URBAN NATURE FOR HUMAN 

HEALTH AND WELL-BEING

A research summary for communicating the health benefits of urban trees and green space

1 Introduction

2 Defining Nature and

Health Research

4 Pollution and Physical

Health

6 Active Living

8 Features that Promote

Physical Activity

10 Mental Health

13 Stress Reduction

15 Social Health, Cohesion,

and Resilience

17 Social Equity and Access

to Nature

18 Conclusion

18 Acknowlegements

19 References

Introduction CONTENTS

Writers, philosophers, and 

naturalists have praised the 

benefits of nature for human 

health, happiness, and well-being for 

centuries, but only relatively recently 

have researchers begun studying and 

quantifying the complex relationship 

between human health and nature.

In 1984, Roger Ulrich, professor 

and director of the Center for Health 

Systems and Design at Texas A&M 

University, published the results of a pioneering study that looked at the recovery rates of gall bladder surgery patients 

in relation to the views from their rooms 

in a Texas hospital. Some of the patients 

looked out over a garden and grove of 

trees, while others had a view of a brick 

wall. Ulrich found that patients with a 

natural view spent fewer days in the hospital and used fewer pain medications 

(Ulrich 1984).

Ulrich’s study helped open the door 

to a new field of inquiry focused on illuminating the ways that nature influences 

our physical, mental, and social lives. 

More than three decades later, a broad 

and diverse body of scientific literature 

describes the human health value of 

nature, confirming that trees, parks, gardens, and other natural settings are as 

essential to livable and sustainable cities 

as the other critical systems that keep 

their residents moving and working.

Findings from the current literature 

indicate the wide range of effects. 

United States Department of Agriculture

Forest Service FS-1096 February 2018
2 | URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING

For instance, 

studies show that—

› People living near parks 

and green space have less 

mental distress, are more 

physically active, and have 

extended life spans.

› Exposure to nature may 

impact human mortality from 

chronic disease.

› When people exercise 

outdoors in natural environments, they do so for 

longer periods of time and at 

greater intensities.

› Positive health effects are 

enhanced when green space includes the presence of 

water, or blue space.

There is also strong evidence that time spent in nature 

can improve the attention capacity of children with attention deficit disorders. Similarly, some research shows 

that inner-city children who grow up in public housing 

buildings with a view of nature have greater impulse control and are able to concentrate better and delay gratification longer.

This report summarizes some of the most prominent 

research related to nature and public health to help urban 

natural resource professionals, urban planners, architects, 

educators, health professionals, 

and community groups effectively communicate the health 

benefits of urban nature to their 

constituents.

Some may argue that the 

observational nature of much 

of the existing research limits 

its utility to influence practice 

and policy—that randomized 

clinical trials, the gold standard 

for evaluating health outcomes, 

are needed to prove a causal 

link between nature and certain 

health effects (see Box 1).

We provide this overview of the current literature to 

describe what we do know; which, taken as a whole, offers 

a compelling case for maintaining and expanding naturebased outdoor environments in cities and bringing people 

closer to nature. We describe limitations of this research, 

and we maintain that there are many opportunities to use 

this scientific knowledge to help improve individual and 

community health. The pace of nature-health research is 

expanding dramatically, and increased funding is supporting further study and new approaches to experimental 

design that will provide even more tangible evidence for 

the connection between the natural environment and 

human well-being.

Hospital patients with nature views from their rooms 

spent fewer days in the hospital and used fewer pain 

medications. 

Photo by: baona, iStockphoto.com

Defining Nature and Health Research

Nature and health research is highly diverse in 

terms of the human populations studied, types of 

nature (e.g., tree canopy, parks, or green streets), 

landscape scales, and health outcomes. This report is 

organized into reviews of research conducted in five general health categories:

1. Pollution and physical health

2. Active living

3. Mental health

4. Stress reduction

5. Social health, cohesion, and resilience

Engaging with nature can bring about multiple health 

effects that occur simultaneously and across short or long 

periods of time. When people exercise in a natural setting, 

for example, they experience the physical health benefits 

of active living, while also reducing stress and perhaps 

alleviating anxiety. They might exercise with family or 

interact with neighbors along the way, receiving the added 

health benefits of social connection. They might have a 

partly negative experience if their asthma or allergy symptoms are exacerbated while out on a day with a particularly 

high pollen count. In most cases, researchers recognize 

the multiple connections or associations and acknowledge 

the difficulty of establishing definitive causal relationships 

between nature and health. In this report, we categorize 

each study according to its primary theme to help the 

nontechnical reader use the information to communicate 

key findings.

Studies and publications within the nature and health 

literature contain a range of terminology—nature, parks, 

gardens, green space, open space, green infrastructure, 

urban forests, urban ecosystems, metro nature, nearby 

nature, and other terms—related to the different features 

and processes that compose the natural environment. In 
URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING | 3

most cases, the location and scale of the research study 

defines the terminology used. Some studies may use 

remote sensing data to provide measures of natural land 

cover and human land use features over cities, regions, or 

countries. Others focus on proximity to a park, the presence of trees lining streets, or even potted plants in office 

environments. Throughout this publication, we try to 

maintain the terminology used by the researchers in the 

referenced study.

There are limitations to the research presented here. 

A large number of studies described in this review have 

been replicated multiple times with consistent findings. 

Other studies are singular, showing interesting results that 

should not be generalized beyond the specific population, 

location, and scale of the study. It is important to interpret 

research findings within their original scope and context.

BOX 1. Studying Health and Nature: Scientific Approaches

Investigative approaches to understanding the connections between human health and nature have evolved 

over time and are continually being updated, in part due to a desire to move from observational studies to 

experiments that quantitatively measures relationships between nature and health outcomes—how nature 

directly and measurably improves public health.

Much of the prevailing social science 

research has been descriptive, or qualitative, because personal connections to 

nature are not readily expressed numerically. Early research described responses 

from people about nature preferences, 

perceptions, mood, satisfaction with 

place or neighborhood, and potential 

behavior. More recent quantitative or 

measured “nature and health” findings 

are largely correlational. They confirm a 

relationship between nature experience 

and measured health outcomes, but they 

don’t answer a key question—why do we 

see such responses? 

Understanding underlying causal 

mechanisms requires experimental studies where we have a control group (not 

exposed to nature) and an experimental 

group (exposed to nature) living under 

similar conditions and then monitoring 

health responses over a long period 

of time. As you can imagine, this can 

bring up many complex issues such as 

exposing individuals purposefully to 

potential unhealthy situations. Setting 

up a large-scale study and controlling for 

the variability in human populations can 

be difficult and costly. Nonetheless, the 

limited number of quantitative studies 

that have been conducted have demonstrated significant effects on human 

health and well-being (Faber Taylor 

and Kuo 2009, Faber Taylor and others 

2001b, Li and Sullivan 2016).

New interdisciplinary research 

collaborations among the environmental, 

medical, and public health fields are 

providing opportunities for experimental 

science. In Louisville, KY, for example, 

the Nature Conservancy has teamed 

with the University of Louisville School 

of Medicine, Division of Cardiology 

to conduct the Louisville Green Heart 

Study. The Conservancy will work with 

communities to plant trees and other 

vegetation while university researchers will conduct a longitudinal study 

to determine the health effects of the 

neighborhood greening (The Nature 

Conservancy 2016).

