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The public health benefits of green infrastructure: the potential of economic framing for enhanced decision-making
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ScienceDirect The public health benefits of green infrastructure: the potential of economic framing for enhanced decision-making Kathryn J Bowen1 and Yvonne Lynch2 Cities are growing rapidly resulting in changing land cover and reduced levels of green infrastructure globally. Climate change adaptation is now becoming a critical agenda item for cities. The potential for ecosystem-based climate adaptation using a green infrastructure approach is appealing for many cities but the business case for implementation has to be made more effectively. There is a substantial body of evidence that shows green infrastructure is significantly beneficial for human health and wellbeing and that it has many applications for climate adaptation. Despite this evidence, the linkage between green infrastructure benefits and improved health outcomes remains to be adequately quantified. There are limited studies from the international grey literature that indicate the potential and substantial economic health value of green infrastructure. Moreover, these studies use different methodological frameworks, making it difficult to systematically evaluate and compare the monetary estimates. The explicit lack of peerreviewed studies specifically evaluating the economic health value of green infrastructure projects highlights the need for such work to be undertaken. Addressing these research gaps would assist to accelerate policy development to drive the implementation of green infrastructure and ecosystem-based climate adaptation outcomes to support sustainable urban development.
Addresses 1 National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 0200, Australia 2 City of Melbourne, Council House 2, 240 Little Collins Street, Melbourne, VIC 3000, Australia Corresponding author: Bowen, Kathryn J ([email protected])
Current Opinion in Environmental Sustainability 2017, 25:xx–yy This review comes from a themed issue on Sustainability challenges Edited by Chiho Watanabe, Steffen Loft, Pengjun Zhao and Tony Capon
Received: 14 November 2016; Accepted: 14 August 2017
http://dx.doi.org/10.1016/j.cosust.2017.08.003 1877-3435/ã 2017 Published by Elsevier B.V.
www.sciencedirect.com
Introduction Although cities and urban settlements cover less than 1% of the planet’s surface [1], they are the nexus of human activity accommodating 54% of the population and 70– 90% of economic activity [2]. The percentage of the world’s population living in urban areas is projected to increase from 54% in 2015 to 60% in 2030 and to 66% by 2050 [3]. Urban land cover is predicted to increase by 1.2 million square kilometres by 2030, nearly tripling global urban land area between 2000 and 2030 [4]. Most cities share similar characteristics that render their populations and assets particularly vulnerable to predicted climate change. This includes often being situated in close proximity to major water sources (rivers, seas, lakes), and having large transient populations. Although research on climate change has been a prominent topic of focus for several decades, the likely impacts of climate change and risks for urban areas has received little attention until recently. Increasingly, it is recognized that cities are ‘vital actors’ in responding to climate change [5]. It is now acknowledged that cities have a critical role in leading urban climate adaptation, but that the ability to do this depends upon the competence and capability of local government and that there is limited evidence of adaptation being realised in practice at city scale [4]. If adaptation to climate change is likely to fall to local government with low levels of capability, then it is likely maladaptation will further compound city challenges. Maladaptation is defined by as ‘action taken ostensibly to avoid or reduce vulnerability to climate change that impacts adversely on, or increases the vulnerability of other systems, sectors or social groups’ [6]. Green infrastructure has been identified as an effective adaptation strategy for climate change [7,8] and is particularly relevant to urban areas. Green infrastructure is the ‘interconnected network of green space that conserves natural ecosystem values and functions and provides associated benefits to human populations’ [9]. It provides multiple benefits from an adaptation perspective including cooling, air quality and reduced flooding, and also provides multiple ecosystem services, which benefit human health and wellbeing [10], thereby increasing the liveability of cities. Despite significant research on the multiple benefits provided by green infrastructure, it has Current Opinion in Environmental Sustainability 2017, 25:1–6
Please cite this article in press as: Bowen KJ, Lynch Y: The public health benefits of green infrastructure: the potential of economic framing for enhanced decision-making, Curr Opin Environ Sustain (2017), http://dx.doi.org/10.1016/j.cosust.2017.08.003
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not been widely embraced as a critical infrastructure element for cities. Green infrastructure planning in many cities has been negatively affected by institutional failures to acknowledge the benefits that ecosystem services provide [11,12]. As a result, green infrastructure is often treated one-dimensionally — that it is something nice to have instead of providing critical ecological and social functions [9,13–15]. This paper seeks to position the implementation of green infrastructure as a crucial and beneficial climate adaptation strategy for cities. It advocates that the business case for investing in green infrastructure needs to be supported by a more sophisticated understanding of the economic value of the health benefits provided by green infrastructure.
