Going Green for Health Inequality

There is little argument that physical activity promotes good health, and that outdoor “green space” such as parks, forests, and recreation fields, promotes physical activity. Many studies have concluded that access to such space has an independent benefit on health and health-related behaviors. Now, however, there is evidence that access to green space many actually reduce the disparities in health care inequality related to socioeconomic status.

A new study published in The Lancet postulates that exposure to quality outdoor recreational space mitigates factors that lead to disease for populations in a lower socioeconomic position. The authors studied the population of England who was less than retirement age, from 2001 to 2005. They examined population groups based on the level of income deprivation and exposure to green space, and obtained mortality records for all-cause mortality, and mortality from circulatory disease, lung cancer, and intentional self-harm.

GardenThe researchers concluded that the health gap between the richest and poorest populations was about half as large in the areas with the most green space, compared to the areas with the least green space. The difference in mortality from circulatory disease was most significant between populations living with more and less green space. There was no difference in mortality rates associated with lung cancer or intentional self-harm, both of which are unlikely to be affected by green space.

A preceding study demonstrated that lower socioeconomic position and related employment status are associated with participating in little or no physical activity. Thus, policies that promote physical activity — such as access to usable outdoor recreational space — are needed, particularly for economically disadvantaged populations. Further, another study observed that a higher proportion of green space was associated with increased self-reported good health, even without increased physical activity. While this study demonstrated a positive relationship between access to green space and an overall healthier well-being, the relationship was not significant in higher income populations. Interestingly, in suburban lower income areas, green space was actually associated with worse health. This led to the interpretation that it may be the quality, as well as the quantity of green space that is significant in achieving health benefits. Similar studies have postulated that the health problems of the lower income populations are too large to be overcome simply by access to green space. Nevertheless, numerous studies have demonstrated a positive association between green space, increased physical activity, decreased stress, and overall perceived good health. This association is seen across socioeconomic divides and in both rural and urban regions.

People from all walks of life enjoy experiencing nature as a means of rest, relaxation, and recreation. Unfortunately, many areas, particularly those in urban neighborhoods, have experienced a decline in the quality and quantity of their usable outdoor space. This increasing urbanization is not expected to slow, and population studies predict that nearly two-thirds of the world’s population will live in urban areas within the next 30 years. This could substantially impact the health, well-being, and quality of life of the people in urban areas, particularly those in lower socioeconomic positions, as they may be unable to move to areas outside of cities or find suitable recreation areas elsewhere.

The authors of the current study suggest that environments that promote good health are critical in the fight to end health inequality. Stress reduction, attention restoration, increased physical activity, and improved social cohesion all likely play a role in the connection between green space and health. Green space does more than just enhance the aesthetics of a neighborhood, and politicians and health care authorities should take the benefits seriously as more people face the prospect of living without access to green space.


J. Maas (2006). Green space, urbanity, and health: how strong is the relation? Journal of Epidemiology & Community Health, 60 (7), 587-592 DOI: 10.1136/jech.2005.043125

Jolanda Maas, Robert A Verheij, Peter Spreeuwenberg, Peter P Groenewegen (2008). Physical activity as a possible mechanism behind the relationship between green space and health: A multilevel analysis BMC Public Health, 8 (1) DOI: 10.1186/1471-2458-8-206

R. Mitchell, F. Popham (2007). Greenspace, urbanity and health: relationships in England Journal of Epidemiology & Community Health, 61 (8), 681-683 DOI: 10.1136/jech.2006.053553

F POPHAM, R MITCHELL (2007). Relation of employment status to socioeconomic position and physical activity types Preventive Medicine, 45 (2-3), 182-188 DOI: 10.1016/j.ypmed.2007.06.012

R MITCHELL, F POPHAM (2008). Effect of exposure to natural environment on health inequalities: an observational population study The Lancet, 372 (9650), 1655-1660 DOI: 10.1016/S0140-6736(08)61689-X

Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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