Similarly, advances in technology and 

the availability of open data sources 

have enabled correlation or relationships analysis that combines vegetation 

data layers, urban land use maps, and 

large-scale health 

data sets—such 

as county-level 

health records or 

large population 

health surveys—to 

examine how 

changes in vegetation may influence 

human health.

What’s next? 

Some of the 

most interesting 

contemporary research is probing 

neuroscience, endocrine, and physiological responses to nature exposure. 

A significant set of questions that are 

now queued up by the science community concern dosage—how much 

nature, how often, what kind; and does 

any of this vary for people across the 

human lifecycle?

Most of the research reported here 

explores health outcomes from visual 

stimulus; scientific investigations are 

now exploring the influence of other 

sensory inputs—sound, smell, ambient 

temperature, and body sensation—on 

health response. And while less prominent across the decades, qualitative 

studies of place, meaning, and social 

interactions continue to reveal human’s 

need to connect with nature for our 

health and wellness.

Photo by: Davel5957, iStockphoto.com

The interdisciplinary Green Heart Study in Louisville, KY, is 

looking at the effects of neighborhood greening. 
4 | URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING

Pollution and Physical Health

Urban trees and other natural systems provide 

a range of physical health benefits. Trees can 

improve air and water quality, mitigate the heat 

island effect, and help alleviate noise (Nowak and others 

2010). Trees can shield people from ultraviolet (UV) radiation, the cause or contributing factor for three types of 

skin cancer (Nowak and Heisler 2010). Urban ecosystems 

are increasingly recommended by national and State environmental protection agencies to mitigate the harmful 

impacts of air and water pollutants, harmful emissions, 

and the negative effects of urban heat and noise (Wolf and 

Robbins 2015).

Air Quality

Particulate matter, sulphur dioxide, ground-level ozone, 

nitrogen dioxide, and carbon monoxide are common air 

pollutants. Excess air pollution can lead to airway inflammation and reduced lung function. Pollution can also 

worsen health problems such as asthma, chronic obstructive pulmonary disease, and cardiovascular disease (Shah 

and Balkhair 2011). Trees and vegetation in parks can help 

reduce air pollution directly by removing pollutants and 

reducing air temperature, both of which contribute to 

smog, and indirectly by reducing energy needs for cooling 

in surrounding buildings and associated pollutant emissions from power plants (Nowak and Heisler 2010).

The effect of vegetation on urban air quality depends 

on the vegetation itself, its position on the site, and overall 

landscape design, as well as the level of air pollution in the 

area. Since pollution is more concentrated at the source, 

vegetation should be planted close to the source. A recent 

review determined that vegetation should preferably be 

low and/or close to roads to reduce sediment and dust, for 

example (Janhäll 2015). The review also found that vegetation should be dense but allow airflow to pass through to 

increase deposition of coarse and ultra-fine particles on 

leaves; vegetation with “hairy” leaves and a large leaf area 

were ideal (Janhäll 2015). In a study conducted in Norway 

and Poland, species such as Scotch pine (Pinus sylvestris), 

Yew (Taxus media) and Silver birch (Betula pendula) were 

efficient species in capturing ultrafine particulate matter 

(Saebo and others 2012).

Vegetation can also increase pollutants by emitting 

volatile organic compounds (VOCs) that can contribute to 

ozone and carbon monoxide formation. VOC emissions 

are temperature dependent. Because trees generally lower 

air temperatures, increased tree cover can lower overall 

VOC emissions and subsequent ozone levels in urban areas 

(Nowak 2002). VOC emissions vary by species. Researchers 

with the U.S. Department of Agriculture, Forest Service 

have identified nine genera that have the highest emission 

rates: beefwood (Casuarina spp.), Eucalyptus spp., sweetgum (Liquidambar spp.), black gum (Nyssa spp.), sycamore 

(Platanus spp.), poplar (Populus spp.), oak (Quercus spp.), 

black locust (Robinia spp.), and willow (Salix spp.) (Nowak 

2002). However, due to the high degree of uncertainty in 

atmospheric modeling, it is not clear whether ozone formation from VOC emissions for these species is greater 

than ozone removal or prevention.

Street trees in particular can trap pollutants beneath 

their canopies or act as a barrier to the natural flow of air 

through the built environment of cities (Whitlow and others 2011). A number of researchers from Cornell University 

are developing models to guide the design and layout of 

tree plantings in urban settings. A recent paper published 

by the researchers recommends planting trees near solid 

barriers to reduce downwind pollutant concentrations and 

using wide vegetation barriers with trees of high leaf area 

density (Tong and others 2016).

Air quality benefits provided by green space are particularly relevant for human health due to the relationship 

between air pollution and respiratory illnesses. Nowak and 

others (2014) found that in 2010, trees removed 17.4 million tons of air pollution across the United States, which 

prevented 850 human deaths and 670,000 cases of acute 

respiratory symptoms.

An important issue in urban forestry is the selection 

and distribution of trees for low allergy impact. Male 

pollen-producing trees are often planted to minimize 

unwanted fruit fall. Tree diversity in an urban area is often 

desired, as concentrations of one species can create heavy 

pollen source areas (Cariñanos and Casares-Porcel 2011).

Urban Heat

While the relationship between urban green space and 

air pollution is complex and less certain (Tong and others 

2016, Whitlow and others 2011), the cooling effects of green 

space are more direct and easily measured.

Cities are generally warmer than surrounding agricultural and forested areas due to the dominance of 

impervious surfaces and energy-absorbing materials, a 

phenomenon often described as the urban heat island 

effect. Heat has direct effects on human health, with 

consistent associations found between increased daily 
URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING | 5

temperatures and increased heat-related deaths, illnesses, 

and hospitalizations, particularly during extreme heat 

periods in summer (Vutcovici and others 2014). Children 

and the elderly are particularly vulnerable. Heat-related 

illnesses range from mild symptoms of fatigue and heatstroke to the worsening of preexisting illnesses, hypotension, and death (Harlan and others 2006).

In Phoenix, AZ, heat regularly reaches dangerous levels, 

making the cooling effects of green space a valuable service. In addition, researchers found that lower socioeconomic and ethnic minority groups in Phoenix were more 

likely to live in warmer neighborhoods with greater exposure to heat stress (Harlan and others 2006). High settlement density, sparse vegetation, and a lack of green space 

were significantly correlated with higher temperatures 

(Harlan and others 2006).

Urban trees are particularly vital for reducing heat 

stress and decreasing the size and effect of the urban heat 

island (Zupancic and others 2015). Trees have the unique 

ability to provide micro-cooling through evapotranspiration, as well as relief from heat stress through shade. 

Both small and large areas of green space can provide 

cool islands within cities. Geographic location and the 

type of available vegetation can also influence the extent 

that green spaces mitigate the urban heat island effect. 

For example, green spaces that are connected and closely 

spaced can improve the flow of cool air through the city 

(Zupancic and others 2015).

Additional studies have found that urban forests and 

green roofs can help reduce urban heat island effects 

(Takebayashi and Moriyama 2007). A recent review 

(Zupancic and others 2015) examined various types and 

scales of green space and found that green space can 

provide cooler air at the park, neighborhood, and city 

level. Every 10 percent increase in overall urban tree 

canopy generates a 2 °F (0.6 °C) reduction in ambient heat 

(Wolf 2008a).

