This study investigated the psychological health and wellbeing impact of the physical environments for leisure activities and a lower risk of mental health issues. Studies that have examined the relationship between anxiety and green. wellbeing, tend to be environmentally responsible in their behaviour and can, The term 'mental health' is commonly only used in relation to mental illness or general wellbeing, and can reduce the risk of mental health problems (Keyes. Ecological public health—the need to build health and well-being, henceforth on challenges, such as obesity, diminished mental health, and well-being and the environment and its relationship to mental and physical health (Lloyd, ;.
These conditions nurtured disease, dramatically shortening life. Yet, although the physical environment, especially in towns and cities, has changed dramatically in the years since the Industrial Revolution, so too has our understanding of the relationship between the environment and human health and the importance we attach to it. The decades immediately following World War II were distinguished by declining influence for public health as a discipline. Yet, as the 20th century wore on, a range of factors emerged to r-establish a belief in the environment as a key issue in the health of Western society.
Yet, just as society has begun to shape a much more sophisticated response to reunite health with place and, with this, shape new policies to address complex contemporary challenges, such as obesity, diminished mental health, and well-being and inequities, a new challenge has emerged.
In its simplest terms, human activity now seriously threatens the planetary processes and systems on which humankind depends for health and well-being and, ultimately, survival. Success will involve nothing less than a fundamental rethink of the interplay between society, the economy, and the environment. Importantly, it will demand an environmental conceptualization of the public health as no less radical than the environmental conceptualization that launched modern public health in the 19th century, only now the challenge presents on a vastly extended temporal and spatial scale.
Curiosity about the environment as a factor in human health and well-being, and indeed health-motivated interventions to manage the physical context for life, substantially predate the modern public health era.
The archaeological record provides evidence of sewer lines, primitive toilets, and water-supply arrangements in settlements in Asia, the Middle East, South America, and Southern Europe, dating back many thousands of years Rosen, Some religious traditions also imply recognition of the importance of environmental factors in health.
For example, restrictions on the consumption of certain foods probably derive from a belief that these foods carried risks to health; a passage in the book of Leviticus conveys the existence of a belief in the relationship between the internal state of a house and the health of its occupants Leviticus [ For the first time, ideas about medicine, diseases, and their causes were being written down.
Among these were ideas about the environment and its relationship to mental and physical health Lloyd, ; Rosen, ; Kessel, While scarcely a template for how societies would come to think about environment and health in the modern era, one Hippocratic text in particular, On Airs, Waters and Places, introduces several ideas that do retain currency. For example, the simple message that good health is unlikely to be achieved and maintained in poor environmental conditions is enduring. Also, through specific reference to the health relevance of changes in water, soil, vegetation, sunlight, winds, climate, and seasonality, On Airs, Waters and Places conceives an environment made up of distinct compartments and spatial scales from local to global, recognizing that perturbations in these compartments, and on these scales, may result in disease.
Such thinking remains conceptually and operationally relevant today. In parts, the Hippocratic Corpus also presages the ecological perspectives now coloring 21st-century public health thinking. These include an understanding of the potential for human activity to impact negatively on the natural world and the importance of viewing the body within its environment as a composite whole.
Environment and Health in the Modern Public Health Era Epidemiology is the basic science of public health and is concerned with the distribution of health and disease in populations across time and spaces, together with the determinants of that distribution.
Environmental epidemiology is a subspecialty dealing with the effects of environmental exposures on health and disease, again, in populations. This differentiation offers a useful framework within which to consider changing perspectives on the role of environment in health since the early s. Also influential was a post-Reformation philosophy that extolled the work ethic and self-sufficiency. The events were to resonate throughout the world, bringing great prosperity to some, but others, especially the urban poor, endured poor housing, severe overcrowding, and an absence of wholesome water or sanitation.
The growing industrial cities became crucibles of squalor, disease, and severely reduced life expectancy as their citizens suffered the ravages of typhus, tuberculosis, and successive cholera epidemics. Unhealthy working conditions and grossly polluted air also damaged health and compounded the misery of urban life at this time.
