Gender differences in relationships between urban green space and health in the United Kingdom⋆
Introduction
Natural or green environments positively influence people’s self-perceived health (de Vries et al., 2003, Maas et al., 2006, Mitchell and Popham, 2007, Sugiyama et al., 2008), blood pressure (Hartig, Evans, Jamner, Davis, & Gärling, 2003), levels of overweight and obesity (Ellaway, Macintyre, & Bonnefoy, 2005), longevity (Takano, Nakamura, & Watanabe, 2002) and risks of all-cause and circulatory disease mortality (Mitchell & Popham, 2008). Possible causative mechanisms behind the green space and health relationship include the psychologically and physiologically restorative effects of nature (Hartig et al., 2003, Pretty et al., 2005), the facilitation of social contacts (Maas, van Dillen, Verheij, & Groenewegen, 2009) and the provision of opportunities for physical activity (Humpel et al., 2002, Kaczynski and Henderson, 2007), though not all studies find associations between green space and physical activity (Hillsdon et al., 2006, Maas et al., 2008). Visual access to green space may, in itself, provide a salutogenic effect (Ulrich, 1984).
There has been little exploration of whether the associations between green space and health vary between different types of people. One study from the Netherlands suggested that the health of young people, the elderly, housewives and those with low socioeconomic status benefited more from residential green space than other groups (de Vries et al., 2003, Maas et al., 2006). This was attributed to the greater amount of time these groups spent in their residential area and thus their greater exposure to green spaces.
There is a larger body of work exploring the influences of other aspects of residential environment on health and this has found that effects may vary by residents’ gender, age or socioeconomic status (Stafford, Cummins, Macintyre, Ellaway, & Marmot, 2005). In particular, gender differences in neighbourhood effects on health have been found in a number of studies. Stafford et al. (2005) found that various social and physical characteristics of the neighbourhood were more strongly associated with women’s health than with men’s. They suggest that the residential environment may be more important for women’s health, perhaps because women have greater exposure to their neighbourhood environment, or are more vulnerable to its effects. Other studies suggest that neighbourhood social environment in particular is more important for women’s health than men’s (Kavanagh et al., 2006, Molinari et al., 1998, Poortinga et al., 2007), whilst its physical environment may be more important for men’s health (Molinari et al., 1998). As men and women benefit from their residential area in different ways, further investigation of gender differences in neighbourhood effects is warranted (Poortinga et al., 2007).
Gender differences in exposure to or use of green space have been suggested by several studies, although this work leads to contradictory hypotheses about how these differences might manifest themselves in health associations. Women are under-represented in their use of green space, proportionate to their numbers in society (Cohen et al., 2007, Hutchison, 1994, Ward Thompson et al., 2003) and are less likely to engage in vigorous physical activity than men whilst in green space (Cohen et al., 2007). Thus we might hypothesise that green space will be more important for men’s health than women’s. Alternatively, women spend more time in their neighbourhood than men because they are more likely to be supervising children, working part time, conducting domestic work or being primary caregivers (Kavanagh et al., 2006). We could therefore hypothesise that the neighbourhood environment (including green space availability) will be more important for women’s health. This study was prompted by these competing hypotheses and by the lack of existing evidence for gender differences in the relationship between urban green space and health.
The setting for this study was the United Kingdom. Evidence of a positive association between green space and health has been found in England (Mitchell and Popham, 2007, Mitchell and Popham, 2008) and Scotland (Ellaway et al., 2005), but lack of a UK-wide green space measure has precluded investigation of green space and health relationships for the entire UK. The study aims were: to develop a UK-wide small area measure of green space coverage; to use it to examine the associations between health and green space coverage; and to determine if there are gender differences in these associations.
Section snippets
Geographical unit of analysis
Our areal units were Census Area Statistics (CAS) wards (2001), the smallest geographical unit for which our health, environment and population measures were available throughout the UK. There are 10654 CAS wards in the UK, but we selected the 6432 wards classified as urban according by the urban-rural classifications of the UK’s constituent countries (DEFRA, 2005, NISRA, 2005b, Scottish Executive, 2006; i.e., settlements with populations >10,000). We restricted our analysis to urban settings
Results
The 6432 urban wards in the study had an average green space coverage of 46.2% (95% confidence interval (CI) 45.7–46.8). Table 1 shows the numbers and distribution of men and women in the urban green space exposure groups. As expected, there were no significant differences between men and women in terms of their green space exposure. Although only urban wards were included in the study, about 2.9 million men and women resided in wards with more than 75% green space.
Clear gender differences were
Discussion
We developed UK-wide, small area estimates of green space coverage and used them in the first UK-wide study of the relationship between urban green space and health, and to investigate gender differences in this relationship. We found a clear protective association of ward-level urban green space coverage with cardiovascular disease and respiratory disease mortality for men, but not for women. Effect size for men was modest with regard to cardiovascular disease (5% reduction in risk for those
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We are grateful to four anonymous reviewers for their constructive feedback on the draft manuscript. We thank the European Environment Agency for access to the CORINE dataset and the Office of the Deputy Prime Minister for access to the GLUD dataset. We also thank SASI at Sheffield for managing the individual level death records. This study was funded by the Forestry Commission.