Green infrastructure and health Green infrastructure as a climate adaptation strategy has the potential to reduce a variety of risks to health posed by climate change, in relation to both physical and mental health and wellbeing. This is particularly the case for risks related to extreme heat. Extreme temperatures increase the risk of mortality and morbidity [4], they also exacerbate cardiovascular and respiratory diseases and mental stress amongst other issues. In Australia, heatwaves claim more human lives than any other natural hazard [16]. In addition to increasing temperatures driven by climate change, cities are also vulnerable to the urban heat island effect (UHI) which can leave inner urban areas between 1.5 C and 12 C warmer at night than surrounding rural areas [17]. Elevated night-time temperatures associated with the UHI make it difficult for many urban residents to recover from any heat stress they may have experienced during the day [18]. However, green infrastructure has been shown to provide effective cooling against hot temperatures in the urban environment [19]. Reduced temperatures due to green infrastructure cooling would likely provide respite for vulnerable citizens during periods of intense heat. Proximity to green space influences the likelihood of undertaking physical activity [20] as does the quantity of available green space [21,22]. For example, having 10% more green space within a 1 km radius in an individual’s neighbourhood was found to be protective of particular diseases including chronic heart disease, upper respiratory tract infection, asthma, chronic obstructive pulmonary disease [23], all health issues which can be exacerbated by climate change, particularly extreme heat. There is a well-established association between viewing, or experiencing, natural environments and lower levels of self-reported stress and improved measures of physiological stress [24–26]. This empirical evidence is strongly Current Opinion in Environmental Sustainability 2017, 25:1–6
supported by a widely accepted theory, known as the stress reduction theory [27]. This theory advocates that viewing natural elements, such as trees and green spaces, or experiencing the natural environment, activates our parasympathetic nervous system to reduce stress and arousal levels [26]. Some studies have shown that green space may indirectly reduce stress levels by serving as a buffer against the adverse health impacts of stressful life events [28,29]. In examining the association between proximity to urban parks and psychological distress in Los Angeles, US [30] and anxiety in Auckland, New Zealand [31] it has been found that mental health is significantly related to residential distance from green space. Individuals living in urban areas with high levels of green space have been shown to have significantly better mental health outcomes in all three years after relocating [32] and urban residents are happier when they are living in urban areas with increased amounts of green space [33]. Access to green infrastructure is associated with improved recovery from illness [34,35]. The design of an individual’s physical environment can influence social behaviour and social interactions [36,37]. Many social commentators have attributed urban living to a ‘sense of social isolation and loneliness’ [38]. It is suggested that this may due to the fact that increased levels of urbanisation are often associated with decreased levels of green space [34,39,40]. Climate change and adaptation to its impacts is, at its heart, an equity issue; it is well established that the urban poor will be impacted most by climate change [4]. In particular, the risk to health from heatwaves is inequitably distributed; those in lower socio-economic circumstances [41], the elderly [42] and people from culturally and linguistically diverse (CALD) backgrounds [43] experience barriers to heatwave adaptation. Communities living in poor neighbourhoods with weak infrastructure and unplanned developments with few green spaces are likely to be more exposed to high temperatures compared to those in more affluent neighbourhoods [44]. Responding to climate change by strengthening green infrastructure can specifically benefit individuals from low socioeconomic status (SES) populations, where it has specifically been shown that a decline in levels of depression and anxiety is related to an increase in exposure to green space and infrastructure [45]. In addition, socioeconomic inequalities in mental health outcomes are higher among those urban dwellers that indicated they have difficulty with access to recreational and green spaces within their neighbourhood [46].
