intended to provide simple and practical advice on how parks and protected areas can support health outcomes for people.
Who should read this?
This toolkit is aimed at those responsible for the management of parks and other protected areas. It is intended to provide simple and practical advice to a range of park and protected areas staff, including planners, site managers, wardens and rangers.
This advice has been prepared by the following EUROPARC members – Pete Rawcliffe (Scottish Natural Heritage), Joel Erkkonen (Parks and Wildlife Finland), Nele Sõber (Estonia Enviromental Board), Carles Castell (Diputació de Barcelona), Tony Gates (Northumberland National Park Authority), Melissa Desbois (Parc National des Calanques), Bridget Finton (Scottish Natural Heritage) and Carol Ritchie (EUROPARC Federation Directorate).
Comments on the advice and suggestions for further contents should be sent to Bridget Finton bridget.finton @ nature.scot.
Why should parks and protected areas be involved in supporting health outcomes?
The following Guiding Principles have been adopted by the EUROPARC Federation. The EUROPARC Federation believes that:
- Positive contact with nature is important for human health. It can create well-being, prevent public health problems and promote an active lifestyle.
- Parks & protected areas connect people with nature and represent a valuable natural asset that can provide specific contributions to the delivery of positive health outcomes.
- Parks & protected areas contribute to individual and community health and well-being, and to wider aspects of economic health and growth.
Planning and delivery of site management to achieve health objectives should be informed by and delivered through:
- Policy – a policy framework at national, regional and / or local level that establishes the connection between the natural environment and health benefits supports management objectives
- Partnerships – community engagement and cross-sector partnerships in implementation reflect joined-up working and provide wider benefits
- Best practice and innovation – a strong evidence-base is supported by many examples of good practice, with innovative projects being shared throughout the parks & protected areas network
- The delivery of health objectives by parks and protected areas is a natural extension of their traditional role in providing for access and recreation – it illustrates the environment sector responding to social needs and should be embedded as part of park management bodies’ core business.
- The importance of parks and protected areas for health promotion and improvement adds to the case for investment in these natural assets.
Policy & the contribution of Protected Areas
- Europe’s nature is a health promoting asset. There is increasing evidence that access to the natural environment can help guard against, treat and manage key health issues such as: depression, coronary heart disease and stroke, type 2 diabetes, obesity and dementia.
- Europe’s national parks and other protected areas are well placed to support health outcomes for people who live in or near them or who visit them.
- There is a range of good practice in Europe’s national parks and other protected areas in increasing physical activity, improving mental health and addressing health inequalities using green exercise and contact with nature through: outdoor recreation, volunteering, learning, gardening and active travel.
- We believe that the contribution of Europe’s national parks and other protected areas to health outcomes can be strengthened through recognition in relevant policy, practice and funding at the European, national and regional level.
- Future revisions to the EU strategies on biodiversity and green infrastructure should make more direct reference to health benefits. A new LIFE Fund on health and nature could help stimulate and mainstream good practice.
Europe’s ‘natural health service’ – the contribution of nature to human health
Contact with nature contributes to good physical and mental health
- A brisk 30 minute walk on five days of the week can reduce the risk of: Heart attack and stroke by 20-30%; Diabetes by 30-40%; Hip fractures by 36-68%; Bowel cancer by 30%; Breast cancer by 20% and Depression/dementia by 30% 
- One in four adults will experience mental health problems at some point in their lives. Outdoor activity and contact with nature can help sleep patterns, reduce stress, improve mood and self-esteem, and provide meaningful social contact .
There is a growing body of evidence on the links between health inequalities and access to nature in urban, suburban and rural settings. Contact with nature can help reduce health inequalities at all stages of life: pre-birth, childhood, adult life and old age .
Experience of the natural environment by young people can be life changing in terms of confidence and skills that can enhance job opportunities .
Physical and mental health are inter-related, and in many ways, inter-dependent. With an ageing population and more people with multiple health issues, the breadth of benefits offered from green exercise make it a useful tool for the health sector.
 Department of Health and Human Services (2008) Physical Activity Guidelines Advisory Committee Report (2008), US, Washington, DC
The health benefits of being habitually physically active appear to apply to all people regardless of age, sex, race/ethnicity, socioeconomic status, and to many people with physical or cognitive disabilities. The amount and intensity of physical activity needed to achieve many health benefits is well within the capacity of most Americans .and can be performed safely. The Report, developed by the Department of Health and Human Services of the US Department of Health and Human Services, provides the scientific basis for these conclusions and the development of federal physical activity guidelines.
