Accounting for Health: The Business Case for Green Space
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Introduction
The evidence is clear. Healthy natural environments are essential for human health. From regulating air and water pollution and to moderating surface temperatures, to providing opportunities for physical activity, recreation and relaxation, greenspaces provide a multitude of physical and mental health benefits (1-4). Many of us can relate to stories of the exhilaration felt, the physical energy exerted, or the respite from the heat achieved from time spent in nature – whether hiking through the forest or taking a relaxing stroll along a tree-lined section of an urban park.
From the air we breathe, to healthy food supplies and clean water, healthy ecosystems are essential for human health. Photo: Helen Doyle
But can those feelings and experiences of “improved health and wellness” be quantified? Can we really measure the health benefits in terms of monetary savings in order to convince decision-makers that protecting and enhancing green space is an environmentally and economically responsible decision for our community? Can we put a dollar value on our natural assets such as parks and urban forests that accounts for healthcare costs avoided, in the same way that we account for the economic benefits and costs avoided from protecting our physical infrastructure, buildings and utilities?
Fortunately, researchers and communities across the Province of Ontario have developed tools to quantify health benefits in terms of economic value. This area of research is not only expanding, its insights are being used by planners, conservationists, community groups, and public health professionals to advocate for the protection and enhancement of green space based on the health economic business case.
One such tool is A Conceptual Framework to Understand the Business Case for EcoHealth in Ontario (5), that presents evidence on the connection between greenspace and physical and mental health benefits, and provides estimates of the economic value of improvements to public health from investing in greenspaces. This tool helps communicate the monetary value of positive health benefits associated with greenspace investment, including:
A Conceptual Framework to Understand the Business Case for EcoHealth in Ontario. Green Analytics Corp. 2020.
reduced burden of illness
decreased use of health services
reduced mortality and
increased productivity
The tool has been applied to different settings in southern Ontario to inform local program, policy, and planning decisions.
The Conceptual Framework applied in the Case Study: Increasing Tree Canopy, Brampton, Ontario (6), demonstrated the extent to which two scenarios for urban tree canopy expansion – increasing canopy cover by 50 per cent and 80 per cent over a current baseline in the case study neighbourhood, resulted in health system savings through reduced exposure to extreme heat days, improved air quality and increased physical activity. Annual net benefits were estimated to be between $2.5 million and $3.2 million CAD.
A second Case Study: Downtown Urban Park, Peterborough, Ontario (7), employed the same Conceptual Framework to demonstrate that the creation of a new urban park could result in significant health system savings through prevented lost productivity associated with poor health, reduced mortality, and increased life satisfaction for local communities. This case study estimated the combined value of these health system savings at $4.2 million annually, with a return on investment from park development cost in 1.5 years.
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Effectively communicating these health system savings with municipalities and local decision-makers can have a significant influence on municipal budgets for investments in green space, and the extent to which communities grow in a more healthy, resilient and economically sustainable manner.
Municipalities have used similar methods and siting tools to help identify and prioritize where nature-based climate solution projects should be established to best protect and enhance the natural environment for climate resiliency. These tools incorporate a wide range of greenspace benefits to community health and health equity related to flood control, air quality improvements, surface temperature regulation and reduction in social vulnerability, to name a few.
A pilot study based on the Toronto and Region Conservation Authority’s Nature-Based Climate Solutions Siting Tool (8), was applied to the Humber River watershed study area to identify priority locations for protection, restoration and enhancement of nature. Prioritization criteria were developed to determine the ecological value or population need related to various indicators of ecosystem function including climate mitigation and adaptation, hazard prevention, and community health.
In the Humber River watershed pilot, recommended priority areas to enhance greenspace included: areas with no existing or potential natural cover that have space available for tree planting and a high summertime surface temperature, and areas near residential buildings where the population is characterized by high levels of deprivation (e.g. residential instability, economic dependency), where the adult population has a higher rate of chronic health conditions, where there was low access to greenspace, and where there was low levels of greenness (i.e. density of healthy vegetation). Including metrics of community health, well-being and health equity, when making decisions on prioritizing and implementing nature-based climate solution projects, is an important step in building more climate-resilient and equitable communities.