Such was the impact of this mix of slum clearance with the introduction of waterborne sewerage and piped water supplies that readers of the British Medical Journal, voting almost two centuries later, still chose it, from a shortlist of 15, as the most important medical milestone since the Journal was first published in The 11, readers who voted even placed it above the discovery of antibiotics and the development of anaesthesia Ferriman, During this time, however, the emergence of epidemiology as the primary mode of inquiry of public health was also pivotal to success.
Other legacies of the Era of Sanitary Statistics have been less enduring. Also, despite a recent reconnection with such arguments, the inherent logic of seeing and tackling disease in its social and environmental context, so obvious to the pioneers of public health, has periodically been less visible in the rhetoric and actions of their successors.
It is appropriate at this point to emphasize the international character of the 19th-century public health movement.
This movement can all too easily be presented as a British phenomenon, with seminal contributions from John Snow — on the investigation of cholera Vinten-Johansen et al. In reality, public health, then as now, advanced through the contribution of many individuals in many nations. For example, the German pioneer of cellular biology, Rudolf Virchow —and his fellow countryman, the hygienist Johan Peter Frank —were hugely important Rather, It might be supposed that the consolidated outputs of European laboratories, especially in the decades between andwould have quickly expunged the miasmic paradigm from 19th-century medicine and public health.
Yet, the concept of miasma was so inculcated in Western thought that, for many, it retained significant explanatory power. Thus, for much of the 19th century there was not a single settled view on disease contagion e. In so doing, Koch established, what had been hypothesized by his teacher, Jacob Henle —some 40 years earlier that disease was microbial. Initially at least, the germ theory did little to diminish interest in the environment as a determinant of health. Indeed, by revealing causal linkages between organisms isolated from their environmental carriers and specific diseases, it conferred scientific coherence on the established sanitary model and vindicated efforts to secure hygienic water, food, and housing.
As Lesley Nash has observed, the germ theorists were initially content to meld the insights of bacteriology with longstanding environmental beliefs. Yet, by the early years of the 20th century, the capacity to examine disease at the microscopic level, which was the engine of diagnostics and therapeutics, was beginning to act on the very foundations that support public health. Medical science gradually made its focus the pathogenic agents of disease, moving attention away from the environment and eroding socioecological perspectives.
The Environment in an Era of Chronic Disease Epidemiology The dramatic reduction in infectious disease was certainly one reason why the epidemiological climate in Western society changed substantially in the midth century.
But just as important was the emergence of a quite disparate set of pathologies believed to be of noncommunicable etiology. These fashions would influence how medical science and the wider society would come to regard diseases and their causes for a generation.
Perhaps surprisingly, those who traditionally were most vulnerable to disease the young, the old, the immunocompromised, etc. Many, it seemed, were aspects of individual lifestyle and behaviors, ostensibly freely chosen.
Another unfortunate characteristic of this approach to epidemiology is that, despite its laudable intent to understand and address disease in populations, its focus is on individuals within those populations. As a result, it fails to elucidate the societal forces whose influence and interplay shape the health and health-relevant choices of those individuals. When viewed through a policy lens, this mitigates in favor of simplistic solutions that target individuals divorced from context and that lack the traction to produce meaningful change.
In summary, the desire to create a mathematical measure of relative risk for a specific factor is understandable. However, risk factor epidemiology uses an approach that is much more flexible than material reality. In the real world, many different factors coexist and interact to create and destroy health. Any specific pollutant under epidemiological investigation inevitably coexists with other pollutants and in a specific exposure context e.
These coexisting factors may be critical in determining the health outcomes from exposure to the pollutant under investigation. Because the outputs of black box epidemiology are abstractions, the relative risk calculation represents an abstraction that can be limited in its capacity to inform policy. The decades following World War II were a time of declining influence for public health and population perspectives, largely for reasons we have outlined.
Yet, in its rhetoric and activities, the discipline of public health seemed at times almost complicit. On the face of it, academic public health and the wider public health discipline had little to say about environment, no longer presenting it as an active component in the then current health challenges for Western society.
Environment in Health and Well-Being - Oxford Research Encyclopedia of Environmental Science
However, the environmental health function was often set in the narrow, hazard-focused, and compartmentalized terms framed for it by laboratory science. The task was largely confined to identifying, monitoring, and controlling a limited set of toxic or infectious threats in their environmental carriers.