 How to improve your wellbeing through physical activity and sport
Created by mind.org.uk, this booklet is for anyone who wants to improve their well-being by being more active through sport or exercise. It covers how being active is important for our physical and mental health, and explores which sports or exercise may be best for you, how to overcome common barriers, potential risks and how to plan your routine safely.
 Nature for Health and Equity - by the Institute for European Environmental Policy and Friends of the Earth
Lack of access to nature and natural areas contributes to health inequality, and improving it is key to tackling these challenges. This briefing highilights the challenges and shares good practice from across Europe.
 Improving Young People’s Lives, UK Government
The role of the environment in building resilience, responsibility and employment chances - a report that provides a compelling context within which to respond to locally determined needs, galvanise programmes like the National Citizen Service, and contribute to the wider ambition of a healthier, greener and more responsible society.
Europe’s ‘natural health centres’ - the contribution of National Parks and other protected areas
Parks and Wildlife Finland
- The estimated total value of health benefits of all national park visits in Finland was 226 million euros in 2013
- National parks are significant exercise environments for Finns. For example, in Pallas-Yllästunturi National Park, visitors moved a total of about 10.2 million kilometers in 2017 by their own power. This equates to roughly the same distance as 255 laps around the world
- Visitors estimated the value of their health and well-being benefits to be around 100 euros per visit. 100 euros is the median value of the answers (the middle value). The self-defined worth of health benefits experienced by all Finnish national park visitors in 2017 has been calculated by Metsähallitus, Parks & Wildlife Finland reports at approximately 310 million euros in total
Provincial Council of Barcelona
A study carried out in 2015/16 looked at Natural Parks as a source of health and well-being. 500 visitors to sites in Barcelona province’s Natural Parks Network were asked about how they perceive natural parks contributing to various aspects of health and well-being.
- 68% recognised a perceived improvement in their health and well-being as a result of their visit
- 76% indicated that their motivation to visit related to the key dimensions of health and well-being
- Of the sites’ attributes that contributed to an improved sense of well-being: forests were mentioned by 71% of respondents; general landscape was mentioned by 69% of respondents; silence was mentioned by 63% of respondents.
See the summary of the study.
Scottish Natural Heritage
- In a review of health walks on Scotland’s National Nature Reserves (NNRs), research found that the walk experience was much more positive than the expectations of many walkers who had not previously been to a NNR. All enjoyed their NNR experience. Many of the groups mentioned the positive effects their walks had on their mental and spiritual health. The review also makes a number of recommendations concerning information, promotion, co-ordination and provision of visitor infrastructure to promote use of NNRs for health walks.
Regional & National Frameworks
The importance of relevant Policy Frameworks at the national and regional level
Protected areas operate within the framework of national and regional policy on health and the environment. Experience suggests that these frameworks can be very helpful in supporting the delivery of health outcomes by individual protected areas, especially when they include:
- Reference to contact with nature in health policy
- Structures and partnerships between relevant health and environment departments and organisations
- Sources of funding for delivery of health outcomes
Scotland - national overview
The Scottish Parliament is responsible for health and environment issues within Scotland, and the key mechanism to steer and monitor delivery of the Scottish Government’s outcomes-based approach is its National Performance Framework. This has established five Strategic Objectives eg a Healthier Scotland; a Greener Scotland, and a set of National Outcomes which guide central and local government planning. National Performance Indicators are used to monitor performance and include:
- delivering a Healthier Scotland –
- Increase people’s use of Scotland’s outdoors
- Increase physical activity
- Improve mental well-being
- Increase the proportion of journeys to work made by public or active transport
- delivering a Greener Scotland –
- Improve the condition of protected nature sites
- Improve access to local greenspace
A robust policy framework recognises the positive links between the environment and human health as presented in a range of national and local government, government agency and NGO policies and strategies which support the government’s top-level objectives. The physical, mental and social health benefits of being active in the outdoors and connecting with nature are identified across sectoral interests and greater integration within the public sector is encouraged by Scottish Government.
