There is now considerable research linking nature contact with health and wellbeing.
It suggests there are five key ways in which exposure to the natural environment is beneficial to human health These are: enhanced personal and social communication skills; increased physical health; enhanced mental and emotional health; enhanced sensory and aesthetic awareness and the ability to assert personal control; and increased sensitivity to one’s own wellbeing.
Beyond mental health research, researchers are also looking at nature contact in relation to children’s development, elderly people and people in work environments, prisons and hospitals. Specifically, in relation to healthcare environments, researchers have identified that contact with green space can lead to the reduction of pain and stress, the alleviation of depression, reduction of aggressive behaviour, increased patient satisfaction, improved recovery rates and improved staff performance and retention.
Research has examined the stress reduction of nature and nature views through psychological (self assessment and preference studies) and physiological measures. The best-known example is by Ulrich (1984) who revealed that hospital patients with a view of natural landscape (whether direct access to a garden, a balcony, indoor plants or nature pictures) benefit from improved recovery rates.
There have also been extensive preference studies looking at both the natural (green and blue) and virtual natural environments as ways to promote health and wellbeing. There is a large body of research on recreational experiences and the value of horticultural therapy.
The growing evidence that viewing nearby nature can measurably reduce patient stress and improve health outcomes was a key factor in the resurgence in interest internationally in providing gardens in hospitals and other healthcare facilities. Ulrich whose own research grew out of a tradition that posited a connection between architecture, health and nature, started to argue for a consideration of ‘ecological health’ within hospital environments. For Ulrich, artwork, soothing music, spaces for families and, most significantly for this research, the addition of gardens and sounds and views of nature were important. His work has inspired subsequent work collectively known as ‘evidence-based design’ (EBD).
Ulrich’s work in America initiated a branch of research that looked more closely at the impact of gardens within. This research identified evidence that views of nature, so-called ‘nature distraction’, and exposure to daylight can help reduce stress (especially environmental stressors such as noise) and depression, reduce pain, increase quality of life for chronic and terminally-ill patients and improve way finding.
Such research also identified some evidence that gardens can reduce costs (less pain relief and shorter stays), increase patient mobility and independence, and improve patient and staff satisfaction. Some researchers and designers have gone on to identify key characteristics of gardens that support people in specific health contexts such as elderly care or paediatrics.
In America and Europe resources have developed in order to promote high-quality EBD research and bring together the different audiences such as healthcare providers, landscape designers, architects and urban planners. EBD has been preoccupied with three categories: stress reduction, safety and ecological health.
While EBD has done much to consolidate the evidence base of studies looking at the effects of green nature, advances in neuroscience, immunology and computer science are also leading to a better understanding of how design impacts on human health. The arena of the therapeutic landscape has shifted from the humanities to science and medicine. Computer science, notably virtual-reality technologies are also leading scientists to a better understanding of the impact of both built and green space. Technology being developed by the military to treat post-traumatic stress disorder (PTSD) has led to initial results indicating that built space, whether virtual or real, impacts on people’s recovery process.
Scientific studies (Sternberg, 2009) looking into the stress produced by hospitalization (for both patient and staff) is now taking place. Sternberg highlights the fact that visual cues are only one in a wider human sensorium that includes sound, touch, movement, memory and doubt that all operate in relation to the science of place and wellbeing. She cites pioneering research looking at age old issues such as the effects of sunlight, visual green space, music and silence, scent, touch, activities such as walking and meditation, and memory of positive and negative places.
Beyond the healthcare research context, there is a broader focus on the restorative effect of green space on human health that has emerged across the world. Attention is being paid to the benefits of green space – at a time when the World Health Organization (WHO) estimates that depression and depression-related illness will become the greatest source of ill-health by 2020. Furthermore, stress is one of the most common work-related health problems. Green care, green exercise, green therapy, adventure therapy, wilderness therapy, animal assisted therapy and ecotherapy are now familiar terms (a type of therapy explicitly relying on the natural world to achieve therapeutic goals).
At the same time, definitions of human wellbeing and ways to measure it have developed. WHO now define wellbeing as ‘an individuals’ perception of their position in life in the context of the cultural and value systems in which they live and in relation to their goals, expectations, standards and concerns’. Wellbeing is increasingly seen as not just about material and social circumstances, but also to do with life satisfaction and realisation of potential (Bird, 2007). There is evidence of a stronger socio-ecological model of health emerging and a psychosocial dimension that puts emphasis on the relationship between people and place. This new focus on ‘ecological public health’ has, at its heart, the concept of human activity as integral and interactive with the natural environment.
This article is intended as a brief overview of the subject and is in no ways definitive. LGHN welcome members’ comments and contributions. The network hopes to provide an ongoing resource and research base for therapeutic landscapes research.
For Information, education, and inspiration about healing gardens, therapeutic landscapes, and other landscapes for health see www.healinglandscapes.org
Listed below are some key texts and websites for those new to the subject. Again, we welcome your suggestions and additions.
Suggested further reading
Bird, W. (2007) Natural Thinking: Investigating the Links between the Natural Environment Biodiversity & Mental Health, Report for RSPB. Available at: http://www.rspb.org.uk/Images/naturalthinking_tcm9-161856.pdf
Cooper Marcus, C., & Sachs, N. (2013) Therapeutic Landscapes. An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces. New York: John Wiley & Sons
Gerlach-Spriggs, N., Kaufman, R.E., & Bass Warner, S. (1998) Restorative Gardens, The Healing Landscape. New Haven; London: Yale University Press
Gesler, W.M., (2003) Healing Places. Oxford: Rowman & Littlefield
Grahn, P., Tenngart Ivarsson, C., Stigsdotter, U., & Bengtsson, I. (2010) ‘Using Affordances as a Health-promoting Tool in a Therapeutic Garden’ in Ward Thompson, C., Aspinall, P., & Bell, S. (eds.) Innovative Approaches to Researching Landscape and Health. Abingdon Oxon: Routledge, pp. 120-161
Hickman, C. (2013) Therapeutic Landscapes. A History of English Hospital Gardens Since 1800. Manchester: Manchester University Press
Minter, S. (2005) The Healing Garden. A Practical Guide for Physical and Emotional Well-being. London: Transworld Publishers/ Eden Project
Shackell, A., & Walter, R. (2012) Green Space Design for Health and Well-Being. Edinburgh: Forestry Commission
Sternberg, E.M. (2009) Healing Spaces, The Science of Place and Well-Being. Massachusetts & London: The Belknap Press of Harvard University Press
Ulrich, R.S. (1984) ‘View through a window may influence recovery from surgery’, Science 224, pp. 420-421
Worpole, K. (2009) Modern Hospice Design. Abingdon Oxon: Routledge
Here we feature research and events that show the therapeutic value of gardens and green space. Our aim is to provide a central forum and to ensure the subject is of interest to a wide range of people. We want to break down barriers and promote serious debate about the role of green space in healthcare interventions.
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