A study of air temperature across the city of Baltimore, 

MD, looked at air temperature differences in relation to 

parks and other green space (Heisler and others 2007). 

When researchers compared temperature points, they 

found that the center of the city was consistently the 

warmest, while parks were generally cooler than surrounding areas. Patapsco Valley State Park, which is heavily forested (68 percent tree cover), was the “coolest” of 

the Baltimore parks, 13 °F (7.2 °C) cooler in the evening 

and about 5 °F (2.8 °C) cooler in daytime relative to the 

warm inner city.

Studies show that park temperatures are strongly influenced by the park’s vegetation and surrounding land cover, 

Street trees can trap pollutants in the air. 

Photo by: anouchka, iStockphoto.com
6 | URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING

but also that parks can influence nearby temperatures, 

sometimes for a distance as great as the diameter of the 

park (Nowak and Heisler 2010).

Human Mortality

The research community is studying the connection 

between nature and human mortality, but it is still difficult 

to draw a causal link. A number of studies describe lack 

of access to nature and associations with disease, such as 

cardiovascular disease, and high mortality rates.

A relationship between trees and human health is demonstrated dramatically by the loss of ash trees, many formerly lining city streets, to emerald ash borer. The emerald 

ash borer, an exotic beetle, was first detected in 2002 in 

Canton, MI, and then rapidly spread across the Midwest 

and into Canada. The pest then began to appear in more 

distant locations as infested trees were unknowingly 

shipped as firewood. Within 4 years of detection, over 

100 million ash trees died. Their disappearance meant 

that many parks and neighborhoods, once tree-lined, 

were now bare. 

This widespread tree mortality served as a natural 

experiment. Researchers looking at human health statistics for counties affected by the emerald ash borer found 

increased human mortality rates, with a large spike in 

people dying of cardiovascular and lower respiratory tract 

illness (Donovan and others 2013). Even after controlling 

for many socioeconomic factors, such as income and education, the analysis showed the same pattern across counties with very different demographic makeups. While the 

researchers were not able to explain the cause of the association, they demonstrated that the relationship between 

trees and human health was undeniably strong. 

Active Living

While super-sized sodas, junk food, and allyou-can-eat buffets are often blamed for the 

obesity epidemic in the United States, another 

key culprit is a steep decline in the level of physical activity. People in the United States are consuming the same 

level of daily calories as they did in the late 1980s, but are 

burning fewer calories in exercise, work, or play. Between 

1988 and 2010, the percentage of women who reported not 

engaging in regular physical activity rose from 19 percent 

to 52 percent. For men, the number increased from 11 percent to 43 percent (Ladabaum and others 2014).

Fewer people walk or bike to work. Many jobs themselves have become increasingly sedentary. Jobs demanding moderate physical activity, which accounted for 50 

percent of all jobs in 1960, have 

plummeted to just 20 percent 

(Church and others 2011). Kids 

are playing outdoors less, 

and fewer are signing up for 

team sports (Physical Activity 

Council 2016). Kids and adults 

are both spending a great deal 

of time sitting at school and 

work and at home in front of 

screens—televisions, computers, and mobile devices 

(Rideout and others 2010).

One result of inactivity is a marked increase in obesity. 

Rates of childhood obesity have tripled (12–19 years old) or 

quadrupled (6–11 years old) since the early 1970s, and those 

of adults have more than doubled (USDA 2010). Obesity 

places people at increased risk of multiple chronic diseases 

and conditions: high blood pressure, high cholesterol, 

type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, cancer, and mental 

illness. The rise in long-term chronic diseases related to 

obesity results in billions of dollars per year in medical 

costs and lost productivity (Center for Disease Control and 

Prevention 2016).

The shift to a sedentary lifestyle has been rapid and 

costly. Though it’s been shown that changes in diet can 

help, daily moderate activity 

is key to controlling weight 

gain. Even 30 minutes of brisk 

walking 5 days a week can 

significantly reduce health 

risks (U.S. Department of 

Health and Human Services 

2008). However, 51 percent 

of U.S. adults are not meeting 

the minimum guidelines for 

aerobic physical activity, and 

26 percent are not active at 

all (Center for Disease Control 

and Prevention 2015). Fewer people bike to work than in the past. Photo by: DeanDrobot, iStockphoto.com
URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING | 7

Research confirms that the availability of parks, trails, 

and nature can positively affect attitudes toward being 

active and encourage physical activity (Wolf 2008b), and 

shows that when people exercise in natural environments, 

they do so for longer and at greater intensities (Kerr and 

others 2012). The following sections provide more information about the beneficial relationships between nature and 

active living and the features of outdoor environments that 

promote activity.

Benefits of Physical Activity

While it’s widely accepted that physical activity is good 

for physiological and psychological well-being, different 

environments influence levels and duration of physical 

activity differently. People who use parks and open spaces 

are three times more likely to achieve recommended levels 

of physical activity than non-users (Giles-Corti and others 2005), and people who exercise outdoors tend to do 

so for longer periods and more energetically than those 

who solely exercise indoors (Ceci and Hassmen 1991, 

Focht 2009).

In one study, a 15-minute stroll through the woods 

increased participants’ attention, positive emotions, “connectedness” to nature, and ability to reflect on a life problem more constructively than a walk through an urban 

setting did for other participants (Mayer and others 2009). 

In a similar study, participants with serious depression 

received significant cognitive benefits and improvements 

in mood after a 50-minute walk in a natural setting relative 

to one in an urban setting (Berman and others 2012).

One of the primary symptoms of depression is rumination, or repetitive thoughts focused on negative features 

of the self (Bratman and others 2015). Participants who 

took a 90-minute nature walk reported having less rumination and exhibited decreased neural activity in a part of 

the brain linked with sadness and self-reflection. These 

findings led the researchers to recommend investment 

in access to natural environments in order to improve 

the “mental capital” of cities and nations (Bratman and 

others 2015).

Researchers have also started addressing the question 

of nature “dosage” (Barton and Pretty 2010, Shanahan and 

others 2015). What types and amounts of nature exposure provide the most benefits? How much is enough? 

Shanahan and others (2015) have proposed that the 

nature–health research community consider measuring the quality and quantity (i.e., the intensity) and the 

frequency and duration of the nature experience, and 

determine how each of these aspects of the nature dose 

are likely to be linked to different health outcomes. They 

propose that future research generate quantifiable naturebased health recommendations.

The availabity of nearby parks can encourage physical activity.

Photo by: BraunS, iStockphoto.com
8 | URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING

Features that Promote Physical Activity

We assume that physical activity in outdoor environments is good for physical and psychological health, but that assumption raises a number 

of other questions. Does the mere presence of nature or 

green space encourage people to be active? Are there 

particular features or nature designs that prompt outdoor 

play or that are better suited to active users? Fortunately, 

researchers are beginning to address these questions.

Transportation systems in most contemporary cities 

and towns focus on efficiently moving automobiles, with 

little consideration of pedestrians, bicyclists, or public 

transportation. Today, less than 3 percent (2.8 percent) 

of the U.S. population commutes to work by walking, as 

opposed to 9.9 percent in 1960, and less than 1 percent 

(0.5 percent) arrives at work on a bicycle (McKenzie 2014). 

