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Dr. Thomas Astell-Burt is the Professor of Population Health and Environmental Data Science at the University of Wollongong in Australia, and does research at the interface between population, wellbeing and environmental studies.
Dr. Xiaoqi Feng is an Associate Professor at the University of New South Wales, epidemiologist and NHMRC Career Development Fellow, conducting research on how environmental factors contribute to the health of children and women.
They are proud to be Founding Co-directors of the Population Wellbeing and Environment Research Lab (PowerLab) at UOW and UNSW.
PaRx sat down with them to learn more about their personal journeys to careers in nature and health, and their ground-breaking research on how green spaces reduce the risk of loneliness and non-communicable diseases.
TAB: I’ve always been interested in our relationships with the natural world. Some of my earliest memories as a kid were devouring TV programs on nature by David Attenborough and on cultures in (what I felt at the time to be) far off places by the likes of Alan Whicker and Michael Palin. During the summer months I’d spend a lot of time camping and hiking in nature with the Scouts and later on, doing the Duke of Edinburgh’s Award. Geography was always my favourite subject at school and I went on to study it for my undergrad and Masters. When I realized there were opportunities to continue learning and to combine skills and ideas in geography with epidemiology as a career path, being paid to build capacities and generate evidence that could lead to better health for people and our planet, it was a no brainer. And so here I am.
XF: I grew up in Beijing, one of the world’s biggest cities. Not only big, but densely populated, so access to green space and blue space was very precious in my home city! I was lucky because near my home, there was a small park and also a large park with water called Long Tan Lake Park. During the summer months these outdoor spaces became places to keep cool, relax and have fun. My family and I would often go boating on the lake. In the winter, these green spaces transformed and the lakes became places where children would learn to skate, as it got so cold many of the lakes would freeze over. My primary school was very close to the Temple of Heaven. This is a very special and large green space containing lots of trees, with many well over 500 years old.
These experiences and the natural environments that promote them in cities are so treasured for child health and development. So, doing research that equips decision-makers with a public health licence to protect and restore these natural assets so we and future generations can also benefit from them is a very important thing. I’d stress that it’s not just about the trees nearby where we live though. It’s also about protecting and restoring trees in far off places. Why? I was taught that the sandstorms that affect air quality in Beijing are in part because of deforestation and desertification that have occurred outside of the city. In other words, we cannot only care for what’s on our door steps.
We need to support actions that shape healthier communities in big cities, smaller cities, regional and remote areas, because we are all connected.
XF: We were already working together on various studies beforehand, but the stars really began to align when we were both at the University of Wollongong in Australia. We invested in people, knowing that the fruits of our labours may take years to emerge, but also feeling that supporting new cadres of health and environment researchers was a rewarding thing to do in and of itself. This area of research is only becoming more important because we need “all hands on deck” as we attempt to address the negligent and reckless profit-driven actions that have left our environments dilapidated and our planetary health in crisis. The research platform we built became known as the Population Wellbeing and Environment Research Lab (PowerLab) and we continue to direct it today with epidemiologists, statisticians and data scientists from multiple universities.
We are very proud that this lab we created is still going strong, and has supported over 10 students through honours and PhD programs. Many of them have launched careers in the Australian Government health and planning departments, and in academic and health sector positions overseas, like at Queens University Belfast and Save the Children Country Office in Bhutan. This, and seeing the impact our research on many city planning and health policies in Australia, have been strong motivators for us. We learn so much from them and it is always better to celebrate successes together!
TAB: Thanks so much for your kind words on our study! We like it too, because it provides a really clear and actionable population-level policy lever for reducing loneliness where there are few alternatives. We posited that parks and woodlands in cities could be part of the answer, and found that to be the case with a cohort of nearly 7000 Australian adults.
There were two key findings. First, increasing local publicly accessible green space from less than 10% to at least 30% of land-use is associated with a reduction in the odds of becoming lonely by about a quarter over 4 years.
That’s after taking into account differences including age, income, education and disability status. The second key finding was that the same change in green space nearly halved the odds of becoming lonely over the same time period in adults living alone.
These results are hugely encouraging and need to be replicated in other settings, because we think the reasons why green space may reduce loneliness might vary depending on where people are. For example, in some areas green spaces may be the hub that brings local communities together. Since green spaces help us reduce levels of stress and anxiety, meeting new people may be a lot easier than in other settings.
But we think that connecting with other people is only part of the story. We also think that time in nature in particular locations can help people to connect with cherished memories and the “more than human world” more generally, which can inspire almost transcendental senses of awe and hope, while also reducing feelings of loneliness and despair. This is such an exciting area of research because reducing levels of loneliness could help to explain why we repeatedly see reduced risks of heart disease, diabetes, hypertension, mental ill-health and even dementia in communities with more green space nearby, especially tree canopy.