Ownership and management of protected areas is spread across public, voluntary and private sectors. National parks, national and local nature reserves, biosphere reserves, forest parks and other areas designated for landscape or nature conservation interest are largely managed by partnerships involving national and local government bodies, voluntary sector organisations, land owners and community interests. Access to the outdoors including protected areas, the urban fringe and urban greenspace is enabled through Scotland’s progressive access legislation which links rights with responsible behaviour.
The Green Exercise Partnership (GEP) in Scotland was founded in 2007 and brought environmental organisations Scottish Natural Heritage and Forestry Commission Scotland together with the national health promotion organisation NHS Health Scotland. A key workstream for the GEP has been working with the National Health Service (NHS) to make use of environmental assets surrounding health-care settings as a health-promoting resource. The NHS Greenspace Demonstration Project, started in 2010, has enabled the green space around a number of hospital sites to be developed for therapeutic purposes for patients, and for physical activity and relaxation for staff, visitors and neighbouring community. Landscape and access improvements have brought a range of health benefits, as well as enhancing biodiversity and delivering more cost-effective estate management systems.
Building on the success of the GEP, the Our Natural Health Service initiative is a cross-sector partnership involving planning, transport, education, sport, health and environment. Scottish Natural Heritage is leading the development of an action programme to mainstream the use of nature-based solutions into health policy and practice and contribute to prevention, treatment and care. Natural assets such as urban parks and green corridors; woodlands and greenspace around settlements; path networks; national parks and other protected areas can all contribute to key health challenges as well as improve quality of life.
Key drivers of health policy include the prevalence of non-communicable diseases, a recognition of the need for more focus on prevention and healthy lifestyles, and widening health inequalities. Actions to encourage more use of Scotland’s outdoors as Our Natural Health Service are being strongly linked to the public health and physical activity agendas within Scottish Government and the health sector, and to the evidence base that shows how green exercise can contribute to tackling physical inactivity, mental ill-health and health inequalities.
A strong focus of Our Natural Health Service will be on the areas of urban and rural Scotland that have low levels of physical activity and suffer from health inequalities and other aspects of disadvantage. Local ‘Green Health Partnerships’ which bring together health and environment sectors are being used to up-scale and mainstream greater use of Scotland’s outdoors to deliver public health outcomes. Drawing on public and voluntary sector stakeholders’ collective knowledge of community needs, existing green health activity, local resources and delivery organisations, the partnerships will co-ordinate activity and co-produce outputs that contribute directly to local health and social care priorities.
Scotland is making significant progress in the green health agenda and is seen as a front-runner within the UK and Europe in this topic. The experience Scottish Natural Heritage has developed in championing this work is being fed into the EUROPARC Federation Commission on Health & Protected Areas, and an IUCN / WCPA Health and Wellbeing Specialist Group set up to promote the links between nature and human health and further adoption of the Healthy Parks Healthy People approach.
Finland - national overview
The perspective of nature and health is divided under several ministries in Finland. However, there is no clear guiding body responsible for combining nature and human health.
- The Ministry of Social Affairs and Health aims to ensure that everyone has an equal opportunity to lead a healthy and socially secure life.
- The Ministry of the Environment is responsible for matters concerning communities, the built environment, housing, biodiversity, sustainable use of natural resources and environmental protection.
- The Ministry of Agriculture and Forestry secure domestic food production and sustainable use of renewable natural resources and create the preconditions for economic activities and well-being derived from these.
- The Ministry of Education and Culture is responsible for the development of education, science, cultural, sport and youth policies, and for international cooperation in these fields.
In the years to come, Finnish society faces major challenges such as aging population, growing prevalence of mental health problems, obesity and type 2 diabetes. These problems will increase health care expenses significantly in the future. All means and actions to make a positive effect to these challenges are very welcome.
Nowadays, benefits of nature for human health and wellbeing are seen as an increasingly important topic in Finnish society. Cross-governmental cooperation and development between various sectors of the state administration and specialists from sports, outdoor and nature sectors has increased substantially over the last few years.
The Natural Resources Institute Finland (LUKE) is a primary scientific institution conducting research on the health impacts of nature. The effects of nature on well-being are also studied in relation to the societal significance of recreational use of nature, multiple use of forests, and the development of nature-based business operations. In addition to LUKE, the University of Tampere and the National Institute of Health and Welfare are the main institutions involved with research on green space, health and wellbeing.
