Tackling health inequalities through green/blue infrastructure

Abstract Green/blue infrastructure - natural features including parks, street trees and waterways - can impact population health positively through multiple use-dependent (e.g. physical activity) and use-independent (e.g. mitigating excess urban heat) pathways. Recent policies such as Green Infrastructure Standards for England, or ‘3-30-300’ tree cover and green space access principles in part aim to capitalise on these benefits. The aim of this five year project is to evaluate how green/blue infrastructure interventions might tackle health inequalities at population scale. It examines the socio-spatial distribution of green/blue infrastructure and how related interventions on planning, managing and investing in this infrastructure can impact health inequalities. It considers a ‘proportionate universalism’ approach, and the possibility that environmental interventions could unintentionally worsen health inequalities. Causal loop diagrams linking nature and health inequalities will be presented, developed through group model building with a range of stakeholders. Findings from two studies will then be presented. Firstly, we consider the equity of the socio-spatial distribution of the urban tree canopy in the UK. Analyses of tree canopy data indicates an inequitable distribution across socio-demographic domains. For example, in England's most socio-economically deprived decile mean urban tree canopy cover was 14.2% (95% CI 13.9-14.5%) while in the least deprived decile was 23.6% (23.2-24.0%). Secondly, we consider population health in coastal communities, using Census data for 2001-2021. Using 2001 data we found that ‘blue space’ health benefits of access to coastal environments might mitigate to some extent the multiple public health challenges in England's coastal communities. However, preliminary analyses of the 2021 Census suggest that these potentially ‘equigenic’ effects may now be insufficient to offset socio-economic drivers of poor health in these communities. Key messages • Green/blue infrastructure interventions can deliver multiple health and environmental co-benefits, but may increase or decrease health inequalities. • Evidence and policy are evolving to deliver nature-based solutions to health inequalities.