blue space and human health: maximising the co-benefits of

BlueHealth is funded by the European Union’s Horizon 2020 research

& innovation programme, grant agreement No 666773

Blue Space and Human Health:

Maximising the co-benefits of adaptation to climate change

Dr Tim Taylor

University of Exeter Medical School

www.bluehealth2020.eu | @BlueHealthEU

Why Europe?

The perfect test bed

• Over 91,000 km of coastline

• 194 coastal cities

• >50% population live within 50 km of the sea & within 2.5km of fresh water


Nine institutions, 90+ researchers

An international multi-partner project


Funded by the European Union

EU Horizon 2020 programme

• €6 million research grant

• Launched January 2016

• Runs until June 2020


What is blue space?

Natural or manmade

Outdoor environment

Featuring water

Accessible to humans

In, on, near, sense

UrbanRural

Coastal

Inl&


Conceptual model

Understanding the benefits of urban blue spaces

Population health &

wellbeing

How do we maximise the

positive impacts of urban

blue spaces?Activities in blue spaces

Physical, social, virtual

Contact with blue space

Indirect & direct interactions Climate & extreme

events

How will natural

processes change over

time?

Quantity & quality

of blue space

How do we ensure the

accessibility of these

spaces?

Urban planning &

infrastructure

How do we design our

cities?


A historical perspective

Beneficial effects on health

Dr Richard Russell (1687– 1759)

Royal Sea Bathing Hospital (Est.1791)

Dr Fortescue Fox

(1934 & 1938 Lancet)

Charlier & Chaineux

(2009) Thalassotherapy


Before BlueHealth

Where were the gaps?

• Previous work links natural environments &

improved health

• Tended to focus on green spaces

• Less known about blue space & health


Knowledge on blue space and health

Existing literature

Slide: Mat White


Blue space and health

Recent research

• Living near the coast

associated with better

mental health, particularly

among those with lowest

incomes

• Based on data from

Health Survey for England


Blue space and health

Recent research

• Systematic review showed

consistent evidence of

positive associations between

blue space exposure and

mental health and physical

activity.

• Need for more longitudinal

studies and natural

experiments to understand

causality.


Coastal adaptation and health

Why is it important?

• The coast is an important provider of benefits to health

• Climate change poses significant risks to the coastal

environment – e.g. sea level rise, flooding

• When planning adaptation it is important to take into

account the potential to increase the co-benefits for health…


Examples of adaptations in coastal environments

Maximising co-benefits

• Seawalls => ensuring space for recreation (walking, cycling,

angling)

Image: oneblackline | Wikimedia Commons

Image: Jon Bennett| Wikimedia Commons




• Use of water for cooling of buildings e.g. canals, fountains…

© atelier GROENBLAUW




• Better urban drainage - reducing pressure on seas from

sewage

Co-benefits and costs of adaptation

Source: Martinez-Juarez, Chiabai, Quiroga-Gomez and Taylor (2015) Ecosystems and human health: Towards a conceptual framework for assessing the co-benefits of adaptation. Basque Centre for Climate Change Working Paper.

Adaptation, Environment and Health Linkages

Adaptation measure Possible impacts on

natural environment

Potential health

implication

Sustainable urban drainage systems

Potential for green corridors for recreation

Possible increase in recreational walking and cycling, improved physical and psychological health

Green roofs Potential improvement in views, potential increase in biodiversity

Possible improved psychological health

Flood defences Potential to provide paths for walking

Possible increase in recreational walking and cycling, improved

physical and psychological health

Emergency warning systems Limited potential to reduce impacts

Direct impacts in terms of reduced mortality and morbidity

Improved wetlands for flood defence

Increased coverage of wetlands and biodiversity benefits

Possible increase in recreation

Urban forests Increased coverage of forests in urban area, cooling and

biodiversity benefits

Reduced heat stress and potential for increase in recreational walking

and cycling, improved physical and psychological health

Source: Martinez-Juarez, Chiabai, Quiroga-Gomez and Taylor (2015) Ecosystems and human health: Towards a conceptual framework for assessing the co-benefits of adaptation. Basque Centre for Climate Change Working Paper.