Parks & Wildlife Finland (P&WF), a unit of Metsähallitus, manages all national parks (a total of 40) and other state owned protected areas in Finland as well as historic sites throughout the country. In addition, P&WF promotes nature conservation more widely through collaboration with neighbouring countries of Finland and several international organisations. P&WF use public funds to provide facilities for outdoor recreation such as trails, nature centres and websites. Several partners of P&WF within nature tourism provide services that enable people to enjoy Finland’s protected areas sustainably. Safe and marked trails (a total of 6,000 km) through Finland’s landscapes encourage everyone to get out into nature.
In cooperation with its partners, P&WF is responding to future challenges through the Healthy Parks, Healthy People Finland 2025 programme. The goal of the programme is to improve social, physical and mental well-being of the Finnish population through green space and contact with nature. The aim is to inspire people to become physically active and to spend time in the natural environment more often and for longer periods in their everyday life as well as their leisure time.
The Healthy Parks Healthy People Finland programme has been implemented through several projects funded by the European Social Fund, the European Regional Development Fund and the Ministry of Education and Culture.
- Moved by Nature project (2013-2015) aimed at developing nature-based health promotion interventions for groups classified as being high-risk groups (e.g. unemployed, overweight and obese, new immigrants, youth at risk of social exclusion).
- Open Air (2012-2014) project focused on embedding nature in rehabilitation and integration services as well as improving access to urban and rural green space.
- Everyone Outdoors project aimed at improving access to nature in collaboration with the Finnish Federation of Adapted Physical Activity (2015-2016).
- Moved by Nature II project (2017-2019) continues to develop nature-based health interventions, however children’s and adolescent’s increased physical activity levels as a target. As part of the project the first outdoor activity centre designed for children and youth in Finland will be developed.
- Equal opportunities to reach nature are being developed further in the Trail to Nature project (2017-2019).
Promoting ‘Green Health’ in Scotland
The Green Exercise Partnership brings together a range of actors so that a Natural Health Service can complement the National Health Service.
OPEN & AIR – Encouraging the Use of the Outdoors
The OPEN AIR projects were delivery and implementation of the Healthy Parks, Healthy People strategy. Both projects formed a project unity:
In 2011 Pembrokeshire Coast National Park Authority hosted the Walkability Project, a ‘health asset’ securing benefits for the community, bringing together interested bodies including the Local Health Board, Leisure Services and the County Council.
There is a significant evidence base for the range of individual and wider social health and well-being benefits that can be achieved through outdoor activity and contact with nature. Key benefits include: better physical and mental health and guarding against future illness; therapeutic and restorative qualities which enhance recovery; reduced social isolation and greater community cohesion, and opportunities to establish lifelong healthy behaviours.
· The evidence suggests that people are more likely to maintain regular physical activity in the outdoors – the attractive and changing surroundings aid motivation and it provides opportunities for social contact.
· One in four adults will experience mental health problems at some point in their lives. Outdoor activity and contact with nature can help sleep patterns, reduce stress, improve mood and self-esteem, provide meaningful social contact.
· The number of people with dementia is growing rapidly. Spending time in the outdoors can bring a range of benefits to people living with dementia and their carers.
· A range of health benefits for young people, including better motor skills for children who play in green spaces; reduced symptoms of ADHD with contact with green spaces; more likelihood of physically active young people in greener and more walkable neighbourhoods.
· Experience of the natural environment by young people can be life changing in terms of confidence, and skills that can enhance job opportunities. Encouraging interest in the natural world and outdoor activity early in life instils confidence in using natural settings and has a positive role in supporting more active, healthier lifestyles in adult life.
· The natural environment is associated with opportunities to make social contact, increase inter-generational connections, avoid isolation and enhance community cohesion. Experience of the outdoors and involvement in its care can lead to stronger more inclusive and sustainable communities.
Physical and mental health are inter-related, and in many ways, inter-dependent. With an ageing population and more people with multiple health issues, the breadth of benefits offered from green exercise make it a useful tool for the health sector. Re-connecting with the environment through green exercise can help patients, their carers, and the general population in terms of healthy lifestyles and prevention of poor health / illness.