These trends are directly related to the obesity epidemic 

and lack of physical activity in the United States (Wells and 

others 2007).

While it may seem intuitive that the availability of green 

space promotes “active transport” (walking and/or biking 

as a means of transportation) by making routes to destinations more attractive, the evidence is actually mixed. When 

it comes to commuting, distance to destination, availability 

of suitable infrastructure (e.g., sidewalks, bicycle lanes), 

and safety are more important factors than green space 

(Heinen and others 2010).

For example, bicycle commuters in Belgium prefer 

paths that are separated from traffic by vegetation barriers, bioswales, or a shoulder (Ghekiere and others 2014). 

The same study concluded that parents were more likely 

to allow children to commute to school by bicycle if the 

path was separated from the road.

Does the mere availability of parks and green space 

promote physical activity? Again, the results are mixed. 

While a number of studies have linked higher levels of 

physical activity with green space access (Sugiyama and 

others 2008), other studies have failed to find a significant 

relationship (Foster and others 2009, Mytton and others 

2012). It is difficult to establish a direct link between levels 

of physical activity and the mere availability of green space 

(Lee and Maheswaran 2011). It is not a simple case of “build 

it and they will come.”

Other factors may be more important in people’s decisions regarding whether to use a given park, trail, or green 

space for physical activity, such as the presence of infrastructure and amenities, attractiveness, organized park 

programming (such as group hikes or exercise classes) 

and maintenance of the grounds, accessibility, and safety 

(Cohen and others 2009, Owen 2004) (see table 1). 

A survey of 1,148 adults living in the U.S. South found 

that the number of adults who met physical activity guidelines was 15 percent higher in neighborhoods with sidewalks (Reed and others 2006). Similarly, an Atlanta study 

combining a Geographic Information System land-use 

study with digital motion trackers found that 37 percent 

of adults living in high walkability neighborhoods were 

likely to meet physical activity guidelines, compared to 18 

percent of those living in low walkability neighborhoods 

(Frank and others 2005).

Table 1. Positive Factors for Physical Activity

Physical Environment

Higher population density (city core rather than suburbs); higher housing density

Mix of land uses (such as residential and retail)

Street design with more connectivity

Accessible public transit

Walking and biking infrastructure (such as sidewalks 

and bike lanes)

Psycho-Social Environment

Safety from crime

Safety from traffic

Absence of social disorder

Aesthetics (including trees and landscape) 

Educational campaigns (such as Walk-toSchool programs)

Incentive programs (such as workplace reimbursement 

for transit use)

Park programming (such as exercise classes, 

group hikes)

Source: Wolf (2008b), Cohen and others (2009).

Perceived safety is an important characteristic and 

precondition for the use of green space for physical activity (Jansson and others 2013). For children, the safety of 

the environment as perceived by their parents is a crucial 

factor in use of a given park or facility (Ferdinand and 

others 2012).

One component of safety is crime. Research on the 

relationship between crime and the presence of vegetation 

indicates that the presence of trees and grass around residences results in less crime than in more barren residential areas (Donovan and Prestemon 2012; Kuo and Sullivan 
URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING | 9

2001a, 2001b; Troy and others 2016). In a study covering 

a rural-urban gradient in and around Baltimore, Troy 

and others (2011) found that a 10-percent increase in tree 

canopy was associated with a roughly 12-percent decrease 

in crime. Kondo and others (2015) examined Philadelphia 

crime statistics relative to roadside gray areas that had 

been upgraded with vegetation for mitigating stormwater 

runoff. They found a significant reduction (18–27 percent) 

in reports of narcotics possession in areas around the 

green improvements, compared to an increase of 65 percent across the city during the same period.

Despite the evidence from research, there is a public 

perception that vegetation provides a screen for criminals 

to hide behind or conceal their activities. A series of studies on a university campus in the 1990s concluded that 

areas with more places for concealment or hiding, such as 

those with more vegetation, elicited more fear and stress 

responses, and less feelings of safety (Nasar and Jones 1997, 

Nasar and others 1993). Thus, while the data may generally show less crime in greener areas, the perception of 

a lack of safety may counteract the actual situation, and 

undermine the attractiveness of a park or trail for physical 

activity (Maas and others 2009a).

Crime Prevention through Environmental Design best 

practices can include urban greening to create more 

defensible, safer outdoor spaces (Cisneros 1995). Visibility 

is a key factor in how users rate green space safety (Kaplan 

and Talbot 1988). Areas with larger trees and more open 

space are generally deemed safer than areas with dense 

vegetation, small trees, and large shrubs (Koskela and Pain 

2000). Greater openness is perceived as less dangerous. 

Managers may want to consider public safety perceptions 

when designing and maintaining urban parks, green space, 

and trails in order to create more welcoming, well-used 

spaces that deter crime and create safer and more active 

communities. A recent study on neighborhood crime in 

Baltimore supports intentional landscape design and maintenance and provides preliminary best practices for deterring criminals. The presence of yard trees, garden hoses, 

and well-maintained lawns, for example, as well as pruned 

shrubs and vegetation, are “cues to care” that can reduce 

crime (Troy and others 2016).

Residents of easily walkable neighborhoods are more likely to meet physical activity guidelines.

Photo by: jhorrock, iStockphoto.com
10 | URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING

Mental Health

F

rederick Law Olmsted, the designer of New York 

City’s Central Park, wrote extensively about the 

mental health benefits of contact with nature. As 

early as 1865, he declared that time in nature provided 

“relief from ordinary cares, change of air and change of 

habits” and “increases the subsequent capacity for happiness and the means of securing happiness” (Olmstead 1865 

[1952]). While Olmstead’s claims were based on personal 

observation and intuition, research is now proving the 

statement highly insightful.

Researchers are finding that time spent in nature provides a wealth of mental benefits, from increased cognitive 

performance and well-being (being at your best) to alleviation of mental health illnesses such as depression, attention deficit disorders, and Alzheimer’s. In this section we 

describe some of this research and how green space and 

parks can be designed and utilized for mental health.

General Mental Health and Happiness

Researchers at the University of Exeter surveyed 10,000 

urban residents in the United Kingdom, asking them how 

satisfied they were with their lives and whether they 

had signs of depression, anxiety, or other psychological 

disorders. After controlling for other factors known to 

significantly influence well-being such as income, employment, marital status, health, and housing, they found that 

as green space increased within a 2.5-mile radius of residents’ homes, overall well-being received a boost as well 

(White and others 2013). One of the researchers explained 

the relationship this way: “We know that getting married, for example, decreases depression and increases life 

satisfaction. And also getting 

a job when you are unemployed decreases stress and 

increases life satisfaction. 

How big were our effects relative to that? Moving from an 

area of little green space to 

an area of quite a lot of green 

space was about a third of the 

effect of getting married and 

about a tenth of the effect 

of moving from unemployed 

to employed” (University of 

Exeter 2016).

In an analysis of a public 

health survey of 11,200 adults, 

Danish researchers found a 42-percent increase in selfreported stress levels among individuals living more than 

1 kilometer (km) away from green space (or blue space at 

lakes and beaches), and those residing beyond the 1-km 

range also had the worst scores on other dimensions of 

general health, vitality, mental health, and bodily pain 

(Stigsdotter and others 2010).