Social & structural interventions

Lessons for coastal adaptation

• Teats Hill, Plymouth, UK

• Deprived area of coastal community

• Community and stakeholders involved:

• Community participation for the design

• Collaboration with council & planners

• New grass/seating/outdoor theatre

• Evaluating impacts• BlueHealth Behavioural Assessment Tool (BBAT)

• BlueHealth Behavioural Assessment Tool (BEAT)

• BlueHealth Community Level Survey (BCLS)

• BlueHealth Slam (DST)


Social & structural interventions

3 new tools

1. Behavioural Assessment Tool (BBAT)

2. Environmental Assessment Tool (BEAT)

3. Community Level Survey (BCLS)

• Help planners, architects, communities

• Evaluate & monitor blue space use

• Assessments pre/post

• Inform blue infrastructure

• Robust, transparent, repeatable


BlueHealth Behavioural Assessment Tool

Assessing what people do at a site

• Systematic observation of site

• Who is doing what, where?

• Maps passive/active behaviours

• Compares groups & activities

• Suggests an observation protocol

• Statistical analysis

• Built in QGIS

• Will be a plugin for public

• Visual geographic heat maps

Before interventionAfter intervention


BlueHealth Community Level Survey

Surveying sites at the local level

• Measures social context & wellbeing:

• Flexible surveys: online, paper, in-person

• Adaptable: user can add questions

• Builds evidence base for plans:

• People: who?

• Visits: where/what/how?

• Did it affect health?


Decision Support Tool

Planning, designing & managing blue spaces

• Aimed at planners, authorities, engineers,

policy makers, businesses, & the public.

• Highlights risks & benefits to

• public health & wellbeing

• the environment


Valuing trips and water quality: an application

Data used

• 14 European countries

• Four waves (Jun-17, Sep-17, Dec-

17, Mar-18)

• Large number of attitudinal,

psychological and well-being

variables were assessed

• More detailed information on last

blue space site visited:

• Visit frequency (last 3 months)

• Perceived water quality


Blue Space VisitsLessons from the BlueHealth

Survey

• 18 possible blue space site types

• Removal of 2 site types (fountains, ice rinks) N = 5,744

0 200 400 600 800 1000 1200

Salt marsh, estuary or lagoon

Sea cliffs

Fen, marsh or bog

Outdoor skating or ice hockey rink

Waterfall or rapids

Rocky or stony shore

Pier

Open sea

Outdoor public pool/lido/spa

Ornamental water feature/fountain

Harbour or marina

Sandy beach or dunes

Streams or ponds

Rural river/canal

Urban river/canal

Nat/art lake/reservoir

Seaside promenade


Travel Cost Method

An introduction

• Assess number of visits to recreational site.

• Typically performed for one site. This study uses data from a general

pan-European household survey and asks about the last visit to a blue

space site.

• Calculation of individual travel cost to that site using information on:

• Round-trip distance between home and site

• Mode of transport

• Vehicle and/or public transport costs

• Opportunity cost of time (often a share of individual income)

• Collect additional information on site type, perceived water quality,

activities, etc.


Perceived water quality

Overview

• Respondents stated the perceived

level of water quality of the site

they visited last

• European bathing water quality

scale:

• Excellent

• Good

• Sufficient (we used: “Acceptable”)

• Poor


Contingent behaviour method

Overview

• Works in combination with travel cost method

Visits in last 4 weeks

Visits in next 4 weeks?

Visits in next 4 weeks?

