involved, and the age group of the participants (e.g. Ward Thompson 2013). For example, playing (informal) football requires a large amount of open space with significant buffer zones separating the activity from other uses (Golicnik and Ward Thompson 2010). Such space would not tend to be particularly biodiverse. Runners and cyclists may prefer more open environments, whilst walkers may select more structured habitats. Site management may exploit such preferences to avoid conflicts (and even collisions) on shared tracks (Santos et al. 2016). People report greater enjoyment of outdoor exercise compared to equivalent exercise performed indoors (Thompson Coon et al. 2011). However, Shanahan et al. (2016) identify a knowledge gap in understanding which characteristics of nature are important in promoting physical activity. Exercise also benefits the immune system (Pedersen et al. 2007): general exercise releases myokines, and this effect is greater in colder environments, such as when exercising outdoors in a temperate climate. Myokines induce an inflammatory/pro-inflammatory response control, influencing the function of chronic inflammation, and can positively affect cognition, reduce depression and reduce inflammatory responses associated with osteoporotic disease (Kaji 2016). For a detailed discussion on green space interventions to promote physical activity, see Hunter et al. Chap. 17, this volume.

# *11.2.6 Mental Health*

While the direct association between appreciation of different levels of biodiversity and well-being are clear, this is less so for mental health (as measured by the absence of mental disorders such as anxiety or depression). However, there is a clear link between access to natural environments and mental health (World Health Organization 2016). Bragg and Atkins (2016) suggest that three key components (being in the environment, meaningful activities within the environment, and the social context) can positively influence mental health. Both active participation in greenspace and observable greenspace are significant in achieving mental health benefits (Nutsford et al. 2013), and horticultural activities programmes for older people lead to reduced levels of depression and improved life satisfaction (Masuya et al. 2014). There is some evidence that exposure to 'beautiful' nature (potentially equating to perceived biodiversity) promotes socially desirable behaviours (Zhang et al. 2014). Beyer et al. (2014) suggested that greening could be useful within a population mental health strategy. For a more in-depth discussion on mental health and biodiversity, see de Vries and Snep Chap.8, this volume, and Marselle et al. Chap. 9, this volume.

# *11.2.7 Physical Health – Infectious Disease (Disease/Pathogen Reduction)*

The links between biodiversity and infectious disease are complex. Although Bernstein (2014) suggested a possible swamping of disease transmission agents by larger species diversity, Wood et al. (2014) identified no such reduction for many diseases, suggesting that if such links were important then biodiversity may increase disease. Conversely, Keesing et al. (2010) found that, although areas of high biodiversity can be a source pool for new pathogens, there was increasing evidence that biodiversity loss can increase disease transmission. They suggested that preserving areas with endemic biodiversity should generally reduce infectious disease prevalence.

Sandifer et al. (2015) examined the links between microbial biodiversity, allergic reactions and respiratory diseases, arguing that exposure to microbial diversity can improve health, for example, reducing allergens that may also influence the management of some respiratory conditions. This reinforces aspects of the 'hygiene hypothesis', which proposes that exposure to microbes at an early age can enhance inflammatory responses and thus heighten human resilience to allergens (Hanski et al. 2012). This point was also reported by Ege et al. (2011), who identified that children raised on a farm were less likely to suffer from asthma. See Damialis et al. Chap. 3, this volume, for further discussion on allergenic responses, and Müller et al. Chap. 4, this volume, for more information about vector borne disease.

# *11.2.8 Physical Health – Non-Communicable Disease*

Systematic review-level evidence demonstrates that proximity to greenspace is linked to a reduction in mortality due to all causes (van den Berg et al. 2015). Cross-sectional studies show increased neighbourhood greenspace is linked to lower levels of type 2 diabetes (Bodicoat et al. 2014). When specifically considering the role of biodiversity, the effects on physical health outcomes are likely to be indirect, via nutrition, protection from stressors, positive effects on personal and socio-cultural well-being, and creation of desirable natural areas for healthy behaviour. Epidemiological studies have been useful in providing evidence of a link between exposure to greenspace and health outcomes measurable at an area and population level (Mitchell and Popham 2008; de Vries et al. 2003). However, fully making the case for the health benefits of biodiverse environments will require further work on the type and nature of the greenspace and its links to health. Much work at the area level has tended to use crude measures of exposure to biodiversity; for example, the percentage of greenspace in the local environment. Recently, Dennis et al. (2018) have developed a sophisticated landcover model that incorporates socio-demographics for an urban city area. Early findings suggest that the strength of the health–greenspace relationship depends on the nature of the greenspace, with lower diversity greenscapes (recreational grassland) having a less strong relationship with good health compared to areas with more complex greenspace (e.g. shrubs and trees).

Access to greenspace in general has been suggested to be beneficial in the management of long-term conditions such as obesity, cardiovascular disease and diabetes. Moreover, when people exercise in the natural environment, the impact of the two protective factors, exercise and greenspace, acting together may be greater than simply summing the positive effects (i.e. may be synergistic: Shanahan et al. 2016). The protective effect of greenspace begins early in life: among children, those with access to gardens and greenspace were less likely to be obese at age 7 years (Schalkwijk et al. 2018). For more on the effect of greenspace on children's health, see Dadvand et al. Chap 6, this volume. Chen and Janke (2012) reported that older people who garden suffer from fewer falls, possibly due to improved gait and balance.

# **11.3 The Role of Public Health in Lobbying for Protecting Biodiversity**

Human societies increasingly place species and natural habitats (especially biodiverse habitats) under considerable pressure (Lawton et al. 2010). Threats to biodiversity include urbanisation, intensive agriculture, increased pollution and impacts of climate change. Whilst the first three threats can be managed locally, regionally or nationally, climate change requires international cooperation. The role and responsibility of public health experts to campaign on climate change and other threats to biodiversity are given forcefully in the 2015 Lancet Commission on Health and Climate Change (Watts et al. 2015). It has become vital for health departments of governments not to operate in isolation; health professionals need to ensure that climate-health-related considerations are integrated into government-wide strategies. One example of cross-governmental working can be seen in the recent UK Environment Strategy, in which health features as a major section (DEFRA 2018). In addition to averting biodiversity loss (e.g. preventing deforestation), climate-related topics requiring cross-governmental thinking also impact directly on public health (e.g. phasing out coal as an energy source will protect cardiovascular and respiratory health). Initiatives to support lifestyles that are healthy for both humans and the environment will also help to provide resilience in the face of the health risks posed by climate change. See Keune et al. Chap 15, this volume, for further information on international and national nature-health initiatives.

Public health professionals need to ensure investment in health systems that can respond to climate change-induced threats to human health. For example, urban flooding can be a significant risk to human health both directly (through the risk of drowning) and through exposure to pathogenic microbes (Jørgensen et al. 2016). Similarly, changes in extreme temperatures in cities (including in Europe) are contributing to significant increases in heat-related mortality levels (Mitchell et al. 2016). Drought conditions can also exacerbate risks to health, for example, from microorganisms in the plumes from cooling towers (Pagnier et al. 2009), since water drawn from rivers containing municipal waste may become more concentrated during droughts.

The appropriate policy for maintaining and developing greenspaces of appropriate size and accessibility for public health has long been debated. In 1929, for London (UK), Unwin recommended 7 acres (2.83 ha) of greenspace be allocated per 1,000 people as playing fields (first report of the Greater London Regional Planning Committee in 1933, cited by Turner 1992). Later work for English Nature recommended an Accessible Natural Greenspace Standards model with (*inter alia*) at least 2 ha of natural greenspace within 300 m of all residents and at least 2 ha of Local Nature Reserve per 1,000 people (Harrison et al. 1995). It was recognised that such guidance was not being implemented by all local authorities and Pauleit et al. (2003) recommended the standards become flexible to address local contexts. Whilst greenspace standards may be appropriate to promote human health and wellbeing, these may need to be revised if greenspace is to mitigate the impacts of climate change on urban centres. For additional discussion about how human health is addressed in planning legislation, see Heiland et al. Chap. 20, this volume.

The International Convention on Biodiversity (2017) suggested that there is already sufficient evidence to justify several actions to protect human health, including integrating biodiverse greenspaces in urban development. It identified the need to address the drivers of ill health and biodiversity loss together (for further discussion on policies linking biodiversity, health and climate change, see Korn et al. Chap. 14, this volume). Governments should invest in research and monitoring, including quantifying the savings from reduced health-care costs and the enhanced productivity that would accompany climate change mitigation (Convention on Biodiversity 2017; Watts et al. 2015). Internationally, governments must support countries to become low carbon economies as a global endeavour (Watts et al. 2015), since consumption in wealthier countries drives carbon use in less wealthy countries. Public health professionals need to engage the public as well (Corner et al. 2014): framing climate change concerns around health and well-being may be more powerful than arguing to conserve the environment without an explicit link to human health (Myers et al. 2012).

# **11.4 Public Health Action at a Local Level**

Locally, a public health-informed system would encourage cities to support lifestyles that benefit both humans and the environment. Steps to achieve this include the development of highly energy-efficient sustainable housing; available low-cost active transportation; and increased access to greenspaces. These measures would promote more resilience in human health, whilst also reducing urban pollution, greenhouse gas emissions, rates of diseases associated with poor air quality (Watts et al. 2015) and diseases associated with a sedentary lifestyle (e.g. cardiovascular disease, cancer, obesity, diabetes). Whilst we acknowledge that all such actions are vital to the public health professional's role, here we focus on access to biodiverse greenspaces.

Although cities are places where the benefits of nature have been historically disregarded in favour of clean and hygienic space (Keune et al. 2013), the concept of greenspace as a resource for public health is long-standing. Access to, and immersion with, nature was first championed in 1772 by the English politician, Joseph Addison and later by the founder of nursing, Florence Nightingale (1860). Many Victorian public parks were created as a public health resource (Wheater et al. 2007). Historically, the visual experiences of rural landscapes as a source of refreshment and renewal of physical, mental and spiritual health was thought to complement medical approaches, and this belief influenced the location of asylums in the 19th century (Hickman 2009). The tradition of therapeutic landscapes was suggested in 1992 by Wilbert Gesler (Bell et al. 2018), who described these as natural

environments, which interact with the social environment, to provide spaces of healing.

A complex set of transactions between accessing greenspace and participating in greenspace led Bell et al. (2018) to develop "palettes of place" from macro-scale areas (countryside, coasts and seaside), through meso-scale (urban parks and riversides) to micro-scale palettes (hospitals, clinic gardens, woods and allotments). Pauleit et al. (2003) make the point that greenspace needs not only to be accessible, but also of good quality. Quality influences the way nature is perceived, and the extent to which people participate in and use nature (Kaplan and Kaplan 1989; Pretty et al. 2005). The modern shift to engage nature has emerged from an ambition to use biodiversity to nurture human health. Hence, the appetite to determine the effect of a mere view of nature has evoked research in a range of settings, populations and activities to illustrate the therapeutic influence of the landscape. For example, Ulrich's (1984) seminal work exploring the restorative influence of views from windows on post-operative recovery of patients following cholecystectomy was one of the first influential studies to demonstrate the positive effects a view of nature can have on recovery. Ulrich reported that patients with a view of trees spent less time in hospital and required less analgesic than those without such views. It is worth noting that behaviour and cognition may also be moderated by naturalistic views: Kuo and Sullivan (2001) recorded reduced aggression associated with mental fatigue for residents in greener (naturebased) buildings, and Taylor et al. (2002) identified increased self-discipline (in girls at least) with increased natural views from home.