Economics The direct damage costs to health from climate change (i.e. excluding costs in health-determining sectors such www.sciencedirect.com
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as agriculture and water and sanitation), is estimated at between US$2–4 billion per year by 2030. These costs are in addition to existing and rising global health costs. For example, in 2010, it was estimated that the global cost of mental disorders was US$2.5 trillion, and this cost is projected to increase to US$6.0 trillion by 2030 [47]. Given global health costs will grow over time, it seems sensible that the business case for increasing urban green infrastructure should consider valuing the economic health benefits provided by green infrastructure. However, there is little peer-reviewed literature assessing the economic health value of green infrastructure projects. Indeed, the few studies that have sought to place a monetary value on the health benefits of green infrastructure projects have emerged largely from the international grey literature [48–50], and these studies use vastly different methods to undertake their assessments. Some studies have estimated the potential healthcare savings that result from an individual’s engagement in physical activity due to the presence of parks and open spaces [51,52] and other studies have estimated the potential healthcare savings that result from the reduced prevalence of mental illness due to increased levels of green space [45]. It is estimated the economic value of improved physical and mental health derived from increased physical activity created by the provision of natural habitats and green spaces in the UK would provide a total economic health benefit of £2 billion (using Willingness to Pay-based values) per annum for a range of physical and mental health conditions [49]. The US Trust for Public Land’s Center for City Park Excellence assessed the economic value of parks and recreational spaces for 10 cities and counties in the United States and estimated annual avoided costs of health care associated with levels of physical activity in parks ranging from approximately US$4 million to US$70 million per year [52]. The general approach of these studies has been to estimate the potential healthcare savings that result from improved physical or mental health due to the presence, or increased levels of, green infrastructure. The monetary estimates that these studies have calculated reveal that green infrastructure has the potential to provide substantial economic health benefits. However, these studies have used different methodological approaches from cost avoidance measurements to cost benefit analysis to estimate the potential benefits. Assumptions for these assessments are underpinned by an assortment of values at individual and community scales and as a result of this, it is difficult to systematically compare the monetary estimates that these studies have calculated.
Policy-maker’s context Urban growth drives land cover change which predominately results in the loss of green infrastructure and www.sciencedirect.com
ecosystem services [38,39,53,54]. Planning for green infrastructure is therefore a challenge for urban policymakers (at federal, state and local levels). The need for cities to rapidly adapt to climate change compounds this challenge as investment decisions become increasingly critical for resource constrained city governments. It is predicted that the investment required for urban adaptation will demand more than the current resources and the capacities of both local and national governments [55] and it is likely that individuals will have to carry the costs [56]. Whilst the benefits of adopting green infrastructure for climate adaptation are clear, the uptake of green infrastructure for this purpose has been relatively slow [57]. Most of the green infrastructure research to date has focused on the biophysical dimensions of green infrastructure over socio-cultural and political-institutional dimensions, which may explain why barriers to uptake exist [57]. Additionally, institutional structures such as large bureaucracies and lengthy decision-making processes may act as barriers to climate risk management in cities. When both of these factors are considered, it is clear that the policymaker’s ability to advance a green infrastructure based climate adaptation agenda is limited. It is not always necessary to frame green infrastructure benefits in monetary terms, but doing so is an effective method to capture the attention of governmental leaders [58] and thereby influence decisions for adaptation outcomes [59]. In this context the ability to accurately value the health benefits provided by green infrastructure can support the business case for climate adaptation. Most city governments factor budget impacts and return on investments relatively highly on decision-making criteria. This method of decision making is highly valued and it supports traditional grey infrastructure choices because these types of infrastructure have agreed and standardized methods of valuation. Whist climate change is not on the political agenda for all cities, the health and wellbeing of citizens is generally highly rated. Powerful synergies may emerge if both climate change adaptation and public health are brought to the fore in policy making in urban settings.
