Professional Documents
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Medical Hypotheses
journal homepage: www.elsevier.com/locate/mehy
a r t i c l e
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Article history:
Received 15 December 2010
Accepted 22 February 2011
a b s t r a c t
Background: Globally, the human and economic burdens of mental illness are increasing. As the prevalence and costs associated with mental illness rise, we are progressively more aware that environmental
issues such as climate change and biodiversity loss impact on human health.
Hypothesis: This paper hypothesises that increased biodiversity in urban environments is associated with
improved mental health and wellbeing. It proposes the ecological mechanism through which the association may exist, and explores the extant literature to determine the extent of empirical evidence to support our hypothesis.
Evidence: While there is a substantial literature investigating the impact of green space and contact with
nature on mental health, we identied only one original research paper that directly investigated the link
between biodiversity and mental health. This suggests that the extant evidence considers only one part
of the story, providing an evidence base which is inadequate to inform policy on biodiversity conservation and public health.
Implications: Our hypothesised relationship between environmental change and mental health proposes
conservation and restoration of biodiversity in urban environments as a form of intervention for improving human health. It also highlights the need for a better evidence base to demonstrate the synergistic
benets of increased biodiversity and mental health to decision makers. Well-designed quantitative epidemiological research is needed to establish the strength of any such causal relationship.
2011 Elsevier Ltd. All rights reserved.
Introduction
Globally, the human and economic burdens of mental illness are
increasing. Mental illness has been estimated to affect over
450 million people internationally [1]. In 2001, unipolar depressive
disorders were responsible for 5.6% of global disability adjusted life
years (DALYs) in high-income countries alone [2]. In Australia in
2010, mental disorders accounted for 13% of total DALYs, and anxiety and depression is, and will remain, one of the countrys top
ve leading causes of disease burden over the next decade [3].
As the prevalence and costs associated with mental illness increase, we are becoming progressively more aware that environmental issues such as climate change and biodiversity loss
impact on human health. Recent studies have demonstrated the
negative effect of environment degradation [47] and environmental disasters [8] on mental health outcomes. However, nature can
also impact positively on mental health and wellbeing, and we
know that contact with natural environments such as forests and
vegetation can improve outcomes across a broad range of human
Corresponding author. Address: School of Population Health, Public Health
Building, Herston Road, Herston Qld 4006, Australia. Tel.: +61 7 3346 4628; fax: +61
7 3365 5442.
E-mail address: j.dean@sph.uq.edu.au (J. Dean).
0306-9877/$ - see front matter 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.mehy.2011.02.040
health indicators [9]. In urban environments, physical, and even visual, contact with green spaces any piece of land covered with
vegetation, including green corridors, woods, parks, elds, or easily
accessible countryside [10,11] is associated with better mental
health outcomes [12,13]. However, while this literature has contributed to an important evidence base for public health interventions in urban settings, many of the green spaces investigated in
these studies (for examples parks and small gardens) do not necessarily improve urban ecosystem health or promote biodiversity
per se.
Hypothesis
This paper hypothesises that increased biodiversity in cities is
associated with improved mental health and wellbeing. It proposes
the ecological mechanism through which the association may exist, and explores the extant literature to determine the extent of
empirical evidence to support our hypothesis.
Biodiversity, or biological diversity is the variability among
living organisms from all sources including, interalia, terrestrial,
marine and other aquatic ecosystems and the ecological complexes
of which they form part; this includes diversity within species,
between species and of ecosystems [14]. Table 1 presents a model
of the ecological linkage mechanism connecting urban
878
Table 1
A model of the ecological linkage mechanism connecting urban environmental
change with mental health.
ing the links between contact with nature and mental well-being is
particularly oriented to the culturally enriching services of
ecosystems, with emphasis on psychosocial benets such as recovery from stress and self-regulation of emotions [23], restoration of
attention fatigue [10,24,25], enhanced sense of community [26]
and settings for physical activity [27,28]. In proposing our
hypothesis we also point to the evidence regarding the relevance
of other ecosystem service types on mental health. The impacts
from diminished regulating services is clearly seen in the link between post traumatic stress and natural disasters such as major
ooding or bushres, and the psychological consequences of environmental stressors such as drought and heat exposure [5,7]. Physical health problems linked to loss of biodiversity and associated
environmental degradation [29] are also associated with mental
health problems through causal and reciprocal relationships
[7,30]. The mental health impacts of impaired provisioning services is seen via a less direct causal pathway through psychological stress experienced due to loss of livelihood, and associated
impacts from life changes in areas such as employment and place
of residence. In short, the capacity of ecosystems to provide sufcient resources and a supportive habitable environment for humans has an important protective function for human mental
health.
study of the psychological benets gained by people using greenspaces in the city of Shefeld demonstrated a positive association
between species richness and psychological well-being. In relation
to our hypothesised ecological mechanism, this study addressed
columns (A) and (C), allowing the authors to specically argue that
their results indicate that successful management of urban green
spaces should emphasise biological complexity to enhance human
well-being in addition to biodiversity conservation ([33, p. 390]).
879
880
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