The ways in which exposure and engagement with nature for well-being has diffused into contemporary public health intervention strategies has been described in a series of models, which we have integrated and reformulated to incorporate the potential for biodiversity enhancement (Fig. 11.3). As a starting point, three distinct ways in which individuals engage with nature are described (Haubenhofer et al. 2010): (i) through outdoor activities such as walking as part of everyday life activities; (ii) through recreational activities such as the use of cycle paths and structured outdoor activities that could promote health; and (iii) nature being used as a therapeutic intervention within a 'green-care' context (left to right in Fig. 11.3). The latter includes, for example, those "nature-based therapy or treatment interventions specifically designed, structured and facilitated for individuals with a defined need" (Bragg and Atkins 2016: 18). Hence the 'nature, health and well-being sector' is a term used to describe green care and health promotion services. The levels of nature and extent to which nature can be used to support well-being is depicted from top to bottom of Fig. 11.3 as earlier described by Pretty et al. (2005), who note that at one level ("viewing nature"), an individual is simply exposed to an environment through vistas; a second level ("being in the presence of nature") involves greater participation in nature through activities such as walking or gardening (referred to as green exercise). The final level ("active participation in nature") is based on a more prescribed approach where activities are considered as "therapies", with an intention to treat, heal or alleviate through experiencing and interacting with nature. Since none of the existing models explicitly consider biodiversity, we have added consideration of how biodiversity links with each of the levels of engagement and how this may be enhanced to improve actual (as well as perceived) biodiversity. The intensity of the

**Fig. 11.3** Model of the interactions between level of engagement with nature, level of public health targeting (combining the models of Pretty et al. 2005; Haubenhofer et al. 2010; Annerstedt and Währborg 2011; Bragg and Leck 2017) with the additions of potential benefits due to enhanced biodiversity. Green care (shaded area) covers a range of targeted activities that overlap those developed through health promotion as well as specific health therapies

exposure to biodiversity varies depending on activity, and is likely to be higher when the participation is more active. For example, conservation volunteering may involve handling plant-life and soil, which brings people intimately in touch with biodiversity (soils can be extremely biodiverse even if they are not always perceived that way). Therapeutic gardens could be biodiverse, for example, through the variety in species required in the creation of a sensory garden. As per the Bragg and Leck (2017) extension to the existing models, well-being and the promotion of health are not static, and individuals often move across and within the nature, health and wellbeing sector (i.e. horizontally between health promotion and health therapy, and diagonally between different activities and therapies).

Box 11.1 is a case study that illustrates the variety of activities that can be supported in a community forest. This suggests multiple beneficial opportunities to access, engage with and, where prescribed, undertake as a therapy. Active participation probably has greater health benefits (Collins and O'Callaghan 2008), and more biodiverse environments can increase the therapeutic effects on humans (Annerstedt and Währborg 2011). Interventions that encourage people to support biodiversity, for example through choice of species when gardening, have the potential to simul-

#### **Box 11.1: Case Study**

#### **City of Trees**

#### *Jessica Thompson, Health and Well-being Lead, City of Trees, UK*

The City of Trees (City of Trees 2018) movement based in Greater Manchester is one of the UK's Community Forestry (England's Community Forests 2018) organisations and forms part of the Northern Forest concept (Braby 2018). City of Trees represents urban forestry, a term widely used in the USA and Northern Europe to define the 'art, science and technology' in relation to trees and plants that exist within an urban setting as well as the "physiological, sociological, economic, and aesthetic benefits trees provide society" (Konijnendijk et al. 2006). In its physical form, the urban forest includes all aspects of green infrastructure found within the urban setting at varying spatial scales, e.g. the mosaic of street trees, woodlands, parks, orchards, gardens, incidental greenspaces, etc. City of Trees advocates a natural capital approach to the benefits of green infrastructure, described as ecosystem services (Natural England 2009), such as biodiversity, climate change adaptation, recreation, health and well-being.

City of Trees strives to be a public facing movement. A team delivers campaigns and community engagement programmes, such as Green Streets (a neighbourhood-greening programme that facilitates community-based street tree planting, Fig. 11.4), community orchard creation and pocket woodland

#### **Fig. 11.4** A

neighbourhood greening programme that facilitates community-based street planting. (Photo credit: City of Trees)

#### **Box 11.1** (continued)

planting, giving people the power to bring nature, biodiversity and food growing to their neighbourhoods. Outreach initiatives such as Woodland Futures and Dementia Naturally Active aim to connect people to nature (Fig. 11.5) as well as tackle issues around social isolation, by providing nature-based activities for therapeutic and vocational rehabilitation. Green infrastructure gives people the opportunity to become stewards of ecosystem services (Andersson et al. 2014), and City of Trees aims to inspire social inclusion through its volunteer initiative, Citizen Forester, encouraging a wide range of audiences to take part in tree planting, woodland habitat management and citizen science recording of tree species. City of Trees also works strategically to strive for an environmental justice approach to developing high-quality green infrastructure, to encourage utility and recreational walking and cycling in support of healthier lifestyles. The work and outcomes of City of Trees has implications for public health priorities on prevention, self-care and early intervention to improve population health and health inequalities.

**Fig. 11.5** Outreach work with schools connects young people with nature. (Photo credit: City of Trees)

#### **Box 11.2: Case Study**

#### **Royal Horticultural Society: Plants for Bugs**

*Alistair Griffiths, Director of Science and Collections, Royal Horticultural Society, UK*

The Royal Horticultural Society (RHS) has identified that the UK's garden plants, gardeners and the 27 million gardens play a significant role in supporting biodiversity. They concluded that the best strategy for gardeners wanting to support pollinating insects in gardens is to plant a mix of flowering plants from different countries and regions. They also suggest that emphasis is given to plants native to the UK and the northern hemisphere (though exotic plants from the southern hemisphere can be used to extend the season). In addition, regardless of plant origin (native or non-native), the more flowers a garden can offer throughout the year, the greater the number of bees, hoverflies and other pollinating insects it will attract and support (Salisbury et al. 2015, 2017).

The RHS translated this research knowledge so as to reconnect people back with nature and encourage more people to put garden plants that attract wildlife into their gardens. An intervention such as this, which encourages people to support biodiversity through choice of species when gardening, has the potential to simultaneously improve both human health (by increasing exposure to biodiverse environments) and the health of the natural environment. The RHS worked with the UK horticultural industry and with the UK Government's National Pollinator Strategy and produced information for gardeners in the form of bulletins on-line (Royal Horticultural Society 2015).

The research findings were also used and disseminated through the RHS networks such as: through the Campaign for School Gardening with 34,000 schools; Britain in Bloom with 300,000 volunteers; and through shows, gardens, and retail, in order to help safeguard nature. The Plants for Bugs work (Fig. 11.6) showcases how scientific research and development, industry, gardeners and government can join together to inspire people to choose and grow garden plants for pollinator and biodiversity benefit. This creates a new ecosystem-service product line, which in turn increases plant sales and the economic bottom line for the horticulture industry, whilst encouraging and supporting biodiversity.

Pollination is a key ecosystem service that substantially contributes to the global food supply and human nutrition (Fig. 11.7). The RHS Pollinator plant lists have been widely adopted by the horticulture industry, and the government's National Pollinator Strategy (England) launched in November 2014 endorses RHS Plants for Pollinators and encourages gardeners to choose plants that provide resources for pollinators.

#### **Box 11.2** (continued)

**Fig. 11.6** Royal Horticultural Society Entomologist Andrew Salisbury using the Vortis bug sampler on the Plants for Bugs experimental plots at the Royal Horticultural Society Wisley Garden. (Photo credit: Royal Horticultural Society)

**Fig. 11.7** Female hoverfly (*Volucella zonaria*) on field scabious (*Knautia arvensis*) on the Plants for Bugs experimental plot. (Photo credit: Royal Horticultural Society)

taneously improve both human health and the health of the semi-natural environment (see Box 11.2).

Research over the last 20 years describes a range of nature-based activities that constitute green care and, crucially, the positive impact on health and well-being for people who may be vulnerable or socially excluded (Berget et al. 2012). The increased interest in such innovative approaches to well-being has led to a proliferation of terms used to denote nature-based work; consequently, the terms *green care* and *nature-based interventions* are often used interchangeably (Bragg and Atkins 2016). The spectrum of nature-based activities includes gardening, vistas and walking, food growing, community gardens, prescribed (for example, an imposed or recommended regimen) exposure to nature, nature-based activity or structured green care activities (Green Care Coalition 2017). Thus, social prescriptions using outdoor nature-based approaches, as available within the nature, health and wellbeing sectors, provide one way in which health professionals with a public health role might facilitate individuals to access biodiverse greenspace.

# *11.4.1 Towards an Emerging Salutogenic Paradigm?*

Salutogensis focuses on factors that support human health and well-being, rather than on those that cause disease (i.e. pathogenesis) (Antonovsky 1979). Predicated on the paradigm that health is a positive state of well-being rather than just "being well" and deterring ill health, salutogenesis originated through Antonovsky's (1979) asset-based approach, which endorses the skills, attributes and resources of individuals and communities to develop resilience and a sense of purpose. Hence, a salutogenic approach has influenced the move away from more medical, pathogenic models to provide a sense of coherence between health and illness.

The lack of proof of causality in the evidence base for biodiversity and human well-being has straitjacketed public health policy. This is because evidence-based commissioning, the process by which health interventions are funded on the basis of their proven effectiveness, requires strong evidence that the intervention (e.g. a green-care intervention) has a causal relationship with health (i.e. disease reduction). This is predicated on a medical evidence hierarchy in which a positivist paradigm prevails. Hence, commissioners may be reluctant to support services lacking experimentally-derived evidence and have been slow to embed salutogenic approaches within health-care policy. However, taking a more proactive and structured approach to the use of nature-based interventions, particularly those involving biodiverse environments, has the potential to influence public health discourse and morph into an emerging salutogenic paradigm. Such interventions may be cost effective by reducing the economic burden on health-care systems; however, in order to demonstrate this, it is essential to develop evaluation methods that can adequately define these health and economic benefits. Evaluation methods need to engage with the complexity rather than attempt to reduce it to measurable outcomes, as is recognised by the UK Medical Research Council's guidance on evaluating complex interventions (Craig et al. 2011). Such methods might include natural experiments/quasi-experiments analysed using stepped wedge or interrupted time-series analyses (Hu 2015), and should include a process evaluation to take into account the varying contexts in which the intervention takes place (Moore et al. 2015).

The shift from a medical model has encouraged a rethink of care and care provision and has latterly become established within a 'Social Prescribing' movement. As a non-medical approach, social prescribing interventions promote personcentred and asset-based approaches for people with diverse needs (Polley et al. 2017). Social prescribing can support communities and individuals by placing the "individual or service user in the driving seat so it creates the opportunity for real and lasting behaviour change because it involves learning and making choices" (Jackson 2016: 14). Also referred to as community referral or asset-based, personcentred approaches, there is no agreed single term used to describe social prescribing. Significantly, its definition may be difficult to hone as it is part of a larger social movement, initiated by the UK National Endowment for Science, Technology and the Arts (NESTA), based on 'people-powered health' designed to help reduce health inequalities, as highlighted in the influential UK Marmot Report (2010).

A social prescription enables a health professional to collaborate with a link worker or community navigator who facilitates a person-centred conversation to design the participant's own solutions to well-being (Bertotti et al. 2018). This wellbeing conversation can prevent unnecessary GP attendance, reduce hospital emergency admissions, reduce social isolation, and help support individuals with a range of conditions (Kimberlee et al. 2014; Chatterjee et al. 2017). Approaches to social prescribing range from long-term condition management to volunteer opportunities with a focus on well-being through supported activities (Dayson et al. 2015). Since 2013, four models of social prescribing have emerged: (i) signposting; (ii) linking with specific projects; (iii) joint partnerships; and (iv) holistic referrals (Kimberlee 2013). This includes, but is not exclusive to, therapeutic horticulture- and arts-based approaches. The ways in which these activities occur are diverse and reflect the contemporary public health approach adopted mainly within third-sector organisations, community groups and charities, rather than commissioned health services.

Examples of nature-based social prescribing interventions range from arranged walks in forests to conservation volunteering and more structured 'green-care' activities such as those observed within therapeutic gardens, all of which fit within the frameworks summarised in Fig. 11.3. Since the more active one becomes with nature, the more likely the exposure to biodiversity, health professionals should work with appropriate bodies to maximise biodiversity enhancement of naturebased social prescriptions. The case study in Box 11.2 explicitly brings people into contact with biodiversity for the benefit of the health of participants and the planet.

