Gröna miljöers potential för att befrämja hälsa och undvika läkemedelsbehandling Matilda (Annerstedt) van den Bosch Leg. läkare, Doktor i Landskapsplanering med inriktning Folkhälsa
Disposition Dagens sjukdomsscenario Promotion och prevention Gröna miljöers hälsoeffekter Ett praktiskt folkhälsoexempel Frågor och diskussion
Health Statistics and Informatics Ten leading causes of burden of disease, world, 2004 and 2030
Dödsorsaker Non Communicable Diseases (NCDs): Kardiovaskulära sjukdomar Diabetes Fetma KOL Cancer Mentala ohälsotillstånd 2/3 av alla dödsfall
Slide courtesy: Ingrid Eckerman, LfM Prevention Läkemedel som komplement Icke-farmakologiska behandlingar Förhindra miljöförstöring Promotion Levnadsvanorna. arv och miljö Förbättra/bibehålla miljön
80 % av NCDs kan förebyggas med rätt åtgärder.
Photo: William Bird Riskfaktorer Stress Fysisk inaktivitet Sociala ojämlikheter i ohälsa
Friskfaktor
Natur vs tegelvägg
Gröna miljöer minskar stress Annerstedt et al. 2012. Green qualities in the neighbourhood and mental health - results from a longitudinal cohort study in Southern Sweden. BMC Public Health Ward Thompson et al. 2012. More green space is linked to less stress in deprived communities: Evidence from salivary cortisol patterns. Landscape and Urban Planning. Roe et al. 2013. Green Space and Stress: Evidence from Cortisol Measures in Deprived Urban Communities. International Journal of Environmental Research and Public Health Alcock et al. 2014. Longitudinal effects on mental health of moving to greener and less green urban areas Environmental Science and Technology
Natur aktiverar parasympatiska nervsystemet TSST 1,0 0,8 0,6 Δ HF-HRV (ms 2 ) 0,4 0,2 0,0-0,2-0,4-0,6 R +10 R +20 R +30 R +40 CONDITION Annerstedt et al. 2013. Inducing physiological stress recovery with sounds of nature in a virtual reality forest Results from a pilot study. Physiology and Behavior.
Lederbogen et al. 2011. City living and urban upbringing affect neural social stress processing in humans. Nature.
Gröna miljöer ökar fysisk aktivitet Carpenter 2013. From 'healthful exercise' to 'nature on prescription': The politics of urban green spaces and walking for health. Landscape and Urban Planning Almanza et al. 2012. A study of community design, greenness, and physical activity in children using satellite, GPS and accelerometer data. Health & Place Hillsdon et al. 2006. The relationship between access and quality of urban green space with population physical activity. J of Public Health Roemmich et al. 2006. Association of access to parks and recreational facilities with the physical activity of young children. Preventive Medicine Toftager et al. 2011. Distance to green space and physical activity: a Danish national representative survey. J of Physical Activity and Health Wheeler et al. 2010. Greenspace and children's physical activity: A GPS/GIS analysis of the PEACH project. Preventive Medicine
Ökad fysisk aktivitet OR Ellaway & Macintyre BMJ 2005;331;611-2 GREENERY
Konijnendijk, Annerstedt, Nielsen, Maruthareevan, 2013. Benefits of Urban Parks: A Systematic Review. Scientific Report for IFPRA Fysisk aktivitet, Fetma Stress HIGH Det finns vetenskapligt stöd för samband mellan tillgång till parker och: o o o o stroke, diabetes, cancer, hjärtkärl- & lungsjukdomar huvudvärk, livslängd, mortalitet, PTSD, ADHD födelsevikt socialt kapital Självrapporterad hälsa, mental hälsa, livslängd, buller, nedkylning Socialt kapital MODERATE LOW
Gröna miljöer minskar sociala ojämlikheter i hälsa 2,2 Incidence Rate Ratio 2 1,8 1,6 1,4 1,2 Highest Income Middle Income Lowest Income Linjär (Highest Income) Linjär (Middle Income) Linjär (Lowest Income) 1 No green Little green Some green More green Very green Exposure to Green Mitchell & Popham, 2008. Effect of exposure to natural environment on health inequalities: an observational population study. The Lancet