General evidence references:
- NHS Forest – evidence summary of health, social, environmental and financial benefits
- Evidence statement on the links between natural environments and human health 2017 DEFRA and University of Exeter
- A Dose of Nature: addressing chronic health conditions by using the environment 2014 University of Exeter
- The Great Outdoors: how a green exercise environment can benefit all. 2013 Gladwell et al
- Benefits of connecting children with greenspace – range of evidence
- Nature-based integration Nordic experiences and examples. 2017 Pitkänen et al
- Natural outdoor environments and mental and physical health: Relationships and mechanisms. 2015 Triguero et al
Visiting the outdoors can help address issues of poor health and health inequalities
Visiting the outdoors, whether it’s urban greenspace close to home, countryside around towns or remote and wild areas of land and water, can help deliver a range of health benefits and can contribute to the attainment of national targets for physical activity.
- A brisk 30 minute walk on five days of the week can reduce the risk of: Heart attack and stroke by 20-30%; Diabetes by 30-40%; Hip fractures by 36-68%; Bowel cancer by 30%; Breast cancer by 20% ; Depression/dementia by 30% (Annual Report of the Chief Medical Officer 2011 ‘transforming Scotland’s Health, NHS Scotland)
- There is a significant relationship between self-reported stress and the proportion of greenspace in the local area (Ward Thompson et al, 2012)
- Health disparities between high income and low income groups are much narrower in areas with ample greenspace (2012 Scottish Health Survey)
- People living near green space experience less health complaints and better mental and physical health than those living in an urban environment. For every 10% increase in green space there was a reduction in health complaints equivalent to a reduction of 5 years of age (de Vries S, Verheij R A and Groenewegen P P,2001)
- People living close to greenspace are more likely to meet physical activity guidelines and less likely to be overweight or obese. (The relationship of physical activity and overweight to objectively measured greenspace accessibility and use, Coombes, 2011)
- Nature provides an added value to the known benefits of physical activity. Repeated exercise in nature is connected to better emotional well-being. (The Relationship between Perceived Health and Physical Activity Indoors, Outdoors in Built Environments, and Outdoors in Nature Pasanen, Tyrväinen & Korpela, 2014)
Wandering in the Woods – Enabling people living with dementia to benefit from visiting woodlands
The evidence gathered throughout the project implementation has shown that there are significant potential physical, social and emotional benefits for people living with dementia in care settings when they can get out into woodland.
Are you delivering a health-promoting park / protected area?
The Health Check-list below is designed to help you think about:
- how best to plan, manage and promote your sites to a wider range of people to improve their general health and well-being; and
- how to link your sites to the health sector so that people at risk of or experiencing specific illness / health conditions can be supported to make use of your sites.
|Strategic planning – is there:
Ø A link between the management objectives of your site, and the national / regional / local health and well-being policy framework
Ø A site management plan that engages with local health stakeholders and responds to health issues and priorities / target groups
|Outreach – does your site have:
Ø Engagement with health sector, intermediary bodies and target groups to ensure activity programmes and volunteering opportunities cater for their needs
Ø Outreach programmes aimed at key target groups or communities
|Monitoring & evaluation – does your site have:
Ø A visitor monitoring system that gathers feedback on health benefits
Ø Monitoring systems for the health benefits delivered through specific activity programmes / health interventions
|Site management – does your site have:
Ø Easily accessible information on the facilities provided at the site
Ø A sense of welcome for visitors
Ø Visitor facilities such as parking for people with disabilities; toilets
Ø A range of access provision, from easy-going paths for people with health issues / disabilities, to specific equipment / furniture to promote physical activity
Ø A range activity programmes delivered directly, or through green exercise providers
Ø Staff who are well trained to support visitors with health issues
|Communications – is there:
Ø Active engagement with local health professionals, providing information and opportunities to experience the ways your site can support health outcomes
Ø A communications plan for your site that specifies appropriate messages for health professionals and for the public / target health groups
Ø Easily accessed information about the site and what it offers to a range of visitors
Ø Do site staff have appropriate skills and confidence to work with health groups
Ø Can you build wider awareness and capacity in your organisation on health
Other opportunities – are you able to:
- Identify local health sector partnerships and provide a place / activity programme / visual identity for green exercise referrals / sign-posting
- Make access to information easier for health professionals and target groups to find by inputting into / establishing a central information service for a wide range of parks / protected areas
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