# **11.5 Use of Biodiverse Natural Environments to Reduce Inequalities in Health**

A major drawback in using greenspace to improve public health is that those who are socially disadvantaged are least likely to have access to good quality greenspace. The health benefits from biodiverse environments tend to be disproportionately experienced by the most advantaged sectors of society (Diaz et al. 2006). This is a social justice issue: the wealthy have less need of the health benefit; they tend to already possess greenspace by having the financial resources to live in greener areas and to own private greenspace; they may travel more extensively to areas of natural beauty; they are more likely to exercise/make use of the greenspace; and finally, they are more likely to displace less advantaged communities from newly greened, previously brownfield sites (i.e. in a process of gentrification).

Estimates of health impacts due to SES can be made at a geographical area level, where for a given area the average SES status is known and health data are available. At such geographical areas (carried out at the neighbourhood level, approximately 1,500 persons), it is also possible to measure aspects of the natural environment using geographical information system databases. These area-level analyses show that greenspace is positively associated with health, even after accounting for SES, e.g. in Holland (de Vries et al. 2003) and the UK (Mitchell and Popham 2008; Dennis et al. 2018). Indeed, the impact of greenspace on health is greater for those in the most deprived neighbourhoods (de Vries et al. 2003; Mitchell and Popham 2008). Specifically, Mitchell and Popham (2008) demonstrated that proximity to greenspace reduced health inequalities, and that this effect was stronger in the neighbourhoods with the lowest SES (Fig. 11.8).

Good access to greenspace in the local environment can disrupt the expected link between relative poverty and ill health (Mitchell et al. 2015). However, Wolch et al. (2014) warn that policies promoting greening of areas for those community areas most in need of such a disruption of health inequality may lead to gentrification and a displacement of the very people most in need. They advocate a balance of greening "just enough" to provide benefits without too great a disruption to planning and development. More research will be needed to determine whether this is appropriate, feasible and at what level it should be implemented.

Residing near to greenspace may not guarantee the full benefits of the natural environment, and in areas where greenspace is more fragmented a more targeted approach might be needed to bring people into contact with nature. This is where the nature, health and well-being sector could target those in socially-deprived neighbourhoods (by using social prescriptions for nature-based interventions) to fit within a public health strategy that aims to reduce inequalities in health.

**Fig. 11.8** Incidence rate ratios for all-cause mortality (**a**) and deaths from circulatory disease (**b**) in income-deprivation quartiles 2–4, relative to income deprivation quartile 1 (least deprived), stratified by exposure to green space. Bars are grouped according to population exposure to green space. Error bars indicate 95% CIs. The total mortality and deaths from cardiovascular disease decreases with increasing greenspace in the environment. In each category of greenspace, relative to the most wealthy (incidence ratio of 1), there is increasing mortality with decreasing income. However, this disparity is far less apparent in the greenest areas, with the least well off group appearing to benefit the most. (Source: Mitchell and Popham 2008)

# **11.6 Conclusion**

Human health is intricately linked with the natural environment. Preservation of the variety of life on the planet is essential to maintain the complex interdependencies between ecosystems and human life. Biodiversity, because of its fundamental relationship with ecosystems services, helps to mitigate the effects of climate change, but is itself at risk of loss due to climate change. Arguably the single biggest priority for public health at a strategic international level is to work across governments and countries to protect biodiverse natural resources and introduce measures to stem climate change. Moreover, public support for such an endeavour is likely to be higher if the enormous impact on the health of the human population is emphasised as the outcome of a successful strategy to protect biodiversity and tackle climate change.

Public health professionals need to work on a large scale to support maintenance, enhancement and development of accessible, biodiverse greenspace. Public health leaders should work within governments to ensure that health considerations are incorporated into environment and sustainability strategies, and vice versa. Such strategies should be cognisant of the fact that populations that suffer from poverty and ill health are disproportionately more likely to also suffer from a lack of biodiverse natural environments. While these populations are a priority target for interventions to improve biodiversity, care should be taken that these efforts, by making the environment more pleasant, healthy and desirable, do not cause poorer populations to be displaced.

Public health practitioners are responsible for devising strategies to promote sustainable lifestyles and facilitate access to natural environments. Access to natural environments should be targeted at those most in need. There is an urgent need to embrace the fact that the natural environment is salutogenic, i.e. health giving. There is an equally urgent need to relax the usual positivistic standards of evidence of effectiveness required in medical intervention, and to utilise more suitable methods to evaluate nature-based solutions, for example, using quasi-experimental or mixed methodologies. This will allow more confident investment in schemes that prioritise access to nature over medical intervention. A significant driver for local decision-makers is the anticipated reduction in health-care costs, since improved outcomes will prevent costly use of doctors and hospitals. Such schemes, including nature-based social prescribing, give local commissioners of services the opportunity to target those from socio-economically deprived areas. Those with responsibility for social prescribing should be encouraged to use prescriptions that bring people into contact with nature, preferably where that engagement is active rather than passive. Further, it is likely that interventions resulting in exposure to environments with greater biodiversity will offer the greatest benefits for human health.

Whatever the scale, biodiversity has a fundamental role to play in human health and well-being. Public health professionals need to embrace biodiversity as a resource and be willing to fight to protect it. In so doing, they can target vulnerable populations and reduce inequalities in health between the richest and the poorest in our society.

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The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

# **Chapter 12 Biodiversity and Health: Implications for Conservation**

**Zoe G. Davies, Martin Dallimer, Jessica C. Fisher, and Richard A. Fuller**

**Abstract** The human health and well-being benefits of contact with nature are becoming increasingly recognised and well understood, yet the implications of nature experiences for biodiversity conservation are far less clear. Theoretically, there are two plausible pathways that could lead to positive conservation outcomes. The first is a direct win-win scenario where biodiverse areas of high conservation value are also disproportionately beneficial to human health and well-being, meaning that the two sets of objectives can be simultaneously and directly achieved, as long as such green spaces are safeguarded appropriately. The second is that experiencing nature can stimulate people's interest in biodiversity, concern for its fate, and willingness to take action to protect it, therefore generating conservation gains indirectly. To date, the two pathways have rarely been distinguished and scarcely studied. Here we consider how they may potentially operate in practice, while acknowledging that the mechanisms by which biodiversity might underpin human health and well-being benefits are still being determined.

**Keywords** Extinction of experience · Green space · Human-wildlife interaction · Nature connectedness · Protected areas · Well-being

M. Dallimer

Z. G. Davies (\*) · J. C. Fisher

Durrell Institute of Conservation and Ecology (DICE), School of Anthropology and Conservation, University of Kent, Canterbury, Kent, UK e-mail<EMAIL_ADDRESS><EMAIL_ADDRESS>
Sustainability Research Institute, School of Earth and Environment, University of Leeds, Leeds, UK e-mail<EMAIL_ADDRESS>
R. A. Fuller School of Biological Sciences, University of Queensland, St Lucia, QLD, Australia e-mail<EMAIL_ADDRESS>
#### **Highlights**

# **12.1 Green Spaces Managed Primarily for People**

Green spaces may support dramatically different levels of biodiversity, depending on their location, history, purpose and use by people. At one end of the spectrum are the green spaces that have been designed with human health and well-being primarily in mind. Historically, these areas were planned to provide inhabitants with relief from the unsanitary conditions that prevailed in overcrowded industrialised cities (Rayner and Lang 2012) and, while constructed from nature in the form of vegetation, there was no explicit consideration of whether these areas provided valuable habitats for species. Indeed, this anthropocentric view of managing natural resources for the benefit of people has re-emerged over the past two decades, with an emphasis on finding nature-based solutions to issues such as heat mitigation, pollution reduction and storm water protection (e.g. MA 2005; TEEB 2010; European Commission 2011; European Commission Horizon 2020 Expert Group 2015). This is particularly true for urban areas where the majority of the human population across the world live, and improving the health and well-being of these city dwellers is a priority in many national and international policy agendas (European Commission Horizon 2020 Expert Group 2015).

Urban areas are often characterised from a conservation perspective by the negative impacts they have on the ecosystems they replace and abut (e.g. see the discussion in Gaston 2010). Green spaces within cities are often considered too small and isolated from one another to sustain viable species populations (Goddard et al. 2010), requiring a collaborative effort on the part of different stakeholders to redress the lack of connectivity (Davies et al. 2009; Dearborn and Kark 2010). One legacy associated with green spaces intended to deliver aesthetic and recreational benefits is the simplification of habitats as a consequence of frequent management (e.g. mowing, pruning of trees and shrubs, removal of deadwood; Aronson et al. 2017). Likewise, the desire to maximise the multi-functionality of green spaces and infrastructure (e.g. green roofs, sustainable urban drainage systems) has perpetuated this problem further through the planting of horticultural cultivars rather than native species (Haase et al. 2017). While some of these initiatives can support biodiversity (e.g. non-native flowering species can be beneficial for some bees; MacIvor and Ksiazek 2015; Salisbury et al. 2015), the use of horticultural cultivars has been linked to a reduction in the forage value of planting for pollinators in general (Bates et al. 2011; Salisbury et al. 2015). Moreover, the spread of alien invasive species from gardens and parks is another significant issue in many parts of the world (Reichard and White 2001; Russo et al. 2017). The conservation value of green spaces that are popular with people can also be limited by significant levels of disturbance and degradation, which prevent native species from colonising and persisting (Brown and Grant 2005), and result in assemblages dominated by adaptable generalists (Kowarik 2011) and the homogenisation of urban biodiversity (McKinney 2006). Even for human-nature interactions that people perceive as being good for wildlife, such as the supplementary feeding of wild birds, we have little evidence as to whether they deliver biodiversity conservation benefits (Fuller et al. 2008; Robb et al. 2008; Jones 2018).

Despite this, suitable habitat within urban areas can support threatened and specialist species, and warrant conservation attention (Baldock et al. 2015; Ives et al. 2016). In developed regions, where intensive use of the wider landscape, particularly through agriculture, has resulted in species declines, urban areas have become important for sustaining regional abundances of some species. Substantial proportions of the populations of some previously widespread and common species now occur in urban green spaces (e.g. Beebee 1997; Gregory and Baillie 1998; Mason 2000; Bland et al. 2004; Peach et al. 2004; Speak et al. 2015; Ives et al. 2016; Tryjanowski et al. 2017). For instance, over 600 species have been recorded in Weißensee Jewish Cemetery in Berlin. It supports 25 plants, five bats and nine birds that are species of conservation concern, and one of the lichens (*Aloxyria ochrocheila*) present on the site is considered very rare across the wider region. The cemetery therefore acts as an unintended refuge for a wide range of taxa (Buchholz et al. 2016).

# **12.2 Green Spaces Managed Primarily for Biodiversity**

At the other end of the green space continuum are formal protected areas, now interpreted as a global conservation network, where the objective is to maintain and enhance biodiversity (see MacKinnon et al. Chap. 16, this volume). Currently, there are more than 200,000 protected areas globally, after a huge expansion of the network over the past few decades (Watson et al. 2014, Butchart et al. 2015). Some of the earliest protected areas were preferentially designated in locations used heavily for recreation (Pressey 1994), and some protected areas are still managed with access and use by people as a primary management goal, such as many of the National Parks in the UK (Smith 2013). However, this is usually the exception rather than the rule for three inter-related reasons.

First, protected areas have overwhelmingly been established in areas not needed for economic activity (Pressey 1994), so they are often sited at higher elevations, on

steep slopes, on relatively unfertile soils and far away from cities and productive agricultural land (Pressey et al. 2002; Joppa and Pfaff 2009). Typically, the human population density is low in these areas and, as such, they are shielded from use by people by default. Indeed, the physical distance between human settlements and the location of protected areas can impose a substantial barrier to their recreational use (Kareiva 2008). Protected areas that are close to or within towns and cities tend to be smaller, more fragmented and in poorer ecological condition than those in remote locations (Jones et al. 2018).