Cognitive Function and Mental Fatigue

The demands of modern life can often be mentally 

exhausting. Focusing attention on flows of information and 

tasks, screening out distractions, and responding to the 

constant stimuli of commuting, work, school, and family 

leaves many people feeling drained, with memory loss and 

reduced capacity for sustained attention (Berto and others 

2010). Rachel and Stephen Kaplan’s Attention Restoration 

Theory (ART) suggests that we can use nature to restore 

depleted cognitive functions and maintain performance 

(Kaplan 1993, 1995).

ART proposes that our brains switch between two 

different attention systems, directed and involuntary. 

Directed attention is what people use at the workplace to 

solve problems and focus on tasks, all the while negotiating the surrounding distractions that typify many offices 

or workplace environments. Directed attention also leads 

to mental fatigue, which is that “drained” feeling that 

affects our cognitive performance.

Involuntary attention, also called soft fascination, is 

what our brain uses when our attention is captured by 

something stimulating or intriguing. Involuntary attention does not require intense focus and involves effortless 

reflection. ART proposes that 

this is the type of attention 

people use in natural environments, which serve as 

places for mental restoration, 

as they enable the directed 

attention system to recover 

from fatigue.

ART has been subjected to 

a number of experiments that 

appear to support its basic 

principles (Berman and others 2008, Li and Sullivan 2016, 

Pilotti and others 2015). In one 

study, researchers gave participants a tough memory and 

The designer of New York City’s Central Park (shown 

here), Frederick Olmstead, wrote extensively about 

the benefits of regular contact with nature. 

Photo by: dolphinphoto, iStockphoto.com
URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING | 11

attention test. Participants 

were then assigned to take 

a 50- to 55-minute walk 

through either the Ann Arbor 

Arboretum or downtown 

Ann Arbor, MI. When the 

participants returned to the 

lab and took the test again, 

the arboretum group scored 

significantly higher (Berman 

and others 2008). According 

to the authors, the results 

demonstrate the valuable 

mental benefits provided 

by time in nature: “Simple 

and brief interactions with 

nature can produce marked increases in cognitive control. 

To consider the availability of nature as merely an amenity 

fails to recognize the vital importance of nature in effective cognitive functioning.”

Most people may not have time to go for a 50-minute 

walk during the middle of their workday, or have access 

to a world-class park such as the Ann Arbor Arboretum. 

However, less immersive contact with nature can provide 

some of the same benefits. Even brief “nature breaks” 

can improve brain performance by providing a cognitive reprieve from the complex demands of modern life 

(Bratman and others 2015, Mantler and Logan 2015, Shibata 

and Suzuki 2002).

In another study, environmental psychologists in 

Australia gave test subjects an attention and memory task. 

In the middle of the test, participants got a 40-second 

break, during which they looked at simulated external 

views: some looked at a simulated view of a concrete roof, 

while others looked at a “green roof” that resembled a 

flowering meadow (Lee and others 2015). The participants 

who looked at the green roof performed significantly 

better on the second half of the test than the others. In 

a study in Norway, participants who sat at a desk with 

plants performed better on a memory and attention test 

than those who sat at an empty desk with no natural 

stimuli (Raanaas and others 2011). In the case of offices and 

schools, the addition of natural features could significantly 

improve attention and content retention rates.

Mental Illness

Contact with nature can also provide relief, and perhaps 

healing, for those who suffer from short-term and chronic 

mental illness (Berman and others 2012), including depression, anxiety, and mood disorders.

Public health researchers from the University of 

Canterbury in New Zealand 

compared neighborhood 

green space across Auckland 

with the New Zealand 

Ministry of Health Tracker 

database for treatment of 

anxiety and mood disorders 

in the area. Socioeconomic 

differences between neighborhoods were addressed 

using a measure of “socioeconomic deprivation” from 

the New Zealand census 

(Nutsford and others 2013). 

The connections were clear. Every 1-percent increase in 

the proportion of usable or total green space resulted in a 

4-percent lower rate of anxiety/mood disorder treatment, 

and a 3-percent lower treatment rate for every 100-meter 

decrease in distance to the nearest usable green space.

A population-level study (2,479 individuals) along a 

rural to urban gradient in Wisconsin compared mental 

health outcomes with a vegetation index and percentage 

of tree canopy coverage (Beyer and others 2014). After 

controlling for a wide variety of socioeconomic factors, 

the authors identified a strong association between better mental health among both urban and rural residents in 

areas with more green space. Higher levels of neighborhood green space were associated with significantly lower 

levels of symptoms for depression, anxiety, and stress. The 

researchers suggested that, “greening could be a mental 

health improvement strategy in the United States.”

In a series of Dutch studies, researchers found a connection between neighborhood greenness (typically within 

1–3 km from a residence), self-reported general health, and 

a lowered risk of physician-diagnosed diseases. Individuals 

with small amounts of green space (10 percent) within 1 km 

of their home had a 25-percent greater risk of depression 

and a 30-percent greater risk of anxiety disorders in comparison to those with large amounts of green space (90 

percent) close to their home (Maas and others 2006, Maas 

and others 2009c). Interestingly, the relation was stronger 

for children and people with a lower socioeconomic status, 

defined according to education level and work status (the 

researchers did not have access to data on income).

Walks in nature can improve cognitive brain function.

Photo by: Halfpoint, iStockphoto.com
12 | URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING

Children and Mental Health

In recent decades, the growing popularity of digital media 

and technology has changed the relationship between 

people and nature. For children, more time interacting 

with digital devices means less time outdoors, less time 

spent in free play, and less real, first-hand experiences 

with nature. Books such as Last Child in the Woods by 

Richard Louv have increased awareness of this issue (Louv 

2005). Research concludes that our growing disconnect 

with nature has real and lasting effects; however, it also 

shows the restorative effects of even limited contact with 

nature for both children and adults in attention restoration and managing symptoms of attention deficit disorders 

(Berman and others 2008).

The ability to harness self-discipline, delay gratification, and control impulses has been linked to a range of 

positive outcomes for kids, including academic success 

and physical and psychological health. Teenagers who lack 

impulse control and self-discipline may be at greater risk 

for delinquency, pregnancy, and drug use (Faber Taylor 

and others 2001a). Some studies show that contact with 

nature can help increase self-discipline. Researchers from 

the Human-Environment Research Laboratory at the 

University of Illinois, Urbana-Champaign, studied 169 boys 

and girls who lived in identical, high-rise buildings in an 

inner city with varying levels of nature nearby. They found 

that the more natural the view from a participant’s home, 

the higher the participant scored on tests of concentration, impulse inhibition, and delayed gratification (Faber 

Taylor and others 2001b). The researchers provided this 

compelling thought: “Perhaps when housing managers 

and city officials decide to cut budgets for landscaping in 

inner city areas, they deprive children of more than just an 

attractive view.”