Conclusion There is a substantial body of work that supports the effectiveness of green infrastructure as an adaptation strategy for climate change. This is because green infrastructure has the ability to, amongst other things, reduce air pollution, regulate climate and improve water management. However, the extent to which these measured physical benefits result in improved human health outcomes remains to be comprehensively determined. To date, there has been little that has quantified and evaluated the human health benefits of using green infrastructure as climate change adaptation strategy [60]. Most of the work that has sought to quantify the health benefits of Current Opinion in Environmental Sustainability 2017, 25:1–6
Please cite this article in press as: Bowen KJ, Lynch Y: The public health benefits of green infrastructure: the potential of economic framing for enhanced decision-making, Curr Opin Environ Sustain (2017), http://dx.doi.org/10.1016/j.cosust.2017.08.003
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green infrastructure has focused on green spaces and natural environments, and very little has quantified the health benefits of more recent green infrastructure developments, such as green roof and walls.
waves in many climates will produce outdoor environments where people will be in extreme danger of heat stress, but that appropriately designed parks can reduce the threat. Intercepting solar radiation through the use of trees was found to be most effective way to reduce the heat load on people. 9.
There is not a single prevailing methodological framework that is used to evaluate the economic health benefit of green infrastructure projects; studies have used different methodological approaches to estimate the potential economic health value of these projects. This makes it difficult to systematically evaluate and compare the monetary estimates that these studies have calculated. This review highlights the real and urgent need to standardize the methodology used to evaluate the economic health value of green infrastructure projects and subsequently calculate monetary estimates to support policymakers and thereby influence city level decision making. It is therefore critical to advance the business case for green infrastructure if we are to support our progress to more sustainable and equitable cities.
Acknowledgements This work was supported by the Victorian Adaptation and Sustainability Partnership, Government of Victoria, Australia. The authors acknowledge the research assistance provided by Marissa Parry (University of New South Wales) which enabled the completion of the work.
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Available online at www.sciencedirect.com
ScienceDirect The public health benefits of green infrastructure: the potential of economic framing for enhanced decision-making Kathryn J Bowen1 and Yvonne Lynch2 Cities are growing rapidly resulting in changing land cover and reduced levels of green infrastructure globally. Climate change adaptation is now becoming a critical agenda item for cities. The potential for ecosystem-based climate adaptation using a green infrastructure approach is appealing for many cities but the business case for implementation has to be made more effectively. There is a substantial body of evidence that shows green infrastructure is significantly beneficial for human health and wellbeing and that it has many applications for climate adaptation. Despite this evidence, the linkage between green infrastructure benefits and improved health outcomes remains to be adequately quantified. There are limited studies from the international grey literature that indicate the potential and substantial economic health value of green infrastructure. Moreover, these studies use different methodological frameworks, making it difficult to systematically evaluate and compare the monetary estimates. The explicit lack of peerreviewed studies specifically evaluating the economic health value of green infrastructure projects highlights the need for such work to be undertaken. Addressing these research gaps would assist to accelerate policy development to drive the implementation of green infrastructure and ecosystem-based climate adaptation outcomes to support sustainable urban development.
Addresses 1 National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 0200, Australia 2 City of Melbourne, Council House 2, 240 Little Collins Street, Melbourne, VIC 3000, Australia Corresponding author: Bowen, Kathryn J ([email protected])
Current Opinion in Environmental Sustainability 2017, 25:xx–yy This review comes from a themed issue on Sustainability challenges Edited by Chiho Watanabe, Steffen Loft, Pengjun Zhao and Tony Capon
Received: 14 November 2016; Accepted: 14 August 2017
http://dx.doi.org/10.1016/j.cosust.2017.08.003 1877-3435/ã 2017 Published by Elsevier B.V.