Second, there has been a growing emphasis in recent years on proactive conservation strategies, such as those that aim to safeguard the last of the world's major wilderness areas (Sanderson et al. 2002; Mittermeier et al. 2003; Watson et al. 2017). This is based on the recognition that the predominant threats to biodiversity spread contagiously across landscapes (Boakes et al. 2010), suggesting that if an area can be protected while it is still intact, the risk of eventual habitat clearance or degradation is much lower (Klein et al. 2009). By definition, the absence of a high density of people, and the pressure they bring to bear on landscapes, is a key component of wilderness quality (Venter et al. 2016), thus further building a case for protected area designation in places away from human settlements.

Finally, there is often tension among management agencies about permitting recreation inside protected areas that have been designated for biodiversity conservation, with many viewing the two things as incompatible and preferring that people are actively excluded (Smith 2013). A prime example of this is mountain biking where, arguably, the impact on biodiversity is usually minimal, but is perceived as being much greater by managers and other types of green space user (Hardiman and Burgin 2013). A further complicating factor is that funds for managing protected areas for recreation are often derived from different sources to those centred on biodiversity (Miller et al. 2009). This means that interagency cooperation might be needed to effectively provide facilities for human use, or zoning configurations that minimise recreational pressures (Stigner et al. 2016). This can require substantial investment to deliver and be complex to achieve.

In spite of the historical bias where most protected areas are located away from regions of intense human activity, there is some evidence that new protected areas are now being established in closer proximity to towns and cities. Global biodiversity targets mandate protecting threatened species and landscapes that currently lack formal designation (Butchart et al. 2015), and many of the remaining high conservation value areas occur in fragmented landscapes nearer to human settlements (Brooks et al. 2006; McDonald et al. 2008). For example, recently established Australian protected areas are being preferentially sited in places with high human population density and large numbers of threatened species (Barr et al. 2016). Likewise, 32 cities within the European Union contain Natura 2000 sites (ten Brink et al. 2016).

Some protected areas have successfully integrated human health and well-being objectives into their remit more proactively. For instance, Secovlje Salina Nature Park in Slovenia hosts the Lepa Vida Spa, which has generated jobs and income in both the tourism and health sectors. In turn, this has provided better public access to the park for 50,000 annual visitors, and the habitat quality of the protected area, which is important for supporting migratory birds, has been improved (ten Brink et al. 2016). Similarly, Medvednica Nature Park in Zagreb attracts over a million visitors annually, while also being home to over 20% of Croatia's entire vascular flora, including more than 90 strictly protected species. Additionally, the park plays a role in improving air quality and mitigating urban air temperatures in neighbouring city suburbs (ten Brink et al. 2016).

# **12.3 Moving Forward with Green Spaces Planned for Both People and Biodiversity**

Presently, although there are few sites explicitly designed and managed to deliver conservation and human health gains in tandem, the potential for synergistic benefits could be substantial. The opportunities to adopt such a strategy are considerable, given the rapid rates of urbanisation globally and that many regions are yet to be developed (Nilon et al. 2017). Urbanisation will not be geographically homogenous, chiefly taking place in small cities comprising less than 500,000 inhabitants across the Global South (United Nations 2015). This vast conversion of land to built infrastructure will undoubtedly pose a threat to biodiversity, not least because most of it will occur in extremely biodiverse regions such as the Brazilian Atlantic Forest and Guinean Forests of West Africa (Seto et al. 2012). Formal conservation protection is therefore imperative to prevent extinctions (Cincotta et al. 2000; Brooks et al. 2006; Venter et al. 2014). Justifying the need to protect natural environments in and around where people live to deliver a multi-faceted suite of objectives is more likely to be persuasive to decision-makers than a rationale based solely on conservation. In already established towns and cities, green spaces can be 'retrofitted' to provide complementary conservation and human health gains (for further information, see Hunter et al. Chap. 17, and Heiland et al. Chap. 19, both this volume). For example, initiatives such as the Biophilic Cities network (http://biophiliccities.org/) promote biodiversity as a central tenet of urban planning and management, so that improvements in human health and well-being arise from co-existence (Beatley and van den Bosch 2018). Metrics related to levels of biodiversity, wildness, tree cover and green space accessibility are included as indicators against which the performance of individual cities can be gauged.

Although not studied extensively thus far, there is evidence to suggest that positive human health and well-being outcomes might be related to specific and often complex natural environments, which could be of conservation value. For instance, people enjoy forests because of their quiet atmosphere, scenery and fresh air, which helps with stress management and relaxation (Li and Bell 2018). In Zurich, Sihlwald Forest is a major recreation area for the city. Formerly a timber concession, the ecosystem is now left to function with minimal human intervention and, therefore, offers residents a different sort of nature experience to more manicured green spaces (Seeland et al. 2002; Konijnendijk 2008).

The decisions regarding where green spaces should be located and how they are managed are complex, with conservation value being one of many factors that must be taken into consideration. Inevitably, biodiversity will be traded off against other economic and societal goals (Nilon et al. 2017). However, maximising the size of green spaces planned for both people and biodiversity is likely to be important for their success. While it is widely accepted that larger areas are likely to sustain more species (Beninde et al. 2015), evidence is growing to suggest that the same might be true for the supply of human health and well-being benefits. For instance, larger forested areas are preferred for outdoor activities (Tyrväinen et al. 2007).

Another core challenge associated with maximising the human health outcomes derived from experiencing nature is making sure that biodiversity is in the right locations for the right people. This is critical because the likelihood of someone visiting a site drops dramatically with distance, with only the fraction of the population that is already strongly connected to nature willing to travel to experience it (Shanahan et al. 2015). Indeed, cities are often characterised by a wide array of inequalities, with those living in deprived communities having the most to gain from using nearby green spaces (Mitchell and Popham 2008; Kabisch Chap. 5, this volume; Cook et al. Chap. 11, this volume). If the health and well-being of all urban residents were prioritised, then one would expect publicly owned green spaces to be more or less evenly distributed across the spatial extent of towns and cities (Boone et al. 2009; Landry and Chakroborty 2009; Pham et al. 2012). On the other hand, if green spaces were being used actively as an intervention to promote better human health and well-being, their placement would mostly likely be adjacent to communities characterised by a high prevalence of health disorders, such as depression and obesity (Lin et al. 2014). However, either is rarely the case, as individuals from ethnic/racial minorities (Heynen et al. 2006; Landry and Chakroborty 2009; Wolch et al. 2013) and/or lower socio-economic status (Vaughan et al. 2013) have comparatively worse access to high-quality green space than the rest of the population. It is therefore vital to ensure that the health benefits that might be derived from conservation initiatives are not just confined to societal groups that have the financial and/or social means to access them (Wolch et al. 2014).

# **12.4 Experiencing Nature to Promote Conservation**

It is commonly asserted that urbanisation has led to the human population becoming progressively disconnected from the natural world (Wilson 1984; Pyle 2003; Miller 2005), a phenomenon that has variously been referred to as the 'extinction of experience' (Miller 2005), 'nature deficit disorder' (Louv 2008) and 'ecological boredom' (Monbiot 2013). By exposing people to nature, it is thought that these experiences can enhance an individual's connection with nature and, in turn, promote conservation concern and pro-environmental behaviours (see Soga and Gaston 2016; De Young Chap. 13, this volume). For instance, Rogerson et al. (2017) found relationships between people experiencing nature and positive environmental behaviour, such as volunteering with conservation organisations. Likewise, childhood experiences of nature have been linked to connectedness to nature in a study of French adults (Colléony et al. 2017), and individuals who grew up in rural areas demonstrated a greater preference for gardens containing more flowers and woodland species than urbanities (Shwartz et al. 2013). Nonetheless, the evidence underlying the relationship between nature experience and positive attitudes/behaviours remains scant and is yet to be fully established (Soga and Gaston 2016).

Individuals may not need to experience biodiversity to want to conserve it (termed 'existence value') (Cooper et al. 2016). This has been shown for coastal ecosystems on Vancouver Island, Canada (Klain and Chan 2012) and marine protected areas in the UK (Kenter et al. 2016), and can be a potential mediator between nature connectedness and well-being (Cleary et al. 2017). Additionally, it is difficult to draw meaningful lessons from studies due to the level of inconsistency between the definitions of what constitutes an experience, what comprises nature, and what attitude or perception is being measured (Clayton et al. 2017; Ives et al. 2017). Moreover, the 'extinction of experience' concept is considered oversimplified because it fails to acknowledge the multi-dimensionality of people's experiences of biodiversity (Clayton et al. 2017), and that some interactions with species can be negative, frightening or uncomfortable (Bixler and Floyd 1997). Relationships with nature are likely to be highly specific to individuals, with cultural contexts and norms also being important and variable across societies (Voigt and Wurster 2014). For example, feeding wild birds is a very popular human-biodiversity interaction in both the UK and the USA (Freyfogle 2003; Defra 2011), but negative associations with birds in Europe may inhibit a connectedness to nature for some individuals (Ratcliffe et al. 2013). Similarly, a fear of birds (known as 'ornithophobia') in Honduras has been reported to occur where birds are perceived as either pest species or as negative spiritual symbols (Bonta 2008). This is a fundamental consideration when designing and maintaining green spaces, as synergistic human health and conservation benefits will not be delivered successfully if the residents are intolerant of the biodiversity they support.

# **12.5 Conclusion**

While very few green spaces are implemented explicitly with both conservation and human health and well-being in mind, the potential for delivering win-win outcomes is considerable. This is particularly apposite, given the rate and distribution of future urbanisation predicted across the highly biodiverse regions of the Global South. However, the rapidly growing body of research examining nature-related health benefits has yet to tease apart the relative value of green spaces that support different levels of biodiversity and ecosystem complexity. This knowledge gap needs to be addressed, so a strong evidence-base is in place to inform effective policy and practice.

**Acknowledgements** We are grateful to our respective funders: ZGD is supported by the European Research Council (ERC) Consolidator Grant 726104; MD is supported by the UK Natural Environment Research Council (NERC) grant NE/R002681/1; JCF is supported by the UK Economic and Social Research Council (ESRC) scholarship ES/J500148/1; and, RAF is supported by an Australian Research Council Future Fellowship.

# **References**

N, Rondinini C, Segan D, Skolnik B, Spalding M, Stuart SN, Symes A, Taylor J, Visconti P, Watson J, Wood L, Burgess ND (2015) Shortfalls and solutions for meeting national and global conservation area targets. Conserv Lett 8:329–337

Joppa LN, Pfaff A (2009) High and far: biases in the location of protected areas. PLoS One 4:e8273

Kareiva P (2008) Ominous trends in nature recreation. Proc Natl Acad Sci U S A 105:2757–2758

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# **Chapter 13 Supporting Behavioural Entrepreneurs: Using the Biodiversity-Health Relationship to Help Citizens Self-Initiate Sustainability Behaviour**

#### **Raymond De Young**

**Abstract** Techno-industrial societies face biophysical limits and the consequences of disrupting Earth's ecosystems. This creates a new behavioural context with an unmistakable demand: Citizens of such societies must turn from seeking new resources to crafting new living patterns that function well within finite ecosystems. This coming transition is inevitable, but our response is not preordained. Indeed, given the complex, multi-decade-long context, the required pro-environmental behaviours cannot be fully known in advance. Furthermore, the urgency to respond will necessitate that whole clusters of behaviour be adopted; incremental and serial change will not suffice. Thus, a culture of small experiments must be nurtured. The process of change will seriously tax social, emotional and attentional capacities. Thus, priority is placed on emotional stability and clear-headedness, maintaining social relationships while stressed, pro-actively managing behaviour and a willingness to reskill. These aspects of coping share a common foundation: the maintenance of attentional vitality and psychological well-being. Changes also must occur in how pro-environmental behaviours are promoted. We must move beyond interventions that are expert-driven, modest in request, serial in implementation and short-term in horizon. New interventions must create the conditions under which citizens become behavioural entrepreneurs, themselves creating, managing and sharing successful approaches to behaviour change.

**Keywords** Behavioural entrepreneurs · Behavioural aesthetics · Biophysical limits · Behaviour change · Energy descent · Mental vitality

#### **Highlights**

• Biophysical limits and climate disruption have created a new behavioural context.

