Professor Selena Gray is Co-Director of our Active People: Promoting Healthy Life Expectancy (APPHLE) HIT and a Professor of Public Health at the University of West of England (UWE). She is the co-author of this blog which was first published as a bmj opinion piece on 3 July 2020.
At this time of national crisis, the importance of access to green spaces and nature for physical and mental health has been starkly highlighted.
The period of lockdown has been associated with physical and mental health risks to those confined to their homes and these disproportionately affect the mental and physical health of those from more disadvantaged communities and those who live alone, or without access to gardens, balconies, or green space. [1,2] Access to high quality green space is not equally driven, with disadvantaged communities having significantly less access, not only to their own gardens or other outside space, but also to green space within 300 metres of their home.  In 2017, 2% of the overall housing stock consisted of high-rise purpose-built flats.  These limited opportunities to access outside space particularly affect children living in disadvantaged areas who are subject to “green poverty.” 
We (the public and health communities) are generally familiar with the requirement for 150 mins physical activity per week. This positively influenced government recommendations during the lockdown and as restrictions were eased, in the advice that people were encouraged to spend time outdoors, and allowed to “Exercise outdoors as often as you wish following social distancing guidance.”  However, there is less awareness of the considerable evidence that exposure to nature of 120 mins per week is also a key factor in maintaining positive mental health.  It is not just physical exercise that we need, but activity in a green (or blue- seaside, rivers and lakes) environment, and engagement with the environment and with nature, to preserve health. Recent academic work on nature connectedness as an important aspect and mediator of wellbeing recognises that our relationship to nature is a deep and two way connection.  The recommendation of 120 mins contact with nature per week should be added to that of the physical activity to support people’s wellbeing and is particularly pertinent at this time.
It is reassuring that the government has recognised the value of urban green spaces and ordered councils keep parks open.  The pressure on these spaces in some communities demonstrates both their lack, and their importance. Ensuring safe access to green spaces with appropriate social distancing may require additional supervision and monitoring of parks, perhaps engaging and drawing on local “friends” groups and volunteers. Could there be a new form of social community asset volunteering drawing on skills of conservation and wildlife trust volunteers that will promote engagement with nature and appropriate social distancing in our green spaces?
Public Health teams in Local Authorities should work with their environment colleagues and aim to identify those most at risk from lack of access to green space, such as those living in flats or without gardens, in areas with high numbers of children with high levels of obesity and physical inactivity. This might include action to ensure that households are aware of where their local parks are, how to access them, and provision of additional supervision to make sure the spaces are safe and being used appropriately. Those with pre-existing mental health conditions, particularly if they live alone, are a particularly vulnerable group who may benefit from targeted support to access their local environment. Local authorities might explore with their local Nature Partners, as well as large anchor institutions, businesses, and private land-owners how they could open up their green spaces to the public for wider shared use in areas with a deficit of green spaces.
For many, this time of restriction has helped individuals strengthen links with their local community and develop a stronger sense of place with their immediate neighbourhood. Many have walked or cycled around their local environment and discovered their immediate neighbourhood afresh. They have had new opportunities to engage with nature and be more aware of the daily changes wrought by the emerging spring in their own locality through their garden, balcony or neighbourhood, with the associated opportunities for mindfulness and positive wellbeing, building on the Five Ways to Wellbeing approach to mental health promotion.  There are opportunities to build on this interest to engage people more actively involved in volunteering or undertaking conservation activities locally.
As we move into a recovery phase there are real opportunities for the nature sector to provide a key role in supporting individuals, both citizens, those recovering from covid-19, and health and social care staff. [1,2,11] Nature based interventions should be seen as part of the therapeutic offering for rehabilitation, post-traumatic stress, and burnout. Local community health services and primary care networks can ensure nature-based projects and providers are included in their signposting information for community connectors or social prescribers. Wellbeing programmes at city farms and nature reserves, green gym classes, walking for health, and conservation volunteering are all recognised forms of green care with a growing evidence base for mental health benefits that could be made safe with appropriate adjustments for social distancing.
In the longer term this pandemic has highlighted the inadequate, and unequal, access by different populations to high quality green space in our towns and cities, and the high proportion of individuals living in housing with no access to gardens, allotments or communal green space. We must ensure that the planning system delivers a comprehensive network of green spaces in urban environments as a matter of urgency. We need a systematic approach to developing linked Networks of Nature Recovery and green spaces within our cities that provide resilience and mitigation against climate change, build biodiversity support rewilding where appropriate and provide all of the population with the mental and physical wellbeing benefits they need. This must form a key part of a coherent response to the climate change and biodiversity emergency which remains crucial when covid-19 is no longer the primary crisis we face.
Selena Gray is Professor of Public Health at the University of the West of England, Bristol and Chair of the West of England Nature Partnership.
Alan Kellas is a Consultant Psychiatrist for people with learning disabilities and Nature Matters representative for the Royal College of Physicians
Competing interests: SG is Chair of West of England Nature Partnership, Trustee of Trees for Cities (charity), Trustee and Board Members UK Faculty of Public Health.
AK is a representative of the Green Care and Nature based approaches to Mental Health and contributor to RCPsych Climate and Ecological Emergency Response Advisory Group. I have provided consultancy advice to the Wildlife Trusts, Defra, Forest England.