Greenspace and human health: An umbrella review

Bo-Yi Yang¹, Tianyu Zhao², Li-Xin Hu¹, Matthew H E M Browning³, Joachim Heinrich⁴, Shyamali C Dharmage⁵, Bin Jalaludin⁶, Luke D Knibbs⁷, Xiao-Xuan Liu¹, Ya-Na Luo¹, Peter James⁸, Shanshan Li⁹, Wen-Zhong Huang¹, Gongbo Chen¹, Xiao-Wen Zeng¹, Li-Wen Hu¹, Yunjiang Yu¹⁰, Guang-Hui Dong¹

Affiliations

¹ Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
² Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Comprehensive Pneumology Center (CPC) Munich, member, German Center for Lung Research (DZL), Munich 80036, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany.
³ Department of Park, Recreation, and Tourism Management, Clemson University, Clemson, SC 29634, USA.
⁴ Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Comprehensive Pneumology Center (CPC) Munich, member, German Center for Lung Research (DZL), Munich 80036, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia.
⁵ Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia.
⁶ Centre for Air Quality and Health Research and Evaluation, Glebe NSW 2037, Australia; Population Health, South Western Sydney Local Health District, Liverpool NSW 2170, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia; School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW 2052, Australia.
⁷ School of Public Health, The University of Sydney, NSW 2006, Australia.
⁸ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
⁹ Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
¹⁰ State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou 510080, China.

PMID: 34622241
PMCID: PMC8479545
DOI: 10.1016/j.xinn.2021.100164

Review

Greenspace and human health: An umbrella review

Bo-Yi Yang et al. Innovation (Camb). 2021.

. 2021 Sep 24;2(4):100164.

doi: 10.1016/j.xinn.2021.100164. eCollection 2021 Nov 28.

Authors

Affiliations

¹ Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
² Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Comprehensive Pneumology Center (CPC) Munich, member, German Center for Lung Research (DZL), Munich 80036, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany.
³ Department of Park, Recreation, and Tourism Management, Clemson University, Clemson, SC 29634, USA.
⁴ Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Comprehensive Pneumology Center (CPC) Munich, member, German Center for Lung Research (DZL), Munich 80036, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia.
⁵ Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia.
⁶ Centre for Air Quality and Health Research and Evaluation, Glebe NSW 2037, Australia; Population Health, South Western Sydney Local Health District, Liverpool NSW 2170, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia; School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW 2052, Australia.
⁷ School of Public Health, The University of Sydney, NSW 2006, Australia.
⁸ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA.
⁹ Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
¹⁰ State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou 510080, China.

PMID: 34622241
PMCID: PMC8479545
DOI: 10.1016/j.xinn.2021.100164

Abstract

Multiple systematic reviews on greenspace and health outcomes exist, but the overall evidence base remains unclear. Therefore, we performed an umbrella review to collect and appraise all relevant systematic reviews of epidemiological studies on greenness exposure and health. We searched PubMed, Embase, and Web of Science from inception to June 28, 2021, and screened references of relevant articles. Systematic reviews with or without meta-analyses of epidemiological studies that examined the associations of greenness with any health outcome were included. Two independent investigators performed study selection and data extraction. We also evaluated the methodological quality of the included systematic reviews using the "Assessing the Methodological Quality of Systematic Reviews 2" checklist. A total of 40 systematic reviews and meta-analyses were included, of which most were cross-sectional studies conducted in high-income countries. Greenspace exposure was estimated with various objective and subjective parameters. Beneficial associations of greenspace with all-cause and stroke-specific mortality, CVD morbidity, cardiometabolic factors, mental health, low birth weight, physical activity, sleep quality, and urban crime were observed. No consistent associations between greenspace and other health outcomes (e.g., cancers) were observed. Most of the included systematic reviews and meta-analyses had one or more limitations in methodology. Our findings provide supportive evidence regarding the beneficial effects of greenspace exposure on some aspects of human health. However, the credibility of such evidence was compromised by methodological limitations. Better performed systematic reviews and meta-analyses as well as longitudinal designed primary studies are needed to validate this conclusion.

Keywords: greenspace; human health; systematic review; umbrella review; vegetation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Figure 1**
Hierarchy of study designs and estimated number of studies on greenness exposure and health at each level Increasingly higher levels (shown here as smaller circles) represent less chance for bias and error, adapted from Biondi-Zoccai. Estimated numbers are derived from past reviews^, and the results of the current review.

**Figure 2**
Flow chart of study selection process

See this image and copyright information in PMC

References

1. United Nations World Urbanization Prospects: The 2014 Revision. (ST/ESA/SER.A/366.) 2015. https://population.un.org/wup/Publications/Files/WUP2014-Report.pdf
1. Nieuwenhuijsen M.J., Khreis H., Triguero-Mas M., et al. Fifty shades of green: pathway to healthy urban living. Epidemiology. 2017;28:63–71. - PubMed
1. Cox D.T.C., Shanahan D.F., Hudson H.L., et al. The impact of urbanisation on nature dose and the implications for human health. Landsc. Urban Plan. 2018;179:72–80.
1. Twohig-Bennett C., Jones A. The health benefits of the great outdoors: a systematic review and meta-analysis of greenspace exposure and health outcomes. Environ. Res. 2018;166:628–637. - PMC - PubMed
1. Markevych I., Schoierer J., Hartig T., et al. Exploring pathways linking greenspace to health: theoretical and methodological guidance. Environ. Res. 2017;158:301–317. - PubMed

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Greenspace and human health: An umbrella review

Affiliations

Greenspace and human health: An umbrella review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

Grants and funding

LinkOut - more resources

Full Text Sources