R. De Young (\*)

School for Environment and Sustainability, University of Michigan, Ann Arbor, MI, USA e-mail<EMAIL_ADDRESS>

# **13.1 Introduction**

How ever vast were the resources used to create techno-industrial society, they were never limitless. And how ever massive was the waste sink that these societies made out of the atmosphere, it is no longer able to absorb their wastes. Biophysical limits and the consequences of having disrupted the Earth's ecosystems lead to an unmistakable outcome: starting this century, citizens of these societies will consume fewer resources and live more simply. Unfortunately, their current worldviews, goals and behaviours are not prepared for this new reality.

Certainly, it is possible to live at a dramatically lower energy and material flux. Indeed, almost all of human history occurred within a pre-industrial low-energy context, and such an existence is commonplace for much of the current global population. However, the comforts and conveniences of techno-industrial society are unlikely to be possible under the new biophysical context outlined below. Thus, the focus of this chapter is on helping the citizens of such a society weather their inevitable transition to a more frugal existence, and it is the experiences and behaviours of those individuals to whom this chapter will refer.

A decline in resource availability occurring alongside a need to respond to climate disruption will upend life patterns and is not welcomed by reasonable individuals. Nonetheless, this looming reality is as well documented as it is stark. Consider that, near the end of this century, addressing climate disruption alone requires that we produce below a tenth of current greenhouse gas emissions, and probably requires a comparable reduction in consumption of energy and materials. The environmental community has long argued for significant reductions in consumption and emissions, but never have order-of-magnitude changes been envisioned.

Our species' adaptive, entrepreneurial nature suggests that we might respond well to this new reality under certain conditions. The needed changes will place a priority on clear-headedness, the ability to thoughtfully plan and manage behaviour and a willingness to continuously build new competencies. These capacities, in turn, depend on mental well-being (see Part II, this volume). After introducing how the new biophysical context has created a new behavioural context, this chapter suggests how to help people to respond well to this new reality.

# **13.2 New Biophysical Context**

Numerous vulnerabilities have been uncovered within the techno-industrial development approach adopted in many parts of the globe (Meadows et al. 1972, 2004). Tainter (1988) evaluated 11 ways that societies might succumb to constraints and, in the process, identified a new vulnerability. Tainter's concept, the risk of diminishing marginal returns from increasing social complexity, is a social version of the economic principle of diminishing returns. In essence, societies solve the problems they face through an increasing investment in social and/or political complexity. However, this approach eventually becomes too costly to maintain and the society adopting that problem-solving approach becomes unsustainable.

Without providing an exhaustive account of all vulnerabilities, it is nonetheless possible to establish our predicament by considering a basic idea. Like all living systems, techno-industrial civilisation has a metabolism: resources are consumed, work done and waste products discharged. It is sufficient for the purpose here to follow just one of many metabolites, hydrocarbons, starting as a source of energy, consumed in the creation and support of social services and eventually becoming a waste. On the input side, the system vulnerabilities are from limits-to-growth (Jackson and Webster 2016; Turner 2008, 2012), a notion that has lingered on the fringe of environmental discourse. Most reactions to the fact of biophysical limits to material growth have varied within a narrow range between dismissive and derisive. However, an expected end to energy-fueled growth is receiving renewed attention from both ecologists and economists (Bardi 2014, 2011; Daly and Farley 2010; Hall and Day 2009). One aspect of hydrocarbon-based limits-to-growth, that of declining net energy, is particularly troublesome and discussed below. On the output side, the waste involves carbon-based emissions that create the well-documented disruptions to the climate system (Hansen et al. 2017). Taken together, these highlight a radically changed biophysical reality where, as McKibben (2010) contends, the planet onto which we were born has been so altered that it is not the world on which we now live.

# *13.2.1 Surplus Energy Decline*

Social systems voraciously consume energy in the course of doing their work. Thus, for social services (e.g. infrastructure, manufacturing, maintenance, provisioning, education, governance, health-care, travel, tourism, entertainment) to continue functioning, there must be a net surplus of energy generated elsewhere. Maintaining a sufficient surplus is becoming increasingly difficult. The issue here has many technical aspects but is also commonsense; it takes energy to get energy and transform it into socially usable forms. Prosperity in techno-industrial society derives from there being a significant surplus available after deducting from the total energy extracted, the amount used to get it (Morgan 2016). One concern that highlights the new biophysical context is a decline in energy-returned-on-energy-invested (EROEI), which is one way to measure surplus energy. EROEI was first studied by Odum (1973); it is a foundation of biophysical economics (Cleveland et al. 1984) and energy analysis (Cleveland 2005; Hall 2011, 2012; Hall and Klitgaard 2011), and is proving useful in macroeconomic analysis (Fagnart and Germain 2016). The low-hanging fruit metaphor explains EROEI. Initially, extraction occurs at more attractive locations containing high-quality resources that are easy to extract, process and deliver. Later, resources are found at inhospitable sites, are of lower thermodynamic quality and are harder to recover, refine and transport. Harder here ultimately means consuming ever-greater amounts of energy in order to extract energy. This is a logical pattern – pursue the easiest to get first – but results in a decline over time in surplus energy (Murphy 2014).

Early on, a massive surplus of energy misled us with the false promise of endless physical growth. False because, although it largely went unnoticed, surplus energy was on an unrelenting decline (Hall 2012, 2017; Heinberg and Fridley 2016; Morgan 2016). The minimum EROEI needed to support a techno-industrial society is being explored by Hall and his colleagues (Hall 2011, 2012; Hall et al. 2009; Guilford et al. 2011). In their analysis, it matters enormously what social services are deemed necessary. As the features included in the definition increase, so too does the EROEI ratio needed to support that society. Historically, EROEI was calculated at the energy source – the wellhead – and included only the energy consumed by the hydrocarbon exploration and production industry. In order to make this concept useful for social decision-making, Hall et al. (2009) developed an analysis that accounts for the many indirect energy costs experienced when providing any particular service to society. This is the surplus energy needed by citizens, organisations or communities pursuing their everyday activities and is reported as the extended-EROEI ratio. This research is still maturing but its general conclusions are firm. Declining surplus energy at the societal level is bringing ever closer the day when the resources at our disposal will be insufficient to maintain growth in, and perhaps the full maintenance of, the personal, social and urban systems to which we have become accustomed.

Thus, considering just one aspect of one input to techno-industrial society's metabolism reveals a significant vulnerability. All is well so long as there is a significant surplus of energy. However, over time that surplus is getting smaller.

# *13.2.2 Climate Disruption*

Climate disruption, a consequence of the rapacious use of hydrocarbon-based fuels, is empirically established and settled science; the evidence is unequivocal. Profound changes to the earth's thermal patterns are occurring (IPCC 2014) and appear to be accelerating (Herring et al. 2018). Furthermore, what were once worst-case and decades-distant consequences are now taking place (Hansen et al. 2017). There is hope that the Rio/Kyoto/Copenhagen/Cancun/Durban/Doha/Warsaw/Lima/Paris negotiating process has finally created a nascent global response. Nevertheless, few people are so optimistic as to believe this response will allow techno-industrial society to continue unchanged or for the planet to return to its preindustrial climate.

Even if the improbable happens (i.e. greenhouse gas emissions are immediately and entirely eliminated) there is enough warming baked into the system to disrupt the climate well into the next century. Apparently, the best to expect is eventually to stabilize the disruption that industrialisation caused. Scenarios that keep atmospheric CO2 concentration levels below 450 ppm by 2100 (essential for keeping global temperature rise below a barely tolerable 2°C) all require quickly initiating and then indefinitely sustaining reductions in emissions (IPCC 2014). Achieving stabilisation at that level requires reductions that are frankly brutal: 40–70% lower global emission by 2050, with higher percentages required from techno-industrial countries and near zero global emission levels by 2100. Never before have we contemplated making such a massive reduction and then to maintain, if not deepen, that reduction forever.

The bleak nature of this new biophysical context is not easily contemplated. Thus, persuasively establishing its inevitability should only be done when serving a worthy purpose. The reason for stating this premise is the expectation that we will soon, one way or another, be consuming far fewer resources. The greater purpose in this chapter is to focus our efforts on discovering the conditions necessary to help citizens to pre-familiarise and pre-adapt themselves to this new reality before being forced to do so by biophysical circumstances.

# **13.3 New Behavioural Context**

During a historically brief period of material affluence, it has been possible to ignore the biophysical foundation of civilisation. Behavioural scientists could focus on improving physical, mental and social well-being while remaining ignorant of resource constraints. During this time conservation psychology developed effective interventions for promoting environmental stewardship (Clayton 2012; Hamann et al. 2016) and responding to global climate change (Clayton et al. 2015). Recently, however, it has been questioned whether a consumer-focused, fossil-fueled technoindustrial society *can ever* be made sustainable (Bardi 2011; De Young 2014; Monbiot 2015; Princen 2014; Princen et al. 2002; Turner 2008, 2012).

# *13.3.1 A Predicament, Not a Problem*

This new behavioural context cannot be framed as a problem, at least not in the common definition of that word. It is a predicament, an unsolvable situation that will play out over many decades, perhaps through this century and into the next. If it were a problem, we would seek a solution and by applying that solution we would

return to normal (Greer 2008). In contrast, predicaments have no solution; instead, they must be endured. Society can respond, but even an effective response does not eliminate the predicament. A useful response does not alter but rather accommodates the new situation. This is adaptation in a classic sense: to change behaviour into new forms that better fit a new reality.

If we faced a problem (e.g. emergency, crisis) then we might be advised to weather the storm until we 'get back to normal'. However, even a functional response to a predicament is unlikely to get us back; accommodation is about 'getting to a new normal'. The new behavioural context is also different in another significant way. Responses will need to be broadly applied across one's entire behaviour pattern, then maintained and even expanded throughout a lifetime. Unfortunately, society has little familiarity with the long-drawn-out behavioural planning and management needed to respond in this way. For while we know behaviours adequate for addressing short-term challenges to health and well-being, there exists little guidance for behaviour change necessary for addressing a many decade- or century-long predicament.

# *13.3.2 Changing Multiple Behaviours*

Early conservation research focused on promoting one or a small suite of behaviours (Hamilton et al. 2018). We designed interventions to promote household recycling, mass transit use and water conservation (see, for instance, Geller et al. 1982). Most early studies focused on either providing information (e.g. environmental education, enhancing procedural knowledge) or motivation (e.g. economic incentives, token rewards). More recently, the focus has shifted to using social norms (e.g. injunctive norms, declarative norms) and team-based interventions (e.g. eco-teams). However, seldom was the focus on promoting clusters of behaviours. Other research explored not how to promote a specific behaviour, but what we know about people who already practice conservation behaviours. Research on long-term participants in environmental stewardship programs report two consistent motivations: the opportunity to do something meaningful to benefit the environment and the chance to learn something new (Ryan and Grese 2005; Ryan et al. 2001).

Later, Stern and colleagues made sense out of the huge array of available behaviours by suggesting we concentrate on those with the greatest environmental significance (Gardner and Stern 2002; Stern 2000). This logic prioritised high-impact behaviours, those with the highest achievable reduction in carbon emissions or resource consumption. The choice is based not only on a behaviour's technical potential (i.e. degree of impact if adopted) but also upon the social scale of its adoption (i.e. realistic adoption rate across an extended time-scale; Stern 2011).

Unfortunately, this approach still easily defaults to the serial adoption of behaviours given the individual costs and efforts involved (e.g. upgrading heating systems, buying fuel-efficient vehicles). If circumstances allow us to be patient then we benefit from their joint effects over time being significant (see Stern and Wolske's (2017) perspective on Wynes and Nicholas (2017)). Implementation principles are being developed that attend to the differences between actions having immediate effects versus reductions that only occur over a decadal time-scale (Wolske and Stern 2018). We are also learning to design interventions that are durable (i.e. the behaviour is maintained long after the intervention has ended; Moore and Boldero 2017) and generalisable (i.e. the effect of an intervention spills over to other contexts and behaviours; Nilsson et al. 2017) both useful features for promoting and sustaining multiple behaviours.

