Ethnicity and children's mental health: making the case for access to urban parks
Authors: Jenny Roe
Journal: The Lancet Planetary Health (2018)

Children living in poverty in the UK are four times more likely to have mental health problems than children from high-income families.1Gutman LM Joshi H Parsonage M Schoon I Children of the new century: mental health findings from the Millennium Cohort Study. Centre for Mental Health, 2015http://cdn.basw.co.uk/upload/basw_120221-1.pdfDate accessed: May 14, 2018Google Scholar In turn, black and minority ethnic (BME) children are more likely to be living in poverty than are white British children.2Pople L Rees G Good Childhood Report 2017. The Children's Society, August, 2017https://www.childrenssociety.org.uk/what-we-do/resources-and-publications/the-good-childhood-report-2017Date accessed: May 14, 2018Google Scholar However, statistics on child and adolescent mental health by ethnicity are woefully lacking in the UK, with the last comprehensive national survey done 14 years ago.3NHS DigitalMental health of children and young people in Great Britain.http://content.digital.nhs.uk/catalogue/PUB06116Date: Aug 31, 2005Date accessed: May 14, 2018Google Scholar For BME adults, research indicates a higher prevalence of diagnosed mental health problems compared with white adults but longitudinal data show that the pattern is mixed and inconsistent over time.4Rees R Stokes G Stansfield C Oliver E Kneale D Thomas J Prevalence of mental health disorders in adult minority ethnic populations in England: a systematic review. EPPI-Centre, UCL Institute of Education, London2016Google Scholar In children, the association between ethnicity and poor mental health might not be clear cut: in a study of children aged 11 years, the prevalence of behavioural difficulties was higher in white British boys than among those of mixed ethnic backgrounds, whereas girls of mixed ethnic backgrounds were at greater risk than white British girls of severe mental health problems.1Gutman LM Joshi H Parsonage M Schoon I Children of the new century: mental health findings from the Millennium Cohort Study. Centre for Mental Health, 2015http://cdn.basw.co.uk/upload/basw_120221-1.pdfDate accessed: May 14, 2018Google Scholar BME children experiencing racial discrimination are likely to experience low self-esteem, and high levels of anxiety and depression.5Bécares L Babies born to mothers who suffer racism have health disadvantages which starts from inside the womb.https://www.runnymedetrust.org/blog/the-link-between-racism-and-childrens-poor-healthDate: Aug 17, 2015Date accessed: May 16, 2018Google Scholar At the same time, our cities, towns, and communities are becoming increasingly multicultural, with 50% of London's population predicted to be of black or minority ethnic origin by 2038. But levels of racial environmental inequalities continue to increase. Ethnic minority groups not only live disproportionately in substandard, overcrowded housing but also have reduced access to outdoor recreational opportunities, including poorer access to urban parks and poorer quality parks.6CABEUrban green nation: building the evidence base. Commission for Architecture and the Built Environment, London2010Google Scholar This issue is also a health inequity since access to urban green space is linked to a range of physical, mental, and social health benefits.7WHOUrban green spaces and health—a review of evidence. WHO Regional Office for Europe, Copenhagen2016Google Scholar But the health benefits derived from urban green space among multicultural communities in the UK are relatively unknown. The association between urban green space and wellbeing appears to be complex. For instance, ethnic minority groups access, use, perceive, and respond to urban green space differently compared with the wider population. Their satisfaction levels with local green space tend to be lower than those of white British people.8CABECommunity green: using local spaces to tackle inequality and improve health. Commission for Architecture and the Built Environment, London2010Google Scholar The potential health benefits derived also differ, with evidence of stronger benefits to social health in certain ethnic minority groups.9Roe J Aspinall PA Ward Thompson C Understanding relationships between health, ethnicity, place and the role of urban green space in deprived urban communities.Int J Environ Res Public Health. 2016; 13: 681Crossref PubMed Scopus (65) Google Scholar To date, however, there have been no data showing how ethnicity moderates associations between urban green space and mental health outcomes in children. In The Lancet Planetary Health, Rosemary McEachan and colleagues10McEachan RRC Yang TC Roberts H et al.Availability, use of, and satisfaction with green space, and children's mental wellbeing at age 4 years in a multicultural, deprived, urban area: results from the Born in Bradford cohort study.Lancet Planet Health. 