Perceived water quality at site

Imagine water quality improvement

Imagine water quality deterioration

Travel cost method

Contingent behaviour method

• This results in three observations per respondent (N = 17,232)


BlueHealth Survey

Respondents by country

0 100 200 300 400 500 600

Bulgaria

Czech Republic

Estonia

Finland

France

Germany

Greece

Ireland

Italy

Netherlands

Portugal

Spain

Sweden

United Kingdom

Respondents


Perceived water qualityLessons from the BlueHealth

survey

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Urban river/canal

Streams or ponds

Salt marsh, estuary o

Rural river/canal

Harbour or marina

Seaside promenade

Pier

Total

Fen, marsh or bog

Nat/art lake/reservoi

Open sea



Outdoor public pool/l

Sea cliffs

Waterfall or rapids

Poor Sufficient Good Excellent

• Perceived water

quality across blue

space site types (N =

5,744)


Perceived water quality

Cross country comparison

0% 20% 40% 60% 80% 100%

Czech Republic

Finland

Bulgaria

Netherlands

Estonia

Italy

France

Germany

Greece

United Kingdom

Sweden

Portugal

Spain

Ireland

Poor Sufficient Good Excellent


Estimating travel cost

Method

• Extract road distances and average travel times between home / point of departure

and visited blue space site from Open Street Map.

• Compute travel cost consisting of:

• Vehicle running costs for a return journey

• Car: 3.6-41 cents per pax per km (from national vehicle associations and/or national tax authorities)

• Bicycle: 6 cents per km (from Bertram and Larondelle 2017)

• Bus: 2.5-12 cents (from EC 2016a)

• Train: 1-15 cents (from EC 2016b)

• Walk / run: €0 vehicle cost.

• Opportunity cost of time: 1/3 of hourly salary, based on annual earning data from

Eurostat, specific to country, marital status and number of children


Travel cost results

Initial findings

• Zero-truncated negative binomial

regression models to identify

determinants of visit frequency.

• Average values of a visit to a blue

space site vary between €16 to a

fen, marsh or bog and €176 to a

seaside promenade.

• Visits at coastal and marine site

types tend to be valued more

compared to inland site types. 0 50 100 150 200

Fen, marsh or bog

Salt marsh, estuary or lagoon

Streams or ponds


Sea cliffs

Rural river/canal

Harbour or marina

Urban river/canal

Open sea

Outdoor public pool/lido/spa

Nat/art lake/reservoir

Waterfall or rapids

Pier


Seaside promenade

Average value per trip (EUR)

Preliminary Results – not for publication

Preliminary results: not for publication


Reaction to (hypothetical) water quality changes

Initial results

• Water quality at the site was changed up and down

experimentally.

• The majority of respondents would not change their visit

frequency as a result.

Improvement Deterioration

N % N %

No change 4,200 73% 4,002 70%

Fewer visits 126 2% 1,285 22%

More visits 1,418 25% 457 8%

Total 5,744 100% 5,744 100%


Valuation of water quality levels

Initial findings

• Average values of

recreational visits to sites

according to water quality

level (N = 17,232)

• These are averages over all

types of blue spaces across

all 14 countries

• Note: these may change with

further statistical analysis

154

208224 224

255

0

50

100

150

200

250

300

Poor Sufficient Good Excellent Outstanding

Val

ue

of

a re

crea

tio

nal

vis

it (

EUR

) (Perceived) water quality level

Preliminary Results – Not for Publication


Implications for adaptation

Maximising the co-benefits

• We know that the coastal environment is important for health

and wellbeing.

• The economic values of health and recreation are large and if

coastal adaptation do not factor these in there can be

maladaptation.

• Considering bathing water quality may also be important for

certain adaptation options – and other negative health

consequences (e.g. vector borne disease)



Summary

• A range of adaptation options have implications for health

• Need for cross-sectoral working

• The opportunities are there – and we have tools to assess the

benefits


Acknowledgements

• Thanks to collaborators, especially Tobias Borger, Mat White,

Lewis Elliott and to the Bluehealth team.


More information online

www.bluehealth2020.eu

BlueHealth is funded by the European Union’s Horizon 2020 research

& innovation programme, grant agreement No 666773

Find out more at www.bluehealth2020.eu

Icons courtesy of www.flaticon.com

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blue space and human health: maximising the co-benefits of

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