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Introduction Although cities and urban settlements cover less than 1% of the planet’s surface [1], they are the nexus of human activity accommodating 54% of the population and 70– 90% of economic activity [2]. The percentage of the world’s population living in urban areas is projected to increase from 54% in 2015 to 60% in 2030 and to 66% by 2050 [3]. Urban land cover is predicted to increase by 1.2 million square kilometres by 2030, nearly tripling global urban land area between 2000 and 2030 [4]. Most cities share similar characteristics that render their populations and assets particularly vulnerable to predicted climate change. This includes often being situated in close proximity to major water sources (rivers, seas, lakes), and having large transient populations. Although research on climate change has been a prominent topic of focus for several decades, the likely impacts of climate change and risks for urban areas has received little attention until recently. Increasingly, it is recognized that cities are ‘vital actors’ in responding to climate change [5]. It is now acknowledged that cities have a critical role in leading urban climate adaptation, but that the ability to do this depends upon the competence and capability of local government and that there is limited evidence of adaptation being realised in practice at city scale [4]. If adaptation to climate change is likely to fall to local government with low levels of capability, then it is likely maladaptation will further compound city challenges. Maladaptation is defined by as ‘action taken ostensibly to avoid or reduce vulnerability to climate change that impacts adversely on, or increases the vulnerability of other systems, sectors or social groups’ [6]. Green infrastructure has been identified as an effective adaptation strategy for climate change [7,8] and is particularly relevant to urban areas. Green infrastructure is the ‘interconnected network of green space that conserves natural ecosystem values and functions and provides associated benefits to human populations’ [9]. It provides multiple benefits from an adaptation perspective including cooling, air quality and reduced flooding, and also provides multiple ecosystem services, which benefit human health and wellbeing [10], thereby increasing the liveability of cities. Despite significant research on the multiple benefits provided by green infrastructure, it has Current Opinion in Environmental Sustainability 2017, 25:1–6
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not been widely embraced as a critical infrastructure element for cities. Green infrastructure planning in many cities has been negatively affected by institutional failures to acknowledge the benefits that ecosystem services provide [11,12]. As a result, green infrastructure is often treated one-dimensionally — that it is something nice to have instead of providing critical ecological and social functions [9,13–15]. This paper seeks to position the implementation of green infrastructure as a crucial and beneficial climate adaptation strategy for cities. It advocates that the business case for investing in green infrastructure needs to be supported by a more sophisticated understanding of the economic value of the health benefits provided by green infrastructure.
Green infrastructure and health Green infrastructure as a climate adaptation strategy has the potential to reduce a variety of risks to health posed by climate change, in relation to both physical and mental health and wellbeing. This is particularly the case for risks related to extreme heat. Extreme temperatures increase the risk of mortality and morbidity [4], they also exacerbate cardiovascular and respiratory diseases and mental stress amongst other issues. In Australia, heatwaves claim more human lives than any other natural hazard [16]. In addition to increasing temperatures driven by climate change, cities are also vulnerable to the urban heat island effect (UHI) which can leave inner urban areas between 1.5 C and 12 C warmer at night than surrounding rural areas [17]. Elevated night-time temperatures associated with the UHI make it difficult for many urban residents to recover from any heat stress they may have experienced during the day [18]. However, green infrastructure has been shown to provide effective cooling against hot temperatures in the urban environment [19]. Reduced temperatures due to green infrastructure cooling would likely provide respite for vulnerable citizens during periods of intense heat. Proximity to green space influences the likelihood of undertaking physical activity [20] as does the quantity of available green space [21,22]. For example, having 10% more green space within a 1 km radius in an individual’s neighbourhood was found to be protective of particular diseases including chronic heart disease, upper respiratory tract infection, asthma, chronic obstructive pulmonary disease [23], all health issues which can be exacerbated by climate change, particularly extreme heat. There is a well-established association between viewing, or experiencing, natural environments and lower levels of self-reported stress and improved measures of physiological stress [24–26]. This empirical evidence is strongly Current Opinion in Environmental Sustainability 2017, 25:1–6