Additional studies from the Human-Environment 

Research Laboratory at the University of Illinois, UrbanaChampaign, conducted over the past decade revealed 

strong evidence of nature’s benefits for children affected 

by Attention Deficit Disorder (ADD) and Attention Deficit 

Hyperactivity Disorder (ADHD) (Faber Taylor and Kuo 

2009, Kuo and Faber Taylor 2004). Of note is a study they 

did that engaged children with ADHD in walks in several 

different environments. The children who walked in a park 

showed more improvements in attention after walking in 

a park than those who took walks in downtown or neighborhood settings. The effect was comparable to those 

reported for common pharmaceutical therapies for ADHD 

(Faber Taylor and Kuo 2009). “‘Doses of nature’ might 

serve as a safe, inexpensive, widely accessible new tool in 

the tool kit for managing ADHD symptoms,” the researchers concluded.

Children and Academic Success

Nature may also play a role in academic success. Researchers linked remote sensing measures of vegetation cover 

around 905 elementary schools in Massachusetts with the 

results of standardized tests. They found that the presence of more trees and vegetation was associated with 

higher scores on standardized tests (Wu and others 2014). 

Adjusting their analysis to account for income, researchers found higher scores of children from both low- and 

high-income areas were correlated with increased vegetation cover.

Another study in Michigan found, after controlling for 

student socioeconomic status and racial/ethnic makeup, 

building age, and size of school enrollment, that views 

from cafeterias and classroom windows with greater quantities of trees and shrub cover were positively associated 

with elevated standardized test scores, graduation rates, 

and percentages of students planning to attend a 4-year 

college, as well as fewer occurrences of criminal behavior 

(Matsuoka 2010). Li and Sullivan (2016) found classroom 

views of green landscapes were related to significantly 

better performance on tests of attention and led to students’ more rapid recovery from stressful experiences.

Landscape Design for Mental Health

The “savannah hypothesis” argues that people prefer open 

landscapes with scattered trees, similar to the African 

landscapes in which humans evolved (Heerwagen and 

Orians 1993). New work supports the idea that the psychological benefits of green space are linked to plant 

species diversity (Williams and Cary 2002). For example, 

people who spent time in a park with greater plant species 

Children are increasingly disconnected with the outdoors. 

Photo by: mkovalevskaya, iStockphoto.com
URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING | 13

richness scored higher on various measures of psychological well-being than participants who spent time in less 

biodiverse parks (Fuller and others 2007). The authors suggest that parks and green space should provide a mosaic of 

habitat patches to support both biodiversity and the wellbeing of human populations.

Stress Reduction

S

tress has become a constant in people’s everyday 

lives—work demands, financial strains, and family 

pressures. The cumulative effect of chronic stress 

can have serious health consequences over time, including depression, anxiety, heart disease, high blood pressure, chronic pain, and type 2 diabetes (Collingwood 2013). 

Researchers in Japan are discovering that surrounding 

oneself with nature can be one of the most powerful stress 

relievers available. In fact the practice of “forest bathing” 

has become a popular way to unwind in Japan and elsewhere (see Box 2).

Getting outside typically involves at least a little exercise, and exercise is a proven mood booster (Aspinall and 

others 2013, Barton and Pretty 2010). Also, being outside 

means people are more likely to encounter neighbors and 

friends, and social contact is another way to reduce stress 

(Heinrichs and others 2003). Views of natural scenes can 

effectively reduce stress (Kahn and others 2008), and this 

is particularly true if initial stress levels are high (Roe and 

others 2013).

BOX 2. Forest Bathing

Shinrin-yoku is the name given to the Japanese art of “forest bathing.” Forest bathing typically involves 

meditative walks through the woods with the objective of reconnecting with nature, decreasing stress, elevating 

natural moods, and strengthening the immune system. Forest bathing is rooted in Shinto and Buddhist practices 

that promote the experience of nature through all five senses. Forest bathers spend time touching and smelling 

leaves, bark, and flowers. Some even bring essential oils along to enhance smells. Meditation is often part of 

the experience as well. The practice originated in Japan in the early 1980s when it was endorsed by the Forest 

Agency of Japan and has since been gaining ground in the United States and other locations around the world.

Since 2004, Yoshifumi Miyazaki, director of the Centre for 

Environment Health and Field Sciences at Chiba University 

in Japan, has taken more than 600 research subjects into 

the woods for monitored forest bathing trips. He and his 

colleagues have found that forest walks, compared with 

urban walks, yield a 12.4-percent decrease in the stress hormone cortisol, a 7-percent decrease in sympathetic nerve 

activity, a 1.4-percent decrease in blood pressure, and a 

5.8-percent decrease in heart rate (Lee and others 2009, 

2011). On subjective tests, study participants also report 

better moods and lower anxiety. The lower concentrations 

of cortisol are a direct indicator of less stress. Overexposure 

to cortisol and other stress hormones has been linked to increased anxiety, depression, heart disease, weight gain, and 

focus and concentration difficulties. Overall, forest bathing 

appears to have significant stress-reduction benefits.

Forest bathing can help decrease stress, blood pressure, 

and heart rate.

Photo by: Smileu, iStockphoto.com
14 | URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING

Stress recovery theory 

(SRT) is based on empirical studies that demonstrated immediate positive 

and physical responses to 

natural settings or even 

views of nature (Ulrich 

1983). When a person is 

stressed, views of nature 

can reduce blood pressure, muscle tension, and 

pulse rate within minutes. 

SRT suggests that this 

is an evolutionary reflex 

associated with the limbic 

system—one of the oldest parts of the brain and the seat of the emotions—in 

response to settings that signal safety and an abundance 

of food. According to SRT, evolution conserved this functional response because more rapid recovery from stress 

helped early humans to quickly move from one survival 

task to another. Certain types of settings, such as places 

with abundant vegetation, calm or slow-moving water, 

savannah-like locations, and unthreatening wildlife, are 

more likely to be restorative.

In one of the earliest and most cited studies about 

stress, Ulrich and others (1991) presented a graphic, 

10-minute work accident film to 120 students. Before and 

after the film, viewers’ stress levels were evaluated using 

measures of blood pressure, muscle tension, and heart 

rate, along with a self-rating of stress. Next, students 

watched a 10-minute video of either pristine nature (a 

peaceful river and forest) or of a congested urban scene 

filled with traffic and pedestrians. Recovery was faster 

and more complete for the subjects who were exposed to 

the nature video. In some cases, participants who viewed 

nature scenes were even more relaxed than before viewing 

the accident film.

The stress-reducing quality of nature has also been 

shown in investigations of cortisol, a hormone released by 

the adrenal glands in response to stress. In one study, scientists measured the levels of cortisol in 25 socioeconomically disadvantaged adults in Scotland and asked them to 

fill out questionnaires about what stressed them out at 

home and at work (Ward Thompson and others 2012). The 

data were then compared to the number of parks, woodlands, and other natural environments in each participant’s 

zip code. The researchers 

found that those who lived 

in areas with the highest 

amount of green space had 

lower levels of cortisol, and 

their self-reported feelings 

of stress were lower than 

those who spent more time 

in urban settings without 

green space. The authors 

recognized the limitation of the small sample 

size, which was used to 

assess the feasibility of the 

study protocol.

In an interview with the BBC, Catherine Ward 

Thompson, the lead researcher on the study, said: “Our 

whole neuroendocrine system has evolved over millennia to respond positively to environments that are seen 

as providing what we need to live and thrive. There is 

something about the natural environment that is biologically part of our system. In a way, we are hard-wired to 

respond to it . . . and this may be turning our bodies back 

into something we have evolved biologically to respond 

positively to” (Kinver 2012).

