Abstract
IntroductionIncreased urbanisation is a potential threat to public health; approximately 55% of the world's population is now living in urban areas (1). Blue space, defined as all forms of natural and manmade surface water, could be an asset in achieving sustainable urban environments that promote human health. If blue spaces are to be used for health, it is essential to quantify their effect and understand the factors that contribute to their usage.
The aim of this thesis was to integrate different types of evidence into co-created system-wide recommendations for leveraging blue spaces for health. To achieve this aim, the following objectives are addressed: 1) Synthesise evidence on the quantitative relationship between urban blue space and investigate whether blue space exposure significantly affects health outcomes; 2) Develop a study to investigate people's perceptions of an urban blue space to qualitatively analyse whether the quantitative impact is perceived as a therapeutic effect; 3) Identify and analyse the key factors influencing the use of urban blue spaces to understand how to increase usage; 4) Develop a systems-based meta-methodology to enable co-creation; 5) Use the systems-based meta-methodology to co-create recommendations for leveraging blue spaces for health and health equity.
Methods
A multi-method approach was adopted. Firstly, a systematic review and meta-analysis was conducted to synthesise the quantitative evidence for the impact of blue spaces on health (Study 1, Chapter 3). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.
The next phase involved conducting intercept interviews with 203 people using the canal towpaths in order to gain qualitative insight into the therapeutic properties of blue spaces and also understand the factors that influence their usage. Data collection took place at access points to the Glasgow Canal, a part of the Forth and
Clyde Canal in Glasgow, the largest city in Scotland. Participants were randomly sampled, with a similar number of participants interviewed across each site. Data from this study were analysed in two stages. The first stage used self-reported data relating to how the urban blue space affected the physical and mental health of users. Data were analysed using an existing conceptual framework which incorporates how the concepts of experienced, symbolic, social, and activity space combine to position urban blue spaces as therapeutic landscapes (Study 2, Chapter 4). In the second stage, a system map of factors influencing usage was developed by qualitatively analysing data from people actively using the towpath. Network analysis metrics were used to analyse the system map's structure (Study 3, Chapter 4).
The final phase of the research was to combine the different sources of evidence into co-created recommendations for system-wide use of urban blue spaces. To achieve this, a meta-methodology called DISCOVER was devised to guide the process in a robust and transparent way (Study 4, Chapter 5). DISCOVER was used to co-create recommendations for leveraging blue spaces for health and health equity (Study 5, Chapter 6).
Results
Results
Study 1, Chapter 3: From 4493 screened citations, 25 eligible studies were identified. Fourteen of these were included in a quantitative synthesis. Beneficial associations were found between urban blue space and obesity (P = -0. 34, 95% Cl [- 0. 19, -0. 09], p < 0. 001), all-cause mortality (HR = 0. 99, 95% CI [0. 97, 1. 00], p = 0. 038), general health (Cohen's d = -0. 09, 95% Cl [-0. 10, -0. 08], p < 0. 001) and self-reported mental health and wellbeing (Cohen's d = -0. 25, 95% Cl [-0.44, -0. 07], p < 0.001). Effect sizes were small but statistically significant, and the overall quality of evidence was good. Evidence for all other health outcomes was incommensurable, and so a narrative description of study results for those outcomes was provided. The systematic review and meta-analysis is published in Cities Journal (2).
Study 2, Chapter 4: A total of 203 intercept interviews were conducted between 12 October 2019 and 10 November 2019. Although safety concerns had health-limiting impacts, interacting with urban blue spaces was predominantly perceived as health-enhancing. They were understood as experienced, symbolic, social, and activity spaces, and these combined to position urban blue spaces as therapeutic landscapes. Findings from this analysis are published in the International Journal of Environmental Research and Public Health (IJERPH) (3).
Study 3, Chapter 4: Network analysis identified Exercise & Health, and Urban Nature as key leverage points and Cleanliness & Maintenance as the key area for improvement. Findings from this analysis are published in Health and Place Journal (4).
Study 4, Chapter 5: DISCOVER was devised by the author as part of this thesis to guide researchers and stakeholders to collectively respond to complex social, health and wider problems. DISCOVER is a strategic research planning and governance framework that provides an actionable, systematic way to implement systems approaches and address complex problems collaboratively. The eight-step framework integrates complementary approaches and methods from social network analysis and systems thinking literature. The eight steps are followed sequentially but can overlap.
Study 5, Chapter 6: The recommendations consist of four strategic objectives, achievable through 12 policy actions. The objectives are themed around the four key mechanisms through which blue space positively impacts health: physical activity, socialisation, mental health and wellbeing, and environmental protection.
Conclusions
Conclusions
Although evidence is growing within the field of urban blue space and health, the quantitative body of evidence remains small and heterogeneous. The qualitative studies build on current evidence, which has suggested that urban blue spaces may foster therapeutic properties, contributing to healthier city environments. It is, therefore, necessary to explore and synthesise multiple sources of evidence to inform the management, governance and revitalisation of urban blue spaces to maximise their potential to be equitable, sustainable and salutogenic. Adopting a systems approach enables the integration of different sources of information and allows for evidence-informed action.
| Date of Award | 2023 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Sponsors | Scottish Canals & Glasgow Caledonian University |
| Supervisor | Sebastien Chastin (Supervisor) |