XF: We’ve got a few projects currently up and running, and a few more in the pipeline. One that I’m leading and Thomas is a co-investigator on is Better Parks, Healthier For All?, involving several universities in Australia and the University of Glasgow (UK). We’re looking to identify which qualities of parks support mental and cardiometabolic health in middle-to-older age. This is important because how we currently measure the quality of parks might not necessarily align with these types of health benefits. Our project will generate evidence on what we need in green spaces and where those investments might be made to address inequities in mental and cardiometabolic health. That’s the supply side of the equation.
We also want to support demand too, and that’s where nature prescriptions come in. Our recent national survey of adults in Australia indicates that about 34% spend fewer than 2 hours a week in nature, but 82% would likely visit green spaces more often if their physician recommended it would be good for their health. This suggests that there’s a substantial proportion of the population that could benefit from nature prescriptions, and a large appetite for it!
The question now, really, is how to make this work equitable, while accounting for differences in local economic, cultural and climatic contexts. That’s why the growth of PaRx is so inspiring—and it is a pleasure to be working with you, Thomas and colleagues at the University of Toronto on our new project (Details coming!—Melissa).
TAB: So many! I recently visited Pearl Beach in the Central Coast of NSW for the first time. I was mesmerized by how immersed this community was within the woods. It was so beautiful and cool on a hot day. If only we could plant and successfully protect large trees in communities across our cities, urban heat islands would be a thing of the past.
There are some places that do this quite well. I like walking around Zetland, a high-density suburb in inner Sydney. Its streets are ultra-walkable and feature quadruple lines of tall trees along wide sidewalks and down the middle of roads. It also has many parks and cafés. People are always walking, meeting and playing outdoors, early morning ‘til late evening. It’s not perfect—we need to reduce the number of cars on the road. But it’s a good example of how to build higher density communities with nature, rather than obliterating it.
XF: My favourite place is the Royal Botanic Gardens in Sydney. I love to run and also to take my little sausage doggie for walks in Centennial Park there. It’s one of Sydney’s largest parks and it is very close to the city centre. It has lots of trees, lakes and so many birds! There’s a big 4 km loop that is super popular for walkers, runners and cyclists. During the pandemic and lockdowns, it went car-free on weekends to cope with increased demand. I didn’t think it was possible to make this park better, but they found a way, and I hope they continue to do it in the future!
TAB: A lot of health professionals I speak with are already advocates for nature, and some even recommend spending time it to their patients. It’s too ad hoc though. What we need is a qualified network of nature professionals in Australia to whom local physicians can confidently refer their patients. Urban forestry, community gardening, wildlife conservation, bird watching, allotments, nature walks—there are so many different options! If this network were available and highly accessible to local physicians, perhaps via a link worker or “nature navigator,” the health sector could really champion time in nature as an adjunct to other forms of care. It may also be that this not only improves the health of individual recipients of nature prescriptions, but also the health of the providers, if they too are also spending time in nature. Finally, given evidence linking contact with nature with pro-environmental behaviour, this may be a way in which the health sector improves its impact on our planet.
XF: I agree with Thomas and add two things. First, we already do this for other forms of healthcare in Australia, such as referrals to qualified professionals for podiatry, dietary advice and support for physical activity. These consultations, both one-to-one and in group sessions, are subsidized across Australia by the Medicare Benefits Schedule. Perhaps we might see referrals to nature professionals also subsidised in the future. My second point is on how we can make this happen. We need to have high quality evidence on what forms of nature prescription are acceptable, cost-effective and can be sustained. Especially in disadvantaged communities, where access to and time in nature is often low, but the potential for health benefit is high.
We need a nature prescribing strategy for health equity.
TAB: Mute your phone and switch off social media alerts! A really fabulous randomized trial by Bill Sullivan and team at University of Illinois Urbana-Champaign found participants who went for a break in nature with a laptop or other hardware had appreciably fewer psychological benefits than their peers who visited nature without the tech. That being said, I do enjoy listening to podcasts when I take long walks through parks.
XF: Go often, at least for a little bit of time, in a green space you know and feel safe in. Also, take time to discover new green spaces too and soak up their stories, history and local communities. And finally, start early. As young children we are more susceptible to environmental influences, for better or for worse. We often forget about the “for better” part as we try to minimize potential harms. Breathing fresher air, unstructured play and learning through interacting with nature can support new generations to be healthier, more pro-social and more pro-environmental.