Only when pathogenic organisms or toxic agents demonstrably escaped their industrial, agricultural, or marine confines to damage health and reinforce the porosity of the human body did environment briefly assume a higher profile. Against this backdrop, it was not necessarily predictable or inevitable that environment would regain a central place in public health. Yet, by the end of the 20th century, a much richer understanding of the environmental contribution to human health and well-being had indeed emerged.
This change cannot be attributed to a single factor in isolation. However, we submit that it is only now, in the 21st century, when the reality of unprecedented anthropogenic damage to global processes and systems and its health implications is self-evident, that the health sector has fully made common cause with the environmentalist movement e. However, for reasons that are distinct from a mounting concern over anthropogenic threats to global environmental systems and processes, we argue that the closing decades of the 20th century and the early years of this century did see a rekindling of public health and societal interest in the local or proximal environment.
This interest has continued into the 21st century. Developing interest in well-being as a concept, the belief that it is important and that it might be enhanced through the organized efforts of society, continues to engage the attention of academics and policymakers.
Although well-being demonstrably impacts health and vice versa, well-being is about much more than health. Rather, it is a measure of what matters to people in every sphere of their lives.
Despite its importance, well-being has proved a challenging target for policy. Some of its components are beyond the reach of policy. Also, on a practical level, integrating the various well-being frameworks and indices that continue to emerge is an ongoing challenge. However, it is sufficient at this point simply to recognize that elevated concern for well-being and its connection to environment can only broaden and deepen concern for the environment in public health.
Participants were recruited based on their regular exercise habits rather than their relationship to the natural world. Participation was not linked to compensation. This study was carried out in accordance with the recommendations of the Manchester Metropolitan University ethics procedure, approved by the Manchester Metropolitan University ethics committee with written informed consent from all participants. All participants gave written informed consent in accordance with the declaration of Helsinki.
All participants acknowledged that they were over 18 and provided their consent before completing the online survey. Materials An online survey was developed using a recognized free web-based survey development tool. The survey included a section on demographics, questions about physical activity choices, the environment in which this activity takes place as well as validated measures of psychological health and well-being.
The physical activity questions asked participants to state their main physical activity and the environment questions asked 1 an open question that asked participants where they undertook their chosen physical activity, and 2 whether the environment was central to their physical activity of choice. Three environment options were provided and participants were asked to choose one of the three options: The NRS is a item scale that measures individuals' affective, cognitive, and physical relationship with the natural world.
The NRS consists of three subscales: Each subscale uses a 5-point Likert scale ranging from 1 disagree strongly to 5 agree strongly. The total score is calculated by averaging all 21 items after reverse scoring appropriate itemswhereby higher scores indicate a stronger connection with nature. Nisbet and Zelenski found NR to be correlated with behavior, environmental scales, and frequency of time in nature, thus supporting the reliability and validity of the NRS.
Alpha was lower than 0. The trait half of the STICSA comprises of a item scale with each item rated on a 4-point Likert scale, ranging from 1 not at all to 4 very much so. The scale assesses an individuals' general mood state and predicts the situations in which different individuals will display heightened state anxiety Ree et al.
Within the trait anxiety scale, anxiety is then further categorized as two subscales comprising of 11 somatic items and 10 cognitive items.
Trait somatic anxiety refers to physical symptoms that are generally experienced, such as feeling dizzy, tense, and suffering from a fast heartbeat. Trait cognitive anxiety refers to general feelings of worry, concern and intrusion of unpleasant thoughts. The Psychological Well-Being Scale developed by Ryff is a item scale with each item rated on a 6-point Likert scale, ranging from 1 strongly disagree to 6 strongly agree. The questionnaire is designed to assess how people perceive aspects of their own functioning, e.
The scale consists of six separate dimensions: Each dimension represents a distinct facet of psychological wellbeing. Environmental mastery was lower than 0. Statistical Analysis Specific analytic strategies were employed to address the study hypotheses. Firstly, descriptive statistics were computed to examine means, standard deviation, and assumptions among the study variables. Next, the aim was to assess whether individuals who regularly undertake nature-based physical activity have higher levels of well-being, lower anxiety, and higher nature relatedness than those who regularly undertake physical activity in indoor environments hypothesis one.
