Green Care: meaning and background

Have you ever heard of the concept Green Care? In Green4C we take a comprehensive approach and use the concept as an umbrella term for many activities. Below we explain how.


One term, many definitions

To many experts, including those of us working on this topic in the Green4C project, Green Care is an emerging concept referring to the “range of activities that promotes physical and mental health and well-being through contact with nature” (Sempik et al., 2010, p.121). Because of the centrality of nature to health and well-being, Green Care can also be understood within the context of nature-based solutions (NbS) (IUCN, 2013). The approach is based on the impact of ecosystems and their services on individual and collective health and well-being. It is important to note that green care is an active process that is intended to promote or improve health and well-being as opposed to a purely passive experience of nature. In other words, whilst the health benefits of experiencing nature are increasingly being recognised, the natural environment is not simply a backdrop for green care activities. Not everything that is green is ‘green care’. Not everything that is green is ‘green care’. The concept of green care can be understood from the different perspectives of the sectors it operates in. Some link the concept of green care to the health care system only, while others broaden the concept to include social rehabilitation, education and employment (Sempik et al., 2010). Green Care can be also viewed as an umbrella term summarising a wide range of activities and targeted beneficiaries, ranging from health promotion (targeted to a general population), disease prevention (accessible to a general population, but typically targeted towards more vulnerable individuals or groups) and therapeutic interventions which include targeted therapeutic or treatment/ rehabilitation interventions for addressing specific needs (Sempik et al., 2010). 


What about the health and “care”?

According to WHO, health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). The project incorporates this definition within a more dynamic health concept, recognizing health as the the ability to adapt and to self-manage (Huber et al., 2011). This implies that the ability of people to adapt to and manage their situation is key to health. That said, the implication of people’s ability to adapt and manage their situation alone must be underlined, as not all people can look after themselves. This is where the “care” comes in, Oxford dictionaries define “care” as “the process of caring for somebody/something and providing what they need for their health or protection”. In addition, as the WHO definition of health explicitly links health to wellbeing the project focusses  wellbeing as being defined as  “a holistic, subjective state which is present when a range of feelings, among them energy, confidence, openness, enjoyment, happiness, calm and caring are combined and balanced” (Pawlyn and Carnaby, 2009). Green4C includes the definition of care, interprets health holistically and includes wellbeing as part of the health concept.

For the purpose of this project we focus on activities which have the following aims: 

Health promotion: “Health promotion is the process of empowering people to increase control over their health and its determinants through health literacy efforts and multisectoral action to increase healthy behaviours.” (WHO, 2020). 

Disease prevention:  “Specific, population-based and individual-based interventions for primary and secondary (early detection) prevention, aiming to minimize the burden of diseases and associated risk factors.” (WHO, 2020). 

Health Intervention and Rehabilitation: within the context of Green4C these two concepts are defined as therapeutic and rehabilitation interventions provided for a segment of the population with special needs, as determined by physical, mental, or social health conditions. The activities are supervised or delivered by trained/qualified practitioners. The activities under this category are mainly reactive and a posteriori to an event, incident or morbidity connected to a disability or that led to an illness. 


And the “green”?

While considering the earlier reference made to the benefits of ecosystems and their services, and considering that the health benefits of experiencing nature are increasingly being recognised, we must also restate that the natural environment is not simply a backdrop for green care activities. That said, the organisation of Green Care activities is often conditioned on access to and sustainable use of natural environments in both rural and urban spaces [1]. The most recent classification of cities and rural areas by EC differentiates three categories and provides definitions for (1) cities, (2) towns and suburbs and (3) rural areas (Dijkstra and Poelman, 2014). In this classification (1) cities and (2) towns and suburbs are referred to as urban areas.

The Green4C project focuses on
a) forests and other natural and semi-natural rural spaces;
b) agricultural lands;
c) urban and suburban green spaces as the geographical spaces where Green Care activities are or can be carried out.

The first two spaces fall under rural areas, and the last one falls under urban areas as per EC classification. Indeed, it was from these spaces, and the transversal sector “Green care tourism” that our four Green4C thematic sectors are defined: Forest-based care, Social agriculture, Urban green care and Green care tourism.


Why is it important?

In general, ecosystem products and services (such as availability of fresh water, food and fuel sources) create basis for livelihoods and human well-being (MEA, 2005). One of the important services provided by ecosystems is also the disease regulation of vectors, pests, and pathogens, and protection against viruses that can spread as the result of human-wildlife interface (WHO, 2020a). Significant direct impacts on livelihoods and human health can occur if ecosystems are eroded and can no longer provide these services.