supported by a widely accepted theory, known as the stress reduction theory [27]. This theory advocates that viewing natural elements, such as trees and green spaces, or experiencing the natural environment, activates our parasympathetic nervous system to reduce stress and arousal levels [26]. Some studies have shown that green space may indirectly reduce stress levels by serving as a buffer against the adverse health impacts of stressful life events [28,29]. In examining the association between proximity to urban parks and psychological distress in Los Angeles, US [30] and anxiety in Auckland, New Zealand [31] it has been found that mental health is significantly related to residential distance from green space. Individuals living in urban areas with high levels of green space have been shown to have significantly better mental health outcomes in all three years after relocating [32] and urban residents are happier when they are living in urban areas with increased amounts of green space [33]. Access to green infrastructure is associated with improved recovery from illness [34,35]. The design of an individual’s physical environment can influence social behaviour and social interactions [36,37]. Many social commentators have attributed urban living to a ‘sense of social isolation and loneliness’ [38]. It is suggested that this may due to the fact that increased levels of urbanisation are often associated with decreased levels of green space [34,39,40]. Climate change and adaptation to its impacts is, at its heart, an equity issue; it is well established that the urban poor will be impacted most by climate change [4]. In particular, the risk to health from heatwaves is inequitably distributed; those in lower socio-economic circumstances [41], the elderly [42] and people from culturally and linguistically diverse (CALD) backgrounds [43] experience barriers to heatwave adaptation. Communities living in poor neighbourhoods with weak infrastructure and unplanned developments with few green spaces are likely to be more exposed to high temperatures compared to those in more affluent neighbourhoods [44]. Responding to climate change by strengthening green infrastructure can specifically benefit individuals from low socioeconomic status (SES) populations, where it has specifically been shown that a decline in levels of depression and anxiety is related to an increase in exposure to green space and infrastructure [45]. In addition, socioeconomic inequalities in mental health outcomes are higher among those urban dwellers that indicated they have difficulty with access to recreational and green spaces within their neighbourhood [46].
Economics The direct damage costs to health from climate change (i.e. excluding costs in health-determining sectors such www.sciencedirect.com
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as agriculture and water and sanitation), is estimated at between US$2–4 billion per year by 2030. These costs are in addition to existing and rising global health costs. For example, in 2010, it was estimated that the global cost of mental disorders was US$2.5 trillion, and this cost is projected to increase to US$6.0 trillion by 2030 [47]. Given global health costs will grow over time, it seems sensible that the business case for increasing urban green infrastructure should consider valuing the economic health benefits provided by green infrastructure. However, there is little peer-reviewed literature assessing the economic health value of green infrastructure projects. Indeed, the few studies that have sought to place a monetary value on the health benefits of green infrastructure projects have emerged largely from the international grey literature [48–50], and these studies use vastly different methods to undertake their assessments. Some studies have estimated the potential healthcare savings that result from an individual’s engagement in physical activity due to the presence of parks and open spaces [51,52] and other studies have estimated the potential healthcare savings that result from the reduced prevalence of mental illness due to increased levels of green space [45]. It is estimated the economic value of improved physical and mental health derived from increased physical activity created by the provision of natural habitats and green spaces in the UK would provide a total economic health benefit of £2 billion (using Willingness to Pay-based values) per annum for a range of physical and mental health conditions [49]. The US Trust for Public Land’s Center for City Park Excellence assessed the economic value of parks and recreational spaces for 10 cities and counties in the United States and estimated annual avoided costs of health care associated with levels of physical activity in parks ranging from approximately US$4 million to US$70 million per year [52]. The general approach of these studies has been to estimate the potential healthcare savings that result from improved physical or mental health due to the presence, or increased levels of, green infrastructure. The monetary estimates that these studies have calculated reveal that green infrastructure has the potential to provide substantial economic health benefits. However, these studies have used different methodological approaches from cost avoidance measurements to cost benefit analysis to estimate the potential benefits. Assumptions for these assessments are underpinned by an assortment of values at individual and community scales and as a result of this, it is difficult to systematically compare the monetary estimates that these studies have calculated.