Three separate MANOVAs were employed; the first focused on anxiety outcomes COGanx and SOManxthe second assessed wellbeing outcomes autonomy, environmental mastery, personal growth, positive relations, purpose in life, self-acceptanceand the third assessed nature relatedness NRself, NRpers, and NRexp in relation to types of physical activity environment indoor, outdoor incidental, and outdoor central.
Prior to analysis, five participants were removed from the dataset due to extreme scores i. Initial analysis using the Kolmogorov-Smirnov test revealed that the data were not normally distributed. To compensate for this feature of the data, bootstrapping was employed which involved resampling and replacing the original dataset 1, times prior to rerunning the MANOVAs.
Bootstrapping is often used in research situations with non-normal data and has been shown to be effective for generating accurate confidence intervals for means see Wang, The bias-corrected method was used to adjust parameter estimates, standard errors, and effect sizes.
In the second stage, physical activity environment was included using dummy codingand in the third stage facets of well-being were included autonomy, environmental mastery, personal growth, positive relations, purpose in life, self-acceptance. Incorporating physical activity environment and well-being facets in latter stages of the analysis enabled an assessment of whether these variables meaningfully contributed to the established NR-anxiety relationship by Martyn and Brymer Well-being facets were examined in relation to NR and anxiety at the correlation stage.
To account for non-normality when computing the correlations and hierarchical regressions, bootstrapping was employed with 1, resamples. Results Table 1 presents descriptive statistics of the subscales for NR, STICSA, and well-being, as well as summary statistics of physical activities the participants engaged in.
Higher NR was evident for outdoors central physical activity compared with indoors and outdoors incidental physical activity. Higher anxiety levels were evident generally for indoors physical activity, whereas lower anxiety scores were evident for outdoors incidental. Wellbeing scores did not appear to be markedly different across the three physical activity environments, and were similar to normative data Widdowson et al.
The majority of participants across the activity environments reported engaging in their main activity for more than min per week. Responses for the duration of the main activity ranged from a minimum of 5 months weight training; indoor group to 35 years horse riding; outdoor central. Interestingly, shorter durations were typically reported for indoor main activities compared with outdoor main activities.
No significant difference was observed for outdoor central physical activity compared with indoor physical activity.
In addition, no significant between-subjects effects were observed for activity and well-being facets. Bootstrapping estimates are not reported given the absence of a main effect. No significant difference was observed for outdoor incidental physical activity compared with indoor physical activity for NRexp. The results for each correlation are shown in Table 2. In addition, all well-being facets significantly negatively correlated with anxiety outcomes.
Assumptions of collinearity, homoscedasticity, independence of errors, and absence of outliers were assessed prior to the hierarchical regression analyses, with no notable issues. The first hierarchical regression with bootstrapping examined NR Stage 1indoor physical activity Stage 2and well-being facets Stage 3 as predictors of SOManx.
Stage 1 reported an R2 of 0. The second hierarchical regression with bootstrapping examined NR Stage 1outdoor central physical activity Stage 2and wellbeing facets Stage 3 as predictors of SOManx. The third hierarchical regression with bootstrapping examined NR Stage 1outdoor incidental physical activity Stage 2and well-being facets Stage 3 as predictors of SOManx. The hierarchical regression analyses examining NR, types of physical activity, and well-being in relation to COGanx did not document any significant effects at Stage 1 or Stage 2 for NR and types of physical activity.
Overall, the MANOVA outcomes indicate firstly that participants who engaged in outdoor physical activity particularly incidental had significantly lower SOManx than participants engaging in indoor physical activity. Additionally, participants engaging in outdoor central physical activity had significantly higher NRexp than participants engaging in indoor physical activity.
The hierarchical regressions indicate that autonomy, NRexp, and outdoor physical activity particularly incidental predicted lower SOManx, whereas indoor physical activity predicted higher SOManx.
These results extend previous work in the area, by revealing the added contribution of types of physical activity and well-being facets to the previously established NR-anxiety relationship. Discussion This study had two main aims; the first was to investigate the impact of the physical activity environment on well-being and trait anxiety for regular exercisers. The second aim was to investigate the relationship between nature relatedness, trait anxiety, and psychological well-being in regular exercisers.
The findings partially support the first hypothesis, indicating that individuals who regularly engaged in outdoor-based physical activity had lower levels of somatic anxiety in comparison with individuals who took part in indoor-based physical activity.