# *13.3.3 Cannot Know the Behaviours Needed*

Dietz et al. (2009) highlighted the importance of simultaneously changing multiple behaviours, each selected for their high short-term impact. However, they also predicted that "lifestyle changes may become necessary in the out-years under constrained energy supply or economic growth scenarios" (2009: 18455). This identifies an important concern. Embedded in our current approach is the assumption that we can know, well in advance, the appropriate environmental stewardship behaviours to promote. This prior-knowledge would be essential for the development of the policies, incentives or nudges (Thaler and Sunstein 2008) necessary to direct behaviour. Such knowledge might also be needed for a new behavioural change approach, that of developing boosts that enhance old, or create new, competencies (Hertwig and Grüne-Yanoff 2017). Yet, under the new context posited here, this assumption is not met. There exists only a general outline of required future behaviours, not their details. Indeed, it is nearly impossible to imagine what everyday life might involve after a drastic reduction in surplus energy coupled with accelerating climate disruption.

This behavioural predicament is twofold. We cannot prescribe the specific behaviours that will need adopting decades hence, other than to suggest that they may be very different from what is now familiar. Furthermore, there will be an urgency to respond, which will necessitate the adoption of whole clusters of behaviours; incremental and serial change will no longer suffice.

# **13.4 New Form of Intervention**

There is a great difference between green consumerism and a newly emerging pattern of behaviours labeled green citizenship. This difference will become increasingly important as we confront the new behavioural context. Much of our current attention focuses on encouraging green consumerism. It is assumed that by modifying consumer choices it is possible to sustain a techno-industrial society. Green consumerism is fully compatible with efforts to make only incremental changes to techno-industrial society. Within this framework, consumers are treated as fully independent, self-determining and sovereign (Princen 2010; Princen et al. 2002). Few, if any, constraints are to be placed on their decision-making, and their consumer choice, once made, is self-justifying and neither to be challenged nor judged. Furthermore, the behaviours promoted must be easily reversible thus preserving the individual's autonomy (Thaler and Sunstein 2008). Green consumerism is also a comfortable approach because it is not a complicated set of behaviours, does not require mentally draining decision-making and it contains the unspoken promise that after achieving an environmentally sustainable state, most of the benefits of modernity will remain. Unfortunately, green consumerism has proven ineffective in curbing collective rates of consumption. Despite greatly improved efficiencies and clever behavioural interventions, society's aggregate energy usage and emissions continue to climb (Dietz et al. 2007; Jackson 2009; Monbiot 2015; Rees 2010).

In contrast, green citizenship is an approach that promotes behaviours based on different motivations and a longer-term time horizon. Recent work suggests that green citizens identify alternate paths of engaging with environmental stewardship that are not limited to the consumptive, product-centric actions defined by green consumerism (Alexander 2011). By moving beyond a consumption focus, green citizens enjoy a broad set of benefits embedded within alternative life patterns. Empirical research reveals that individuals find the pursuit of competence (e.g. developing new skills), frugality (e.g. pursuing resourcefulness), community participation and opportunities for meaningful action to be intrinsically satisfying and durable motivators of long-term environmental stewardship (De Young 1996; Ryan and Grese 2005; Ryan et al. 2001). Furthermore, and most relevant to the issue at hand, green citizens are revealed to be explorers and problem-solvers (Hamilton et al. 2018). These citizens are engaged in anticipatory adaptation (Lyles 2015; Ryan 2016), a pro-active form of pre-familiarisation, planning and capacity-building (Wamsler et al. 2018). The emerging profile of green citizens suggests a need for interventions that dramatically differ from those aimed at promoting green consumerism (Guckian et al. 2017). However, green citizenship may involve more mentally taxing reflection and planning, an issue returned to shortly.

# *13.4.1 Small Experiments*

The new behavioural context includes the stressful conditions of great and prolonged uncertainty, and grave stakes. These are circumstances where we would be advised to start with small steps. As Scott (1998: 345) advises, "Prefer wherever possible to take a small step, stand back, observe, and then plan the next small move". Scott's (1998) idea follows, in part, the 'small experiment' approach to environmental problem solving outlined by Kaplan (1996; see also Irvine and Kaplan 2001; Kaplan et al. 1998).

Small experiments are a framework for supporting problem-solving that is based on people's natural tendency to explore and understand (Kaplan and Kaplan 2003, 2009) and on their brain having evolved to prospect the future not just track the past (Seligman et al. 2013). The small experiment approach supports behavioural innovation, maintains local relevance and allows for the rapid dissemination of findings. It contrasts with the large-scale approach that dominates research these days, in that it helps non-scientists systematically discover what works in their community. Small experiments are going on all the time. They are often the basis of stories told by gardeners, teachers, do-it-yourself creators and community organisers. They are present when experts and citizens jointly apply their separate talents and knowledge to an issue of mutual concern. Small experiments are so common that they could be mistaken as inconsequential. In fact, they are a powerful means of behavioural experimentation.

# *13.4.2 Behavioural Entrepreneurship*

Clearly, the needed interventions change when addressing the new behavioural context. No longer adequate are approaches focused on single and specific behaviours. If this were not challenging enough, even with our current expertise we are unable to know exactly which future behaviours will need promoting. Thus, what we must support is the capacity of future citizens to identify the needed behaviours without our being there. Furthermore, citizens also would need to innovatively execute and maintain those behaviours in that future. Taken together, such capacities constitute entrepreneurial thought, craft and action. In the present, this calls for a unique form of intervention. We need to support *behavioural entrepreneurs* by creating conditions today under which individuals develop the capacity to anticipate, envision and prospect a future context. Then, when later they are in that context, those individuals will be able to craft innovative responses and self-regulate their behaviour to carry out those responses. The shift here is subtle, and perhaps appears academic, but it is a move away from expert-driven, delivery-based interventions toward the facilitation of citizen-developed interventions occurring in a partially unknowable future context.

This is neither a radical nor an unfamiliar approach although it is rarely used in the current rush to promote behaviour change. It is derived from Lewin's (1952) pioneering work using citizen groups to affect fundamental change by first honestly presenting people with the situation being faced and then giving them the trust, time and support needed to craft their own responses. Programs based on Lewin's approach are being developed to promote environmental stewardship (Fisher and Irvine 2016; Matthies and Kromker 2000) including the community-based initiatives called Ecoteams (Davidson 2011; Nye and Burgess 2008; Staats and Harland 1995; Staats et al. 2004). There are also larger-scale examples including eco-housing and ecovillages (Litfin 2013; Nelson 2018) and transition towns (Hopkins 2008). It is significant that the larger-scale examples were neither initiated nor supported by corporations, governments or major environmental organisations, instead they selfinitiated. Behavioural entrepreneurship is about self-initiating behaviour change. Yet, whether acting individually or in groups, these entrepreneurs will need the capacity to envision, craft and then initiate responses all while functioning within a radically changed context.

# **13.5 Capacities-First Approach**

Given that today we cannot fully know the behaviour patterns needed later this century, we must instead ask *what are the conditions under which* future citizens can respond with competence and equipoise. There is an innovative means of extracting these conditions. It employs a method used within psychological discussions of intentionality (Baumeister et al. 2011; Mele 2001) and is referred to as a capacitiesfirst approach (Seligman et al. 2013). This approach is a form of envisioning (Meadows 1996) and is wholly unlike our current tendency to construct interventions that are primarily past-driven.

A past-driven approach is a leveraging of traits, decision-making tendencies, knowledge, norms and motives from people's immediate and distant past. For instance, we assess whether an individual holds an eco-centric, ego-centric or social-centric value orientation and then create an intervention that leverages their dominant orientation. Another example starts with individuals who are inclined toward a specific environmental stewardship behaviour but lack the necessary procedural knowledge to carry out that behaviour. The intervention would then focus on providing the needed behavioural skills and strategies. A third example is making more salient an existing social norm using a public service announcement. In each instance, we, the experts, assume the role of creating interventions that manipulate existing factors to promote conservation behaviours among citizens.

In contrast, a *capacities-first* approach is future-centric. Citizens are imagined as actively coping with the challenges in that future context having successfully recast their behaviours into forms that fit that future ecological situation. Perhaps most significant, these future citizens are in no particular need of expert designed and managed interventions. However, perhaps we, the experts, could be of some help in the present. Although we cannot assume to know the specific future behaviours that citizens will be pursuing, we may assume that how they go about identifying and self-initiating those behaviours will be much the same as they do today. They will be using the same mental processes, cope with the same social challenges, be affected by the same emotions and need to develop skills well matched to the future context. Therefore, employing a reverse-engineering metaphor, we can imagine, in the present, what general capacities those future citizens must be in possession of, and the support they will come to rely upon while creating and initiating specific future behaviours. Providing for the development of those capacities now and supporting them in the future becomes a necessary, although perhaps not a sufficient, pre-condition for supporting future sustainability.

# *13.5.1 Needed Future Capacities*

Applied here, this approach involves identifying the capacities that would be needed in order for citizens to plan, self-initiate and regulate their behaviour. A complete list of such capacities and their functional relationships would be long, drawing from the full range of social science research. For the purpose here, we can bound the list by considering only those features needed for conducting the mental work of envisioning, crafting and implementing behaviours in a future context.

Hertwig and Grüne-Yanoff (2017), in their explanation of the advantage of using boosting rather than nudging to change behaviour, mention creating competencies that are useful across a range of situations including, presumably, those for which we cannot in advance know the details. Their discussion of these capacities includes improving people's competencies to exercise their own agency. One example is the authors distinguishing between short- and long-term boosts with the latter focused on creating generic problem-solving capacities that would be useful in future situations (Sunstein 2016).

Wamsler et al. (2018) are more specific in their discussion of the relationship between mindfulness and sustainability. They highlight such individual capacities as being able to maintain an adaptive and flexible response to events, the minimising of impulsive and habitual reactions and similar self-regulation skills. Analogous capabilities were uncovered in the study of green citizenship (Hamilton et al. 2018) where participants identified the importance of a capacity for openness in approaching a situation so as to avoid habitual response. Green citizens also seek opportunities to learn new skills while simultaneously deriving intrinsic satisfaction from these same opportunities (Guckian et al. 2017; Hamilton et al. 2018).

These ideas suggest a preliminary set of three capacities necessary for effectively responding to the new biophysical and behavioural context.

**Mental Clarity** Clear-headedness would be necessary for envisioning desired future states. Conscious deliberation and reflection are needed to plan the intermediate and long-term goals, and relevant behaviours, needed for achieving those future states.

**Building Competencies** Given that future behaviours are unknowable in their details there is the need for a motivation to continuously develop new competencies rather than merely the training of specific skills. Particularly important is the ability to understand diverse and complex social and natural systems in order to be able to identify intended and unintended consequences of future actions.

**Emotional Regulation** The premise of this chapter cannot help but be unsettling. Nonetheless, given the likely need for social coordination, it will be necessary to maintain pro-social inclinations under the stress of difficult biophysical circumstances. Maintaining a positive emotional state will help to build and maintain social and behavioural resources.

# *13.5.2 Supporting Capacity Building*

As disparate as the aforementioned capacities for clarity, competence building and emotional stability may seem at first, they share a common foundation: the ability to maintain attentional vitality (Basu 2015). Mental clear-headedness is a precondition for human effectiveness (Kaplan 1995) and thus vital to behavioural entrepreneurship. Envisioning future situations and, more importantly, imagining groups of behaviours that need to be adopted together for an effective response will need to be done while in the presence of the radically changing biophysical and behavioural contexts outlined above, the desperate needs of others and unmet personal needs.

It is here that the enormous adaptive significance of mental vitality becomes clear. It allows for pausing to insert our own intentions between the demands of the immediate environment and the future for which we are seeking to prepare a response (De Young 2010). With this ability, future citizens could envision multiple futures without undue confusion, contemplate alternate priorities and explore alternatives instead of jumping to first conclusions. In addition, and most relevant here, it allows imagining which combinations of behavioural responses will work well together. The importance of this ability cannot be overstated. Without this ability, future citizens could not override automatic functioning whether based on innate stimulus-driven patterns (e.g. inherited inclinations) or learned patterns (e.g. habitual responses). In short, the entrepreneurial thought, craft and action needed to respond well will depend on citizens maintaining their mental vitality.