Research has further clarified how natural areas in 

urban environments can help buffer people from stress 

factors. For example, green space between residences and 

high-traffic roads can reduce nuisance noise levels (GidlöfGunnarsson and Öhrström 2007, Nilsson and Berglund 

2006) and vegetation can increase privacy and conceal 

aesthetically displeasing structures (Smardon 1988). Just 

the presence of natural features near homes, schools, hospitals, and workplaces appears to be beneficial (see Box 3). 

Residents of public housing with nearby vegetation may 

more effectively cope with stress compared to those with 

homes surrounded by concrete (Kuo 2001).

Medical studies have shown that exposure to stress, 

especially for prolonged periods, can reduce immune 

response in humans. Recently, Kuo (2015) proposed 

enhanced immune functioning as a “central pathway” 

between nature and health. The author points out that 

natural environments have physiological and psychological 

effects related to immune functioning and that the natural 

world includes chemical and biological agents that boost 

immune functions (Kuo 2015).

Natural features near workplaces can provide a place to 

reduce stress during the workday. 

Photo by: shanksekala, iStockphoto.com
URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING | 15

BOX 3. Healing Gardens

Hospital settings are inherently stressful. Stress, anxiety, depression, and post-traumatic stress disorder 

(PTSD) are documented in many clinical studies on patient and family stress in relation to hospitalization. 

Even when medical procedures are routine, patients describe stressful feelings. For hospitalized patients 

requiring more complex treatments for cancer therapies, transplant surgery, stroke rehabilitation, palliative 

care and more, patients and their families often note high levels of stress.

Legacy Health, a nonprofit operating hospitals in Oregon 

and SW Washington, has embraced the installation of 

healing gardens at all of their locations as a way for 

patients and staff to relax, recover, and rejuvenate. Their 

first therapeutic garden was built in 1991; there are now 

12 gardens at their 8 hospitals. 

Physicians, nurses, and therapists from a range of 

practices—psychiatry, physical rehabilitation, pediatrics, 

trauma, cancer, burn, and family birth centers—prescribe 

use of the gardens to their patients. Visitors and employees 

are also encouraged to use the gardens. Behavioral health 

patients participate in horticulture therapy treatments, 

and patients from the Children’s Hospital engage in weekly 

nature stations.

Patients and staff report that using the Legacy hospital 

gardens helps them to relax and rejuvenate, and families of 

patients say that time spent in restoration in the gardens 

allows them to be able to better help their loved ones.

Therapeutic gardens:

› Encourage activity and movement

› Help reduce stress

› Help build social and emotional support

› Provide a wealth of sensory and natural benefits from 

the sun, wind, rain, breezes, smell of soil, birdsong, 

trees, shrubs, flowers, butterflies, water sound, hummingbirds, moonlight, and more Healing gardens provide a place for patients to reduce stress 

during hospital stays. 

Photo by: Legacy Health

Social Health, Cohesion, and Resilience

Humans are naturally social, but the nature of modern life has decreased the quantity and quality of 

our social ties. Most people no longer live within 

extended families, and many live far away from even their 

closest family members. As Robert Putnam’s Bowling Alone: 

The Collapse and Revival of American Community documented, Americans are increasingly isolated and disengaged from traditional institutions and networks such as 

churches, labor unions, and civic organizations that used 

to form the basis for their social lives (Putnam 2000).

Americans are far more socially isolated today than they 

were two decades ago, and a sharply growing number of 

people say they have no close friends (McPherson and others 2006). Similar to physical activity, social relationships 

are important for health and well-being. For example, lack 

of strong social relationships has been directly linked to 

the development and progression of cardiovascular disease 

(Knox and Uvnas-Moberg 1998) and health-threatening 

behaviors such as smoking, drinking, gang involvement, 

and drug use (Cubbin and others 2008).

Generally, research has shown a positive relationship 

between social ties and cohesion and green space (de Vries 

and others 2013, Francis and others 2012, Maas and others 2009b). Perceptions of social coherence and the extent 

and depth of local social interactions can be associated 

with perceptions of the greenness of the neighborhood 

(Sugiyama and others 2008). Of course, the type of green 

space matters. A 2013 study found a similar relationship 
16 | URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING

between green space and perceptions of social cohesion, 

but the researchers determined that the quality of the 

green space—measured in terms of variety of plants, maintenance, orderly arrangement, absence of litter, and general impression—mattered more than the quantity of green 

space in promoting social cohesion in the neighborhood 

(de Vries and others 2013).

Green, or nature-based, infrastructure builds physical resilience in a community and is key to mitigating 

natural disasters. Effective urban forestry programs and 

active environmental stewardship networks can provide 

the leadership to respond to and recover from natural 

disasters (Tidball and Krasny 2013). Erika Svendsen and 

Lindsay Campbell of the Forest Service’s New York City 

Field Station research the relationship between environmental stewardship, healing, and community resilience 

in the aftermath of disasters (Svendsen and others 2014). 

They have documented how communities in New York City 

created “living memorials,” or green space dedicated to 

memorializing the lives lost in the 9/11 attacks (Svendsen 

and Campbell 2010). The same authors looked at the 

role of nature in the rebuilding effort that took place in 

Joplin, MO, after the devastating 2011 tornado that completely destroyed much of the town and killed 161 people 

(Svendsen and others 2014). They found that as volunteers and community groups become actively involved in 

the stewardship of natural resources, their communities 

show increased civic engagement and ecological literacy. 

Additionally, communities that work together to create 

green infrastructure designed to be resilient to storms and 

other disasters can also generate and nurture social connections in these shared places.

Social Cohesion and the Elderly

Walkable green space is associated with greater longevity in older people (Takano and others 2002), and this is 

likely connected to the increased social interaction that is 

often associated with outdoor time for elderly individuals. 

For the elderly, increased social interaction is correlated 

with lower rates of mortality, depression, and cognitive 

impairment (Almedom 2005, Lubben 1988, Maas and others 2006). These studies highlight the importance of having accessible parks, gardens, and green space in close 

proximity to neighborhoods with large numbers of elderly 

residents as well as care centers.

Community gardens can improve nutrition, increase 

physical activity, and provide a location to socialize with 

neighbors. Community gardens can also provide a source 

of fresh fruits and vegetables often not readily available. 

Alaimo and others (2008) found that adults were 3.5 times 

more likely to consume at least five servings of fruit or 

vegetables a day if someone in their household participated in a community gardening project within the last 

12 months. Studies show a range of mental health benefits from gardening as well: reductions in the severity 

of depression, increased attention (Gonazalez 2010), and 

prevention of the onset of dementia and negative dementia behaviors and symptoms (Fabrigoule and others 1995, 

Simmons and others 2006).

Alzheimer’s disease is one of a number of cognitive 

impairments, collectively termed dementia, that primarily 

affect older individuals. Dementia patients with access to 

therapeutic or outdoor gardens exhibit fewer disruptive 

or agitated behaviors (Ellis 1995, Mather and others 1997). 

Time spent in parks and gardens can improve quality of 

life and function of dementia patients by reducing negative 

behaviors up to 19 percent, improving sleep patterns and 

improving hormone balance (Chalfont and Rodiek 2005, 

Mooney and Nicell 1992). Gardening appears to be particularly effective, improving mobility and dexterity, increasing 

confidence, and improving social skills among dementia 

patients (Rappe 2005, Ulrich 2002).