All types of green spaces can provide both physical and mental health benefits. Everyone benefits from access to greenspace. Photo: Helen Doyle
Another example of how a population health and health equity lens is being incorporated into planning decisions related to natural environments is the Peel Region Tree Planting Prioritization Tool (9). Recognizing the multitude of health, equity and environmental benefits of urban tree canopy cover, the increased threat to the urban forest from climate change and development pressures, and municipalities’ limited budgets to maintain existing trees and plant new trees, the Region developed a decision-making tool for prioritizing tree planting that considered environmental, social and economic sustainability metrics. Examples of tree canopy benefit metrics included: mitigation of urban heat island effects and air pollution, support for physical health and emotional well-being, and enhancement of social equity and economic value. The tool generates maps of geographic areas where tree planting would have the greatest benefits. From a population health and health equity perspective, these would include areas with a higher proportion of groups at increased risk of experiencing heat-related illness – older adults, people with chronic illnesses, socially disadvantaged individuals and newcomers. The Tree Planting Prioritization Tool aligns with Peel Region’s Urban Forest Strategy (10), including Guiding Principle 3: “All residents should have the opportunity and means to benefit equally from the ecosystem services provided by the urban forest”.
Conclusion
While evidence linking natural environments to positive health outcomes and health equity helps increase awareness and support for protection and enhancement of greenspace, providing the health economic business case for investments in greenspace using tools outlined above, may have greater potential to influence local decision-making on greenspace policies, programs and projects that truly account for health.
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Helen Doyle, B. Sc., CPHI (C) is the Environmental Health Workgroup Chair at the Ontario Public Health Association. Email her here.
Resources
(1) Kingsley, Marianne, EcoHealth Ontario. 2019. Climate change, health and greenspace co-benefits. Commentary. Health Promotion and Chronic Disease Prevention in Canada. Vol 39. No 4. April 2019
(2) Toronto Public Health. (2015). Green City: Why nature matters to health – An Evidence Review. Toronto, Ontario. Report based on: The impact of urban green space on health: A systematic review, prepared for Toronto Public Health by Parallax Communications and Habitus Research. https://static1.squarespace.com/static/5c3cebfd45776eee4408f72d/t/5c89d9d40852295fc191d250/1552538072865/Green_City_Why_Nature_Matters_to_Health_An_Evidence_Review.pdf
(3) Zupancic, T., Westmacott, C., Bulthuis, M. 2015. The Impact of Green Space on Heat and Air Pollution in Urban Communities: A meta-narrative systematic review https://davidsuzuki.org/wp-content/uploads/2017/09/impact-green-space-heat-air-pollution-urban-communities.pdf
(4) Millennium Ecosystem Assessment, 2005. Ecosystems and Human Well-being: Synthesis. Island Press, Washington, DC. World Resources Institute https://www.millenniumassessment.org/documents/document.356.aspx.pdf
(5) Green Analytics. 2020. A Conceptual Framework to Understand the Business Case for EcoHealth in Ontario. https://static1.squarespace.com/static/5c3cebfd45776eee4408f72d/t/5ecb445972e6a72aac117171/1590379619631/FO_8.5x11_EH_REPORT_FA_4WEB+%281%29.pdf
(6) Green Analytics Corp. 2020. Prepared for the Greenbelt Foundation and EcoHealth Ontario in partnership with Toronto Region Conservation Authority and Region of Peel Public Health. EcoHealth Economic Valuation Framework. Quantifying the Health Return on Investments in Greenspace. Case Study: Increasing Tree Canopy, Brampton, Ontario
(7) Green Analytics Corp. 2020. Prepared for the Greenbelt Foundation and EcoHealth Ontario in partnership with the City of Peterborough. EcoHealth Economic Valuation Framework. Quantifying the Health Return on Investments in Greenspace. Case Study: Downtown Urban Park, Peterborough, Ontario
(8) Lam, S., Chin, A., Akbari, A., Eastwood, M., and Shrestha, N. (2022). Nature-Based Climate Solutions (NBCS) Siting Tool: Phase 1 Pilot Study Report. Toronto and Region Conservation Authority.
(9) Gregory Richardson. 2016. Peel Region Tree Priority Planting Tool https://www.iclr.org/wp-content/uploads/PDFS/17_Peel_Region.pdf , and as referenced in Cities Adapt to Extreme Heat. Celebrating Local Leadership. 2016. Institute for Catastrophic Loss Reduction and Health Canada. https://www.iclr.org/wp-content/uploads/PDFS/cities-adapt-to-extreme-heat.pdf
(10) Peel Region Urban Forest Strategy. 2011 https://www.mississauga.ca/file/COM/2012eacagendapart2_june5.pdf