2018; 2: e244-e254Summary Full Text Full Text PDF PubMed Scopus (55) Google Scholar address this gap by highlighting how urban green space can help support the mental wellbeing of ethnic minority children (aged 4 years) living in Bradford, UK. The authors identified differential effects from access to urban green space on the wellbeing of south Asian children compared with white British children. They measured the association between an objectively measured quantity of urban green space (by use of the normalised difference vegetation index) and mental wellbeing of children (by use of the Strengths and Difficulties Questionnaire) in a highly deprived population, also adjusting for use of urban green space (time spent outdoors) and the perceived quality of a frequently used local park (satisfaction levels) as reported by parents. The study showed that the amount of green space is associated with increased wellbeing in south Asian children, but not in white British children, although this association was not sustained after controlling for parental perceived satisfaction with green space (ie, the association between quantity of green space and child wellbeing is confounded by parental quality perceptions of the green space their child uses most frequently). This is an important finding showing that quality may be as—if not more—important than quantity in mediating green space and health associations, and might be particularly significant in multicultural contexts. This finding raises important questions for future research: for example, does the quantity of green space have a more beneficial health effect when it is of higher quality? Or can quality override quantity, suggesting a case for so-called pocket urban parks that are more evenly—and equitably—distributed across neighbourhoods? And how can we develop better metrics of quality? The authors acknowledge the limitations of a single satisfaction variable in their study (as defined subjectively by parents in the context of one park—the one most frequently visited). Other quality metrics might include wider neighbourhood evaluations of urban green space (by use of robust audit tools within the community)8CABECommunity green: using local spaces to tackle inequality and improve health. Commission for Architecture and the Built Environment, London2010Google Scholar and quality perceptions of park aesthetics, the natural richness of the environment, and visitors' perceived safety. The authors found that the amount of time children spent outside did not affect health outcomes, suggesting that even a small amount of time spent outdoors regularly might be beneficial for children's wellbeing. Nor did the sex of the child moderate the associations between mental health and urban green space—another surprising finding, given that older ethnic minority girls report restrictions on their access to and use of urban parks.8CABECommunity green: using local spaces to tackle inequality and improve health. Commission for Architecture and the Built Environment, London2010Google Scholar Understanding how use of green space and access patterns change by sex and age is important for future research. Overall, this study contributes to our understanding of how access to outdoor play opportunities in local parks could help improve the wellbeing of south Asian children. Why this association was not found in white British children is unclear and warrants further study. The effects of psychological health disorders during childhood are far more important over a lifetime than physical health problems.11Goodman A Joyce R Smith JP The long shadow cast by childhood physical and mental problems on adult life.Proc Natl Acad Sci USA. 2011; 108: 6032-6037Crossref PubMed Scopus (253) Google Scholar The UK Government's recently announced plans to transform access to mental health services for young people have been criticised as inadequate and a missed opportunity by leading children's charities.12Campbell D Government plans to tackle mental health crisis 'will fail a generation'.The Guardian (London). May 9, 2018; https://www.theguardian.com/society/2018/may/09/mps-take-to-task-plans-to-tackle-mental-health-crisis-among-youngDate accessed: May 14, 2018Google Scholar We urgently need greater innovation in how we tackle children's mental health issues, including provision of better quality housing and schools, and improved access to recreational and play opportunities in local neighbourhoods. These efforts require investment in park design and place keeping, and engagement of local communities in the decision making and design process to promote use, satisfaction, and ownership of neighbourhood parks. These are not new arguments,8CABECommunity green: using local spaces to tackle inequality and improve health. Commission for Architecture and the Built Environment, London2010Google Scholar but with these new findings we need to propel the discussion forward. I declare no competing interests. Availability, use of, and satisfaction with green space, and children's mental wellbeing at age 4 years in a multicultural, deprived, urban area: results from the Born in Bradford cohort studyPositive effects of green space on wellbeing differ by ethnicity. Satisfaction with the quality of green space appears to be a more important predictor of wellbeing than does quantity of green space. Public health professionals and urban planners need to focus on both quality and quantity of urban green spaces to promote health, particularly among ethnic minority groups. Full-Text PDF Open Access