Yet, preserving mental vitality is difficult even in the best of times since handling all the information we crave, as well as dealing with the onslaught of unbidden information, easily leads to our being overwhelmed and mentally exhausted. The challenge is all the more formidable under the premise of this chapter. Yet, while the cognitive demands placed on behavioural entrepreneurs will certainly tax their mental well-being, research has repeatedly highlighted the restorative effect of time spent in natural settings (see Marselle Chap. 7, this volume; Marselle et al. Chap. 9, this volume; Kaplan and Berman 2010; Kaplan and Kaplan 2009). This leads to a fascinating, if somewhat counterintuitive, aspect of the new biophysical context. It is possible that life will become less affluent, less easily mobile and less consumerbased. At the same time, everyday life may become more locally oriented with everyone more involved in their own provisioning. Thus, slowly over time, daily access to nearby nature may increase. Given that such access can improve mental, physical, social and spiritual well-being (see Cook et al. Chap. 11, this volume; Irvine et al. Chap. 10, this volume), the very restoration needed to effectively respond to the new context will be available within that same context.

Mental vitality is a state-of-mind essential to entrepreneurial behaviour but there is also a need for citizens to derive a motive from such engagement. Fortunately, the motives necessary to support behavioural entrepreneurship are embedded in the very challenges involved and are well-studied. It turns out that humans are intrinsically motivated to pursue capacity building (De Young 1996, 2000; Howell 2013; O'Brien and Wolf 2010; Sheldon et al. 2011; Van der Werff et al. 2013). Chawla (1998) found that environmentally involved individuals credit intrinsic motivation when explaining the development of competence in both responding to difficulties and interacting effectively with others. There are also intrinsic satisfactions embedded in the pursuit of green citizenship (Guckian et al. 2017; Hamilton et al. 2018; Wolf 2011). It is indeed fortunate that people are able to derive a deep and direct intrinsic motivation from those behaviours that will need to be commonplace in the future.

There is a fascinating technique for focusing people's attention on the future by increasing their psychological connectedness to their future self (Schelling 1984). Zaval et al. (2015) were able to increase this connection by having participants write a brief essay about how they wished to be remembered. Envisioning their legacy had the effect of helping people to have a much longer time-horizon and be intrinsically motivated to pursue environmental stewardship behaviours.

Another means of helping people to develop future-oriented competencies is offered by Fredrickson's *Broaden and Build* model (1998). This model identifies the behavioural benefits of maintaining a positive emotional state. Fredrickson explored the paradox that while negative emotions are linked to specific action tendencies (e.g. anger promotes urge to attack, guilt leads to desire to make amends) there are no specific behaviours linked to positive emotions. Negative emotions also are known to greatly narrow the scope of attention, the information considered and the capacity for reflection. In contrast, positive emotional states expand cognition; inspire creativity, exploration and the development of future behavioural options. This has the effect of expanding our repertoire of behavioural responses. Fredrickson describes the broadening effect as widening the scope of thoughts that come to mind, and the building effect as increasing the resources available for responding (e.g. new plans, strategies, social relationships). Although positive emotional states are transitory, the physical, intellectual and social competencies, and resources built endure.

# **13.6 Conclusion**

After having supported the capacity building of future behavioural entrepreneurs, we might imagine how their behaviour change strategies would develop. One vision has them analytically and rationally creating technically efficient responses to the new contexts and then adopting behaviours in well-organised packages having the highest environmental impact. A second vision imagines citizen-artists who have elegantly crafted lives functioning harmoniously within a diverse social community and vibrant natural environment with patterns of behaviour evolving and interacting beautifully. In the latter vision the slowly adapting structure of everyday life would comprise a behavioural aesthetic resulting in great contentment and sense of accomplishment.

These two visions of how behaviour change efforts may unfold are not mutually exclusive. Indeed, a mixture of the two seems plausible within a given community and across time. However, the second vision is much less common among experts who focus on changing people's conservation behaviour. Thus, providing support for this second vision seems a useful place to conclude. It turns out that the second vision, like behavioural entrepreneurship, is neither a radical nor an unfamiliar approach to environmental stewardship.

# *13.6.1 Conservation Aesthetic*

Aldo Leopold (1933) is remembered for his promotion of a conservation and land ethic. However, near the end of his book, *A Sand County Almanac* (1949), he introduced the idea that the planet also could be restored using a conservation aesthetic. The distinction between these approaches to behaviour change is dramatic. A land ethic, whether voluntary or mandatory, involves "a limitation on freedom of action in the struggle for existence" (Leopold 1949: 202), an obligation to exercise restraint. In contrast, a conservation aesthetic would have us seek interactions with nature because we derive satisfaction from them. A conservation aesthetic is revitalising, unleashing pleasures derived from the hidden riches of interacting directly with the biodiversity of nature.

# *13.6.2 Behavioural Aesthetic*

Modern industrial society rejoices in its many technical efficiencies and innovations. However, these accomplishments are challenged by new data (Bonaiuti 2017). What seems efficient from one perspective is brittle from another. Material production and consumption on a global scale turns out to require complex systems and demand massive energy inputs. This leads to increasing economic and social system vulnerabilities as the complexity reaches diminishing marginal returns (Tainter 1988) and as the production of natural resources both becomes less predictable and suffers from declining energy surpluses. Furthermore, focusing on the output from this vulnerable complex system reveals that consumer consumption, the end goal of the entire enterprise, is an astonishingly inefficient means of providing for social and spiritual well-being (De Young and Princen 2012; Kasser 2009; Kjell 2011; O'Brien 2008).

Critiques of modernity are not new. Nevertheless, there is a new claim that industrialisation destroys the aesthetic quality of everyday life. Berry (1987: 165–166) has made this observation about what one gains from daily work in non-industrial enterprises. He cites the work of Gill (1983: 65) on the higher calling that working manually fulfills, "…every [one] is called to give love to the work of [their] hands. Every [one] is called to be an artist". Berry makes this same claim throughout his poetry, fiction and non-fiction writing, frequently offering up small-scale agriculture as an instance of an artistic enterprise involving multiple and overlapping daily decisions centered on the concepts of beauty, resourcefulness and feeding of spiritual

well-being as much as the body. Perhaps, as we endeavor to first repair and then maintain the planet, everyone will be called upon to be an artist, an idea consistent with Seligman's (1999) notion that authentic happiness comes from "living life as a work of art".

Thus, we have an idea, previously applied to agrarian pursuits but perhaps applicable to everyday enterprise, that would have us seek an aesthetic outcome to the behaviours we pursue. In addition to the environmental impact notion mentioned earlier, this current idea would involve selecting behaviours that, when they are considered in the whole, constitute something of beauty that enhances mental, social and spiritual well-being. This idea would have citizens weave together desired and valued outcomes matched to environmental stewardship goals, the use of old and the learning of new skills with all being adjusted through reflection and equipoise. The term *behavioural aesthetic* captures both the ongoing process and most certainly the outcome achieved across time; this is a form of performance art but at the everyday level and focused on sustainability.

# **References**

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# **Chapter 14 Global Developments: Policy Support for Linking Biodiversity, Health and Climate Change**

#### **Horst Korn, Jutta Stadler, and Aletta Bonn**

**Abstract** This chapter highlights key policy processes at the international level dealing with the alignment of policies for the biodiversity-climate-health nexus. Recent developments by UN Conventions and major international organisations, such as the Convention on Biological Diversity, the Ramsar Convention and the United Nations Framework Convention on Climate Change (UNFCCC), together with the World Health Organization (WHO) and the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES), are discussed. Special attention is given to newly emerging integrative global policy processes and partnerships between the Convention on Biological Diversity and the WHO, also in the framework of the Agenda 2030 for Sustainable Development and avenues to translate them into local policy through the global partnership ICLEI – Local Governments for Sustainability. Conclusions are drawn to foster the joint implementation of policy goals.

**Keywords** Biodiversity-climate-health nexus · Science-policy interface · UN conventions · CBD partnership · IPBES · SDG goals

#### **Highlights**

• Policy agendas of health promotion, climate change adaptation and biodiversity conservation are starting to become aligned.

H. Korn (\*) · J. Stadler

Federal Agency for Nature Conservation (BfN), Isle of Vilm, Putbus, Germany e-mail<EMAIL_ADDRESS><EMAIL_ADDRESS>
A. Bonn

German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Leipzig, Germany

Institute of Biodiversity, Friedrich Schiller University Jena, Jena, Germany e-mail<EMAIL_ADDRESS>
Department of Ecosystem Services, Helmholtz Centre for Environmental Research – UFZ, Leipzig, Germany

# **14.1 Introduction**

Biodiversity forms the foundation of life on Earth and human health, as it underpins the functioning of ecosystems and associated ecosystem services (Cardinale et al. 2012). We depend on the contributions from nature to people (Díaz et al. 2018) for providing our food and fresh water, regulating climate, preventing floods and disease, as well as providing recreational benefits and aesthetic and spiritual enrichment (see also Irvine et al. Chap. 10, this volume). Biodiversity contributes to both traditional and modern medicines and supports local livelihoods and economic development (Romanelli et al. 2015). Because of these fundamental linkages between biodiversity and human health, it is surprising that this important crosscutting issue made it –only in the last few years – prominently onto the agendas of important international conventions and organisations such as the Convention on Biological Diversity (CBD), the Ramsar Convention on Wetlands and the World Health Organization (WHO). Given the fact that climate change increasingly has direct and indirect effects on both biodiversity and human health, it is even more important to stress the links between the topics in order to foster nature-based solutions for promoting health and adapting to climate change.

This chapter highlights some key policy processes to tackle the relationships between (1) biodiversity and climate change, (2) biodiversity and health, (3) climate change and health and (4) the biodiversity-climate-health nexus on the international level. The field is developing fast, and this chapter represents the status as of August 2018. The connection between biodiversity and health – sometimes also in relation to climate change – is also emerging in many practical regional and local initiatives, coming from both a nature conservation angle and a medical angle. (For an overview about European Nature and Health network initiatives see Keune et al. Chap. 15, this volume.)

# **14.2 Biodiversity and Climate Change**

Much work has been done on the direct effects of climate change on biodiversity (e.g. changes in phenology and in species' distribution, composition and interactions; see Bellard et al. 2012; Parmesan 2006; Thomas et al. 2004) as well as indirect effects of these changes on human health (Pecl et al. 2017). But vice versa, biodiversity also affects the climate system and can also ameliorate climate change

**Fig. 14.1** Relationship between biodiversity, climate change and health. White arrows indicate a positive impact; dark arrows indicate a negative impact. The thickness of the lines corresponds to the strength of the impact

effects through nature-based mitigation (e.g. through carbon sequestration and carbon storage in vegetation or soils; see e.g. IPCC 2014) and adaptation measures (Lo 2016) (see Fig. 14.1). The latter – for example, reducing the urban heat island effect and disaster risk – have strong implications for human health and well-being. This was taken up and elaborated on by major international policy processes such as the Ramsar Convention on Wetlands in its resolutions (e.g. see Resolution XII.13: Wetlands and disaster risk reduction (Ramsar 2015)) and related activities reflected in the themes of the World Wetlands Days 2017 "Wetlands for Disaster Risk Reduction", and 2018 "Wetlands for a sustainable urban future". Ecosystem-based approaches to adapting to climate change and reducing disaster risk have also been an important topic in the processes of the CBD (Lo 2016).

# **14.3 Biodiversity and Health**

The emergence of the ecosystem service concept led to the Millennium Ecosystem Assessment (MA 2005) with its synthesis report on health (Corvalan et al. 2005) followed by the Economics of Ecosystems and Biodiversity reports (TEEB 2010) and several national assessments (Schröter et al. 2016). These assessments mainly focused on economic benefits of nature and mention health benefits only little or less explicitly.