“Wander gardens” are confined outdoor spaces that 

enable activity without restraint but prevent departure. 

Access to these spaces is associated with improvements in 

the mobility of elderly patients (Detweiler and others 2012). 

At a dementia facility in Virginia, Detweiler and others 

Community gardens are a great way for seniors to get 

physically active outdoors. 

Photo by: laflor, iStockphoto.com
URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING | 17

(2009) found that patients with access to a wander garden 

had about 30 percent fewer falls and a reduction in fall 

severity. In addition, they found significant reductions in 

the amount of medications used (a 10.5-percent reduction 

overall, with a range of 3.4 to 22.2 percent).

Social Equity and Access to Nature

Many people, because of lack of access, transportation, or general familiarity, visit parks 

and green space rarely or not at all (Blanck and 

others 2012). Physical activity and frequency of park use 

depend on demographic, socioeconomic, and regional 

characteristics and reflect inequalities in park distribution 

(Sister and others 2010) or in the accessibility of parks and 

green space (Comber and others 2008).

While we note the mixed findings on access to green 

space in diverse communities (Troy and others 2007), a 

number of studies have concluded that the distribution 

of urban green space is related to measures of socioeconomic status, such as income, education, race/ethnicity, 

and occupation, and regularly report that neighborhoods 

with higher socioeconomic status enjoy greater access 

to nearby green space (Gordon-Larsen and others 2006, 

Jennings and Johnson Gaither 2015, Martin and others 2004, Wen and others 2013). The lack of recreational 

facilities and green space in low-income communities is 

associated with decreased physical activity and increased 

obesity, both of which place people at higher risk for 

mortality (Mitchell and Popham 2008). Efforts to address 

physical inactivity and other health concerns related to 

inequitable access to green space would benefit from 

analyzing how green spaces 

are distributed throughout 

diverse populations (Jennings 

and others 2012).

Equal access to nature 

seems to help remediate some health disparities 

between low- and highincome neighborhoods. 

Several studies have found 

that limited access to green 

space in low-income neighborhoods can negatively 

affect cardiovascular health, 

in comparison to wealthy 

neighborhoods (Jennings 

and Johnson Gaither 2015). 

However, low-income neighborhoods with large amounts 

of green space have cardiovascular mortality rates 

similar to those of wealthy neighborhoods (Mitchell and 

Popham 2008).

Access to green space can also reduce other health 

conditions such as obesity, psychological health, and heatrelated illness (Jennings and Johnson Gaither 2015). For 

example, higher tree density in urban areas is associated 

with decreased risk of childhood obesity (Lovasi and others 2013) as well as depression and type 2 diabetes (AstellBurt and others 2014) among low-income urban families.

Studies also document how green space play a role in 

reducing stress. By monitoring patterns of salivary cortisol (a biological indicator of stress), a study in low-income 

areas of Dundee, Scotland, reported healthier daytime salivary cortisol patterns and lower levels of perceived stress 

for residents with higher proportions (more than 43 percent) of green space (Roe and others 2013).

Low-income communities typically have fewer 

resources to help them deal with pollution, fewer municipal services to mitigate the effects of pollution, and fewer 

resources at the household level to buffer families from 

the effects of pollution. Therefore, poorer communities are at a higher risk of exposure to air pollution and 

the effects of extreme heat 

(Huang and others 2011, 

Jesdale and others 2013). 

Since chronic health conditions can disproportionately 

affect low-income communities (Marmot and Allen 2014), 

limited access to the benefits 

from green space is a particularly important issue for 

vulnerable populations.

While much of the discussion of the connection 

between green space and 

health focuses on urban 

environments, rural children 

and adults have higher rates 

Rural communities face different barriers to active 

living than those in urban areas. They often and have 

limited access to recreation and physical activity 

opportunities. 

Photo by: Willard, iStockphoto.com
18 | URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING

of obesity than their urban counterparts, and the barriers to active living in rural areas are often much different 

than the challenges of increasing physical activity in urban 

areas (Yousefian Hansen and Hartley 2015). Rural communities often lack transportation options and have limited 

access to recreation and physical activity opportunities. 

Other barriers may include isolation, climate and terrain, cost and safety fears such as high traffic speeds, the 

threat of loose dogs and wild animals, crime concerns, 

and lack of sidewalks and lighting (Yousefian Hansen and 

Hartley 2015).

Conclusion

People are dependent on nature for food, water, 

security, health, and well-being—we are connected 

with the natural world for our very survival. Green 

spaces also make us happier and healthier. The evidence of 

the link between nature, health, and preventive medicine 

will hopefully spur more direct collaboration between the 

health, urban planning, education, and natural resource 

communities. With the growing pressures of modern life, 

these are critical connections to pursue; the answers to 

some of the biggest challenges facing these groups lie in 

the recognition of shared interests, goals, and objectives. 

This area of research will continue to grow in the coming years and decades, illuminating the essential role that 

nature plays in the health and well-being of our minds, 

bodies, and spirit.

Acknowledgments

The Forest Service’s National Urban Forest 

Technology and Science Delivery Team (NTSD) is 

comprised of urban program staff and science delivery experts from across our regions and research stations, 

working collaboratively to deliver quality urban natural 

resources science, technology, and information to improve 

the long-term sustainability of urban ecosystems. This 

publication is part of the team’s effort to deliver urban forestry research and information to partners, stakeholders, 

and customers. NTSD team members Annie HermansenBaez (Forest Service Southern Research Station), Beth 

Larry (Forest Service Research & Development), and 

Lauren Marshall (Forest Service State & Private Forestry) 

managed the writing and production of this report. Josh 

McDaniel helped with the literature review and writing of this report. Zoe Hoyle (retired Forest Service), 

Louise Wilde and Sonja Beavers (Forest Service Office of 

Communications) provided editorial and layout reviews. 

Raghu Consbruck and Tracy Bryant provided the graphic 

design and layout of this publication. 

Photo credit for page 1 is Alija, istockphoto.com.

The following natural resource professionals, health 

professionals, and scientists donated their time and expertise by reviewing this document and helping to greatly 

improve the final report:

› Cindy Blain, California ReLeaf

› Dana Coelho, Forest Service, Rocky Mountain Region, 

State and Private Forestry

› Patti Erwin, Arkansas Forestry Commission

› Susan Granberry, Georgia Forestry Commission 

› Teresia Hazen, Legacy Health 

› Viniece Jennings, Forest Service, Southern 

Research Station

› Michelle Kondo, Forest Service, Northern 

Research Station

› Kathleen Sheehan, Forest Service, Pacific Northwest and 

Alaska Regions, and Private Forestry

› David Stephenson, Idaho Department of Lands

› Erika Svendsen, Forest Service, Northern 

Research Station

› Kathy Wolf, University of Washington/Forest Service
URBAN NATURE FOR HUMAN HEALTH AND WELL-BEING | 19

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How to cite this publication

U.S. Department of Agriculture, Forest Service. 2018. 

Urban nature for human health and well-being: a research 

summary for communicating the health benefits of urban 

trees and green space. FS-1096. Washington, DC. 24 p.

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