However, the difference between the exercise environment where nature was central to the experience and the indoor environment was apparent but not significant. In relation to hypothesis two, the findings indicate that although the activity environment was not influential relative to wellbeing facets, and only autonomy was meaningful in relation to NR; NRexp, autonomy, and outdoor physical activity predicted lower somatic anxiety, whereas indoor physical activity predicted higher somatic anxiety.
Taken together this study provides further evidence that feeling experientially connected to nature is related to some aspects of psychological well-being and low somatic anxiety.
This study also suggests that for individuals who meet UK physical activity guidelines for regular physical activity the presence of the natural world might not be a central determinant for self-reported levels of trait anxiety or psychological well-being.
How an individual feels toward the natural world and exercising outdoors even if nature is not central to the experience seems to be more important. In relation to hypothesis one, the results show that for regular exercisers there were no differences in overall trait anxiety levels, and cognitive anxiety levels or psychological well-being levels, across all physical activity environments.
There was, however, differences in somatic anxiety levels. Although previous research has reported that physical activity in the natural world conveys significantly greater psychological benefits than indoor physical activity e. Psychological wellbeing levels for all participants in this study were in line with population norms. Regular physical activity has been associated with positive psychological well-being Penedo and Dahn, A meta-analysis conducted by Penedo and Dahn concluded that all types of exercise are beneficial for a range of physical and psychological well-being outcomes.
Regular physical activity has been associated with greater levels of life satisfaction, increased quality of life outcomes and increased happiness as compared to non-exercisers Stubbe et al. Previous research examining the wellbeing benefits of nature-based exercise has most often focused on short-term green exercise interventions with participants who may not have been regular exercisers.
This study indicates that for those who regularly exercise the immediate exercise environment does not seem to be a key determinant for well-being benefits. Results from this study are similar to those found by Kerr et al.
The Environment in Health and Well-Being
However, the rich sensory experience afforded by the natural environment might still act as a welcome distraction or motivator for those who struggle to maintain regular exercise or for those wishing to start regular exercise.
Regular physical activity has also long been associated with lower levels of overall trait anxiety irrespective of confounding factors such as age and gender Petruzzello et al. On average trait anxiety levels for total trait anxiety, cognitive anxiety, and somatic anxiety were comparable to normative anxiety scores for this cohort and considerably lower than clinical populations.
Average scores for somatic anxiety were significantly lower for the outdoor incidental group. This is most likely because the cohort in this study were regular exercisers.
Regardless of the type of anxiety measure utilized trait or state, self-report, or behavioralor irrespective of the exercise regime undertaken intensity, time, typeresearch has consistently reported a link between lower anxiety scores and regular participation in physical activity Landers and Petruzzello, ; Anderson and Shivakumar, The anxiolytic effects of regular exercise for trait anxiety are stronger and longer lasting than many traditional therapeutic processes Anderson and Shivakumar, This is particularly the case for trait somatic anxiety as regular exercise is said to mimic many of the physiological responses to anxiety e.
However, the significantly lower scores recorded for the outdoor incidental group and the lower but not statistically significant scores for the outdoor central group might be related to being comfortable exercising in all weathers and conditions.
It is possible that exercising outdoors is associated with being more comfortable with uncomfortable somatic and sensory experiences. As with well-being, the natural environment might still facilitate motivation and act as a distractor that encourages continued participation and therefore the anxiolytic benefits of regular exercise. Hypothesis two was partially supported in that there were negative correlations between NRtotal, NRexp, and NRself and trait anxiety, and positive correlations between NRexp and the autonomy subscale for psychological wellbeing.
The subscale measuring external worldviews on nature NRpers was not correlated with well-being or anxiety. NRexp and autonomy were significantly related with lower anxiety levels. Another point of particular interest was that even though anxiety levels for this cohort were similar to normative, non-clinical values there were still significant negative correlations between overall trait anxiety and overall nature relatedness, and between trait cognitive anxiety, trait somatic anxiety, and NRtotal, NRexp, and NRself.
Furthermore, NRexp, autonomy, and the outdoor physical activity environment specifically incidental predicted lower somatic anxiety but not cognitive anxiety.