Policy-maker’s context Urban growth drives land cover change which predominately results in the loss of green infrastructure and www.sciencedirect.com
ecosystem services [38,39,53,54]. Planning for green infrastructure is therefore a challenge for urban policymakers (at federal, state and local levels). The need for cities to rapidly adapt to climate change compounds this challenge as investment decisions become increasingly critical for resource constrained city governments. It is predicted that the investment required for urban adaptation will demand more than the current resources and the capacities of both local and national governments [55] and it is likely that individuals will have to carry the costs [56]. Whilst the benefits of adopting green infrastructure for climate adaptation are clear, the uptake of green infrastructure for this purpose has been relatively slow [57]. Most of the green infrastructure research to date has focused on the biophysical dimensions of green infrastructure over socio-cultural and political-institutional dimensions, which may explain why barriers to uptake exist [57]. Additionally, institutional structures such as large bureaucracies and lengthy decision-making processes may act as barriers to climate risk management in cities. When both of these factors are considered, it is clear that the policymaker’s ability to advance a green infrastructure based climate adaptation agenda is limited. It is not always necessary to frame green infrastructure benefits in monetary terms, but doing so is an effective method to capture the attention of governmental leaders [58] and thereby influence decisions for adaptation outcomes [59]. In this context the ability to accurately value the health benefits provided by green infrastructure can support the business case for climate adaptation. Most city governments factor budget impacts and return on investments relatively highly on decision-making criteria. This method of decision making is highly valued and it supports traditional grey infrastructure choices because these types of infrastructure have agreed and standardized methods of valuation. Whist climate change is not on the political agenda for all cities, the health and wellbeing of citizens is generally highly rated. Powerful synergies may emerge if both climate change adaptation and public health are brought to the fore in policy making in urban settings.
Conclusion There is a substantial body of work that supports the effectiveness of green infrastructure as an adaptation strategy for climate change. This is because green infrastructure has the ability to, amongst other things, reduce air pollution, regulate climate and improve water management. However, the extent to which these measured physical benefits result in improved human health outcomes remains to be comprehensively determined. To date, there has been little that has quantified and evaluated the human health benefits of using green infrastructure as climate change adaptation strategy [60]. Most of the work that has sought to quantify the health benefits of Current Opinion in Environmental Sustainability 2017, 25:1–6
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green infrastructure has focused on green spaces and natural environments, and very little has quantified the health benefits of more recent green infrastructure developments, such as green roof and walls.
waves in many climates will produce outdoor environments where people will be in extreme danger of heat stress, but that appropriately designed parks can reduce the threat. Intercepting solar radiation through the use of trees was found to be most effective way to reduce the heat load on people. 9.
There is not a single prevailing methodological framework that is used to evaluate the economic health benefit of green infrastructure projects; studies have used different methodological approaches to estimate the potential economic health value of these projects. This makes it difficult to systematically evaluate and compare the monetary estimates that these studies have calculated. This review highlights the real and urgent need to standardize the methodology used to evaluate the economic health value of green infrastructure projects and subsequently calculate monetary estimates to support policymakers and thereby influence city level decision making. It is therefore critical to advance the business case for green infrastructure if we are to support our progress to more sustainable and equitable cities.
Acknowledgements This work was supported by the Victorian Adaptation and Sustainability Partnership, Government of Victoria, Australia. The authors acknowledge the research assistance provided by Marissa Parry (University of New South Wales) which enabled the completion of the work.
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