Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities

Abstract

Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.

Keywords: atopic disease; birth outcomes; cardiovascular disease; diabetes; green infrastructure; mortality; normalized difference vegetation index (NDVI); obesity.

Figure 1

Search, screening, and selection process following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol.

Figure 2

Descriptive statistics for the 90 included papers. CVD = cardiovascular health/disease. Gen health = general health.

Figure 3

Bar charts showing the distributions of EM by SES and race/ethnicity. Scores of −1 indicate stronger protective effects for privileged populations (high-SES people or white people). Scores of 0 indicate no differences in protective effects between more and less disadvantaged populations. Scores of 1 indicate stronger protective effects for disadvantaged populations (low-SES people or racially/ethnically minoritized people). Comparisons between the two bar charts show that green space appears to exhibit stronger protective effects for low-SES people than for high-SES people, whereas green space does not show clear differences in protective effects by race/ethnicity.