Research also shows how activities in forests and urban green spaces can have positive impacts on stress reduction and psychological relaxation and the immune function (Rook, 2013; Alcock et al., 2014; Gascon et al., 2015; Kondo et al., 2018; Hunter et al., 2019). Social capital can be promoted by increasing the time spent in accessible and pleasant green areas, improving relational and emotional skills and increasing social wellbeing, self-esteem and positive attitudes towards the environment in general (Peters et al., 2010; De Vries et al., 2013; Sonntag-Öströmet al., 2015). Urban green spaces also encourage physical activity among the general population and add to mental health benefits (Barton and Pretty, 2010). These are just some examples of the positive impacts Green Care activities can bring. By improving the basis for evidence-based knowledge exchange and entrepreneurial activities in Green Care sector, the Green4C project ultimately aims to enhance these positive impacts.

 Find out more about Green4C project and activities here!


References

  • Alcock, I., White, M. P., Wheeler, B. W., Fleming, L. E., & Depledge, M. H. (2014). Longitudinal effects on mental health of moving to greener and less green urban areas. Environmental science & technology, 48(2), 1247-1255.
  • Barton, J., & Pretty, J. (2010). What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environmental science & technology, 44(10), 3947-3955.
  • De Vries, S., Van Dillen, S. M., Groenewegen, P. P., & Spreeuwenberg, P. (2013). Streetscape greenery and health: stress, social cohesion and physical activity as mediators. Social science & medicine, 94, 26-33.
  • Dijkstra, L., & Poelman, H. (2014). A harmonised definition of cities and rural areas: the new degree of urbanisation. WP, 1, 2014.
  • Gascon, M., Triguero-Mas, M., Martínez, D., Dadvand, P., Forns, J., Plasència, A., & Nieuwenhuijsen, M. J. (2015). Mental health benefits of long-term exposure to residential green and blue spaces: a systematic review. International journal of environmental research and public health, 12(4), 4354-4379.
  • Huber, M., Knottnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., … & Schnabel, P. (2011). How should we define health?. Bmj, 343.
  • Hunter, M. R., Gillespie, B. W., & Chen, S. Y. P. (2019). Urban nature experiences reduce stress in the context of daily life based on salivary biomarkers. Frontiers in psychology, 10, 722.
  • IUCN (2013). Nature-based solutions. The International Union for the Conservation of Nature Available at: https://www.iucn.org/commissions/commission-ecosystem-management/our-work/nature-based-solutions
  • Kondo, M. C., Jacoby, S. F., & South, E. C. (2018). Does spending time outdoors reduce stress? A review of real-time stress response to outdoor environments. Health & place, 51, 136-150.
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  • Pawlyn, J., Carnaby, S. (2009). Profound intellectual and multiple disabilities: nursing complex needs. Chichester: Wiley-Blackwell.
  • Peters, K., Elands, B., & Buijs, A. (2010). Social interactions in urban parks: stimulating social cohesion?. Urban forestry & Urban greening, 9(2), 93-100.
  • Rook, G. A. (2013). Regulation of the immune system by biodiversity from the natural environment: an ecosystem service essential to health. Proceedings of the National Academy of Sciences, 110(46), 18360-18367.
  • Sempik, J., Hine, R. Wilcox, D. eds. (2010) Green Care: A Conceptual Framework, A Report of the Working Group on the Health Benefits of Green Care, COST Action 866, Green Care in Agriculture, Loughborough: Centre for Child and Family Research, Loughborough University.
  • Sonntag-Öström, E., Stenlund, T., Nordin, M., Lundell, Y., Ahlgren, C., Fjellman-Wiklund, A., Järvholm, L.S., Dolling, A. (2015). “Nature’s effect on my mind” – Patients’ qualitative experiences of a forest-based rehabilitation programme. Urban For. Urban Green, 14.
  • WHO (1948). Constitution for the World Health Organization. Copenhagen: WHO Regional Office for Europe.
  • WHO.(2020). Assessment of essential public health functions. Available at: http://www.emro.who.int/pdf/about-who/public-health-functions/health-promotion-disease-prevention.pdf?ua=1
  • WHO (2020a). Ecosystem goods and services for health. Available at: https://www.who.int/globalchange/ecosystems/en/
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