In the policy arena, the international treatment of the linkages of health and biodiversity began with the COHAB Initiative that was established in response to outputs of the First International "Conference on Health and Biodiversity – COHAB 2005", which took place in Galway, Ireland in August 2005 (see Box 14.1). The recommendations from that meeting addressed a number of key issues at the interface of biodiversity and human well-being, and raised issues of governance, equity

#### **Box 14.1 Co-operation on Health and Biodiversity – COHAB Initiative**

The COHAB Initiative operates through Partnership arrangements with a growing network of organisations worldwide, representing government and multi-lateral agencies, academic institutes, NGOs, indigenous communities and the private sector. These organisations share a common interest – to enhance co-operation between the health and biodiversity sectors, working together for a healthy planet with healthy people. Major areas of focus include:

COHAB Initiative Partnership arrangements provide a framework within which organisations may collaborate to increase the effectiveness of their efforts in addressing the issues linking the conservation and sustainable use of biodiversity with health, well-being and livelihood security. Partners range from Intergovernmental organisations (mainly from the UN-System), to international non-governmental organisations and a variety of country-based organisations.

(http://www.cohabnet.org, accessed 25.05.2018)

and participation. These were the core issues around which the COHAB Initiative was then established (COHAB 2005), and which provided the basis for further development of the topic. The COHAB Initiative, which is less active now, had a strong influence to put the topic on the agenda of the CBD and stimulated the joint work programme of the CBD and the WHO, which are now the main global actors in this field (see sect. 14.5.2).

# **14.4 Climate Change and Health**

The direct link between climate change and health issues is well developed (e.g. WHO 2016; Wolf et al. 2015; see also Lindley et al. Chap. 1, Hunter et al. Chap. 17, both this volume). Already in 2008 the World Health Assembly developed a global Work Plan to support member states in climate change and health protection that

was updated in 2014 (WHO 2015).1 In 2015, the *Lancet* Commission on Health and Climate Change prominently recommended ten concise policy actions for the next 5 years on climate change adaptation to protect public health (Watts et al. 2015), which urged joint working across sectors and scaling up of investments to secure a climate-resilient public health system. Human health was also included as an important aspect in the European Environment Agency indicator report on climate change (Füssel et al. 2017). International policy commitments were documented in the Paris Agreement of the United Nations Framework Convention on Climate Change (UNFCCC), which recognised "the social, economic and environmental value of voluntary mitigation actions and their co-benefits for adaptation, health and sustainable development"(UN 2015a).

 Unfortunately, the interlinkages between climate change, health and biodiversity only gained little attention within international climate policy, so far.

# **14.5 Biodiversity–Climate–Health Nexus**

Despite the many activities in the individual fields of biodiversity conservation, climate change mitigation and adaptation as well as the improvement of human health, the benefits that intact ecosystems can provide to people's health in the face of climate change has only been recognised slowly during the last decade. There are many opportunities to bring the three topics of biodiversity, health and climate together in a constructive way and to tackle real issues. Biodiversity can help to prevent or minimise human-induced or natural disasters that are caused or accelerated by climate change.

For example:

The emphasis of policy linkages was first on wetlands (see below) and naturebased solutions in urban areas (Kabisch et al. 2016, 2017; WHO Regional Office for Europe 2016), while the biodiversity-climate-health nexus has also been considered in much broader applications (see also Romanelli et al. 2015). In the following sec-

<sup>1</sup>For an overview of policy measures see http://www.who.int/globalchange/health\_policy/en/ (accessed 8 August 2018).

tions we provide some examples of international policy processes that take an integrative approach.

# *14.5.1 RAMSAR-Convention*

In 2012, the Ramsar Convention published a Technical Report "Healthy wetlands, healthy people" (Horwitz et al. 2012) that extensively reviewed the relationship between biodiversity (here in the form of wetland ecosystems), climate change and human health. The evidence of ecosystem services of wetlands and their benefits to human health and livelihoods was considered to be well established. Wetlands can provide food and shelter, flood control and mitigation of climate change through carbon storage as well as modes of transport and sources of beneficial drugs. As such the maintenance of 'healthy wetlands', including people as part of wetlands, was therefore considered to be very important. Nevertheless, it was also stated that the current understanding of climate change-induced increases in health and disease risks in wetlands should be taken into account when co-managing wetlands and human health. Decision-making should seek to maintain the capacity of wetlands to adapt to climate change, as functioning mangroves or floodplains and other wetlands can provide important buffers to climate-induced extreme events and associated risks of human health problems (Horwitz and Finlayson 2011), including risks of vector-borne diseases (see Müller et al. Chap. 4, this volume).

A draft version of the Ramsar report was already issued as a background document for the Ramsar COP 10 (Ramsar 2008) and led to Ramsar Resolution X.23, which recognised that the changing climate is expected to continue to increase the risk to human health of matters associated with wetland ecosystems. Importantly, the resolution emphasised tackling health risks, but also considered principles of equity and prevention in public health measures through wetlands. Contracting parties were urged to ensure that decision-making on co-managing wetlands and human health issues takes into account current understanding of climate change-induced increases in health and disease risk. The resolution text reflected the suggestions from the expert report (see above).

In Resolution XI.12 on Wetlands and Health (Ramsar 2012), the Conference of Parties to the Ramsar Convention raised the concern that threats to wetlands like climate change can act as drivers for disease emergence and re-emergence beyond natural cycles. Nevertheless, this link between wetlands, health and climate change is not directly addressed in the operative paragraphs of the resolution.

Three years later, as one of the outcomes of Ramsar COP 12 the Conference of Parties identified in Resolution XII.13 (Ramsar 2015) the link between wetlands and disaster risk reduction, and stated that healthy and well-managed wetlands can reduce disaster risk. Since many risks are expected to increase with climate change, joint work between technical and nature-based solutions to disaster risk reduction will be needed to secure human health.

Several resolutions of the Ramsar convention have led the way to link biodiversity with health issues and disaster risk reduction in a holistic way, also referring to climate change. This expertise now needs to support the aims of the 2030 Sustainable Development Goals (SDGs) and is an important contribution to the 2050-Vision of the CBD.

# *14.5.2 World Health Organization and Convention on Biological Diversity Partnership*

Although health is already mentioned in the Preamble to the text of the Convention on Biological Diversity (CBD 1992) 2 and was included in the CBD Aichi Target 14, in 2010 (CBD 2010),3 the first full CBD decision on biodiversity and human health, under the joint work programme with the World Health Organization, was only concluded at the 12th Conference of the Parties, held in November 2014 in Pyeongchang, South Korea (CBD 2014). "All human health ultimately depends on ecosystem services that are made possible by biodiversity and the products derived from them. While the inter-linkages between biodiversity, ecosystem services and human health are inherently complex, inter-disciplinary research is aiming to develop a more thorough understanding of these essential relationships".4

Important for preparation of the next COP was a joint report with the title "Connecting Global Priorities: Biodiversity and Human Health, a State of Knowledge Review" that was published in 2015 by the Secretariat of the Convention of Biodiversity together with the World Health Organization and numerous partners (Romanelli et al. 2015). It covers a wide range of topics concerning both terrestrial and aquatic ecosystems. A focus lies on the contribution of biodiversity to physical health through provision of food and nutrition as well as pharmaceuticals and traditional medicines. Further, the report deals with regulating services of water and air quality as well as the contribution of biodiversity to mental and cultural well-being. Health aspects include consideration of the microbial diversity as well as noncommunicable and infectious diseases. Strategically, this report already considers links to global adaptation to climate change and associated disaster risk-reduction considerations, necessary tools, metrics and research avenues, and ultimately how

<sup>2</sup>CBD, Preamble: "Aware that conservation and sustainable use of biological diversity is of critical importance for meeting the food, health and other needs of the growing world population, for which purpose access to and sharing of both genetic resources and technologies are essential,…" (see: https://www.cbd.int/convention/articles/default.shtml?a=cbd-00, accessed 8 August 2018).

<sup>3</sup>Aichi target 14: "By 2020, ecosystems that provide essential services, including services related to water, and contribute to health, livelihoods and well-being, are restored and safeguarded, taking into account the needs of women, indigenous and local communities, and the poor and vulnerable." (see: https://www.cbd.int/decision/cop/default.shtml?id=12268, accessed 8 August 2018).

<sup>4</sup>For an overview of COP decisions and SBSTTA recommendations related to health see https:// www.cbd.int/health/ accessed 8 August 2018).

strategies for health and biodiversity can contribute to achieving the SDGs and thereby align conservation, health and climate goals in a comprehensive way.

This report formed the basis for the further development of the topic on Biodiversity and Human Health at the CBD-COP13 in Mexico (CBD 2016b). In this decision, parties, other governments and relevant organisations are invited to carry out a wide range of comprehensive, integrative and far-reaching activities based on identified interlinkages at various levels and between different sectors. The Annex contains a comprehensive list of health-biodiversity linkages, which provides a good source of information when dealing with other sectors.

Following the COP13-Decision the field progressed rapidly, and already at the following meeting of the CBD-SBSTTA (Subsidiary Body on Scientific, Technical and Technological Advice) the subject on the scientific and technical side (CBD 2017) was further developed. SBSTTA draws on information *inter alia* from new reports issued by the Regional Office for Europe of the World Health Organization on the evidence of urban green spaces for health in 2016 (WHO Regional Office for Europe 2016), which was followed swiftly by a review of the impact of actual interventions in urban areas and their effectiveness (WHO Regional Office for Europe 2017). The SBSTTA-Recommendation stresses again the collaboration of different international organisations, and the national integration of biodiversity and health aspects into different sectors as vitally important, so that a holistic treatment of the topic is possible. The topic will therefore remain high on the international agenda.

A memorandum of understanding was signed between the CBD and the WHO in 2015, which provides a solid base for cooperation (WHO and CBD 2015), and also through an interagency liaison group on biodiversity and health that was established in 2017.5 During its first meeting, important areas of further work were identified, such as the need for indicators for biodiversity and health and the development of simple messages around topics like: (1) ecosystem degradation, (2) diversity of diets/nutrition, (3) urban green spaces and (4) prevention. Climate change is treated here as a cross-cutting issue (CBD and WHO 2017).

In 2017, the WHO also co-sponsored the international conference "Biodiversity and Health in the face of climate change – Challenges, Opportunities and Evidence Gaps" (Marselle et al. 2018), which was organised by the German Federal Agency for Nature Conservation (BfN) and the European Network of Heads of Nature Conservation Agencies (ENCA), and which led to formal ENCA recommendations that are further elaborated on in the concluding chapter of this volume (Marselle et al. Chap. 20).

The CBD-COP-Decision XIII/3 to enhance implementation of the Aichi targets and to mainstream and integrate biodiversity within and across sectors (CBD 2016a) identified health as one of four key mainstreaming sectors for the 2050 Vision of Biodiversity, which should be taken up in post-2020 consideration of the CBD and is already an agenda topic of the 14th Conference of the Parties to take place in Egypt in November 2018.

<sup>5</sup>See: https://www.cbd.int/health/ilg-health/default.shtml

So far, the WHO European Health 2020 Framework mainly deals with the connection of health and the environment in relation to pollution and, for example, safe outdoor play for children (WHO 2017). However, the further collaboration between the CBD and the WHO may fuel the recognition of the importance of biodiversity for human health, in particular in the face of climate change within WHO policy more widely, both in Europe and globally.

# *14.5.3 Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES)*

The Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) is the intergovernmental body that assesses the state of biodiversity and of the ecosystem services it provides to society, in response to requests from decision-makers. As an outcome of its sixth meeting in Medellin/Columbia in March 2018 it decided on a procedure to determine the focal topics of its next assessments. The topic biodiversity and health is currently high on the international political agenda, but it is premature to speculate about a possible IPBES assessment on that topic. It is up to the CBD-COP to put this desire forward formally and the IPBES-Plenary as an independent body can decide to take it on board as a new subject or not (as of August 2018).

Due to this rapid development, with key events taking place towards the end of 2018 (CBD-COP14) and the beginning of 2019 (IPBES-7), we will know only by that time how the topic will have advanced on the agendas of these international treaties and organisations and if it will be considered as a priority for the Post-2020 system of the CBD. This would nicely link with the original Millennium Assessment report on health (Corvalan et al. 2005).