Intervention
Naturassisterad terapi Ekoterapi, hortikulturell terapi m.m. Währborg et al. 2014. Nature-assisted rehabilitation for reactions to severe stress and/or depression in a rehabilitation garden: Long-term followup including comparisons with a matched population-based reference cohort. J of Rehabilitation Medicine Annerstedt & Währborg 2011. Natureassisted therapy: Systematic review of controlled and observational studies. Scandinavian Journal of Public Health
Annerstedt & Währborg 2011. Nature-assisted therapy: Systematic review of controlled and observational studies. Scandinavian Journal of Public Health
States of ill health in the included studies Category Generally psychiatric Diseases Depression, chronic schizophrenia, shcizoaffective, bipolar disorder, mood and anxiety disorders, behavioural disturbance, personality disorders Substance abuse Alcoholism, other substance abuse or addiction Stress related Adolescence problems Post Traumatic Stress Disorder, mental fatigue, attentional fatigue Juvenile delinquency, antisocial behaviours, disruptive behaviour diagnosis, mood disorders, substance abuse Ageing Somatic disorders and developmental disabilities Dementia Physically handicapped, multiple disabilities (e.g. orthopaedic), hearing impairment, breast cancer, paediatric cancer, cardiac surgery, myocardial infarction, congestive heart failure, cerebral palsy, obesity, developmental disabilities Others Attachment- and adjustment disorders, opposition defiance, conduct disorders, cognitive impairment, emotionally handicapped
Principal findings Evidence grade 1: 4/6 studies significant effect Evidence grade 2-3: 26/29 studies health improvements Meta-analyses: modest effect size Some evidence for effect in schizophrenia, dementia, substance abuse, attention deficit, behaviour disorders, obesity, cardiac rehabilitation
Andra positiva effekter av natur Förbättrad mental hälsa (Alcock et al. 2014) Förbättrad kognitiv förmåga (Berman et al. 2008) Minskade symptom av ADHD (Taylor & Kuo. 2011) Motiverar miljövänligt beteende (Hartig et al. 2011; Wyles et al. 2013) Ökat välbefinnande, förbättrad självupplevd hälsa (MacKerron & Mourato, 2013) Ökat socialt kapital (Fan et al. 2011) Minskad mortalitet (Peters et al. 2010) Förbättrar immunsystemet (Rook, 2013; Li et al. 2006, 2008, 2010) Minskade negativa effekter av miljö- och klimatförändringar (Escobedo et al. 2011; Susca et al. 2011)
Folkhälsoindikatorer: The Parma Commitments, WHO 2010 We aim to provide each child by 2020 with access to healthy and safe environments and settings of daily life in which they can walk and cycle to kindergartens and schools, and to green spaces in which to play and undertake physical activity. new indicators for monitoring the implementation of the Parma commitments
Urban Green Space Indicator, UGSI Ett mått på folkhälsa Ju mer grönt desto bättre folkhälsovärde för staden Ska implementeras i hela Europa GIS-data och populationsdata GIS = Geografiska Informationssystem Annerstedt, Egorov, Mudu, 2014. A GIS-based Urban Green Space Indicator The Public Health Rationale and Results from a Case Study. ICUH 2014, The 11th International Conference on Urban Health
Population inom buffer zonerna
Storleken har betydelse UGSI (300, 5ha) UGSI (300, 5ha) =31.3% UGSI (300, 2.5ha) =50.5% UGSI (300, 1ha) =68.5%
Take home message Vi lider idag av sjukdomar som svarar dåligt på läkemedelsbehandling. Gröna miljöer minskar vår tids sjukdomsbörda och behovet av läkemedel minskar.
Tack för att ni lyssnade! Frågor? Kommentarer? Matilda.van.den.bosch@slu.se Forskare vid SLU Styrelseledamot i Läkare för Miljön Vice ordförande i Svensk Beteendemedicinsk Förening