How nature can be used to improve wellbeing
 Nature’s Potential
It is evident from the data presented in this report that Surrey is not exempt from many of the social or health-related difficulties plaguing the younger members of today’s society, such as mental health and weight problems or specific challenges associated with the most vulnerable. Utilising the outdoors and engaging with nature has the potential to reduce the negative impact of several of these difficulties. Among other advantages, it has been linked to reductions in obesity and related diseases (like heart disease and diabetes), vitamin D deficiency, high blood pressure, and the symptoms of ADHD, asthma, eye problems like myopia, and chronic pain (McCurdy, Winterbottom, Mehta, & Roberts, 2010). In addition, we know from part two of this report that nature can positively impact psychological wellbeing, by acting as a buffer for mental distress and inducing a sense of relaxation (Barton & Rogerson, 2017; Korpela, Hartig, Kaiser, & Fuhrer, 2001) as well as improving resiliency and the ability to cope with problems (Dobud, 2016; Ginsburg, 2007). The natural environment was also deemed useful in improving mood and self-esteem and reducing symptoms of mental health diagnoses such as depression and anxiety (Barton & Pretty, 2010; Dobud, 2016; Song et al., 2019). It therefore makes sense to utilise nature in addressing some of the key problems of mental health and wellbeing in Surrey.
 Why Surrey would benefit from increased nature engagement
 The Surrey Hills
A significant reason we should be focussing our efforts on bringing young people into nature is that it is right on our doorstep. Inhabitants of Surrey are fortunate enough to have access to the Surrey Hills, an AONB which stretches across a quarter of the county ("What is an AONB? | Surrey Hills", 2019). The Surrey Hills AONB organisation describes it as an “attractive landscape mosaic of
farmland, woodland, heaths, downs and commons” ("Vision For Surrey Hills | Surrey Hills", 2019). Accessibility is a key barrier to young people engaging with the outdoors (UCL Institute of Health Equity, 2014), so the abundance of wild nature within arms-reach makes it much more feasible for outdoor-based initiatives to be successful. It also has the potential to create sustainable long-term benefits through developing healthy habits and encouraging greater personal usage of local environments in the future.
 Surrey’s vulnerable populations
In addition, nature has the potential to reduce several types of disadvantage affecting local residents, whilst preventing further problems from developing. This is because it has been shown to improve overall wellbeing of the population, whilst providing added benefits for vulnerable populations, for whom the advantages seem to be amplified. For example, those with stress related illnesses respond more favourably and intensely to exposure to outdoor environments (Piccininni et al., 2018). In addition, individuals with lower mental health show larger benefits in mental wellbeing and self-esteem than those with higher psychological health after exposure to natural environments. These boosts have been observed after both long-term changes such as increases in local green space, or through a short-term exposure of green exercise or nature interaction (Barton & Pretty, 2010; Berman et al., 2008; Berman et al., 2012; Weimann et al., 2015). Likewise, some of the
recommendations for how to reduce self-harming behaviours included going outside, “informal social networks” and “structured group activities” (Fortune et al., 2008, p. 1; "How butterflies can help prevent self-harm", 2015) suggesting how nature can be directly relevant to recovery.
Regarding neurodevelopmental disorders, nature is another potential solution. It is highly relevant to Surrey in particular, as the growing number of ASD (Autism Spectrum Disorder) individuals can benefit from the natural world. Young people with autism have shown positive responses to nature, such as improvements in good social behaviours like talking, looking at faces and laughing (O'Haire, McKenzie, Beck, & Slaughter, 2013). In addition, it encourages better emotional control and positive affect, sensorimotor engagement and socialisation (Li et al., 2019). Similarly, those with ADHD benefit from green space, with higher residential greenness or tree cover linked to reductions in the symptoms of hyperactivity or inattention (Amoly et al., 2014; Taylor et al., 2001).
Concerning specific populations in Surrey, such as young carers, nature interventions seem a great way to meet a lot of their immediate needs. The Surrey Young Carer’s Health Survey (2013) reports that the top five priorities that young carers believe will help improve their wellbeing are:
• Peer support from other young carers
• Carer breaks
• More time for social and/or physical activities
• Sometime to talk to
• Organised activities (i.e. holidays)
The research suggesting that nature facilitates social interaction and inclusion (Greenwood & Gatersleben, 2016; James et al., 2016; Peschardt & Stigsdotter, 2013; Plane & Klodawsky, 2013; Ward Thompson et al., 2004) can help with two of these suggestions; peer support from other young carers and someone to talk to. Wells and Evans (2003) even suggests this improved sociability may act as a buffer for their stress. In addition, the evidence highlights how the natural environment can be utilised to increase physical activity levels (Ambrey, 2016a, 2016b; Bjork et al., 2008; Huang et al., 2017; James et al., 2016), especially in young people (Almanza et al., 2012). It represents an accessible location which improves adherence to nature-based activities (The Wildlife Trust).
Although it cannot create more free time for young carers, it does provide the opportunity for more “physical activity” and “organised activities”. Finally, nature is hugely restorative, and allows individuals to escape their everyday life, which helps young carers have a “break”. The concept of positive distraction encourages people to focus on things other than their stressors, which creates a sense of being away (Gonzalez et al., 2010; R. Kaplan & Kaplan, 1989; S. Kaplan, 1995; Ulrich et al., 1991). Furthermore, those who live in poverty or have low socio-economic status have shown greater change in both physical and mental health after being exposed to natural environments, and also rate these areas as the most meaningful for improving quality of life (Plane & Klodawsky, 2013; Twohig-Bennett & Jones, 2018). For example, green spaces have been shown to reduce depressive symptoms in pregnant women, especially for those considered economically deprived (McEachan et al., 2016). The psychological benefits may even be amplified in young deprived individuals (Munoz, 2009; Ward Thompson et al., 2006), alongside those who spend their days managing the home, the elderly, and the less educated. For example, in children of mothers with low levels of education, there was a negative correlation between distance from a city park and mental health (Balseviciene et al., 2014).
 Income inequality
In addition, socio-economic inequality is a large problem in Surrey. This is often considered surprising due to its reputation as an affluent county, as many people are oblivious to the several areas that experience extreme deprivation and poverty (Community Foundation for Surrey, 2013). The inequalities are also potentially intensified due to the prevalence of knowledge economy in the area, which is higher than the national average (25% compared to 21% for the UK). It means that those who can afford to be educated well and have access to good academic opportunities are likely to succeed financially in the industry much more than those who are less educated or are income deprived (AECOM, 2017).
For example, one local area that demonstrates the large variation in income is Elmbridge, in which the pay gap in 2014 between the top and bottom earners was around £11,423 per annum higher than the average for the UK (Figure 7; New Economics Foundation, 2015).
Figure 7. The gap, in pounds, between the top 20% and bottom 20% of full-term gross annual earnings in the UK, compared to that of Elmbridge in Surrey. Reprinted from Inequality in Elmbridge by the New Economics Foundation. Retrieved from https://neweconomics.org/2015/11/inequality-in-elmbridge.
Income inequality has several potentially negative consequences, such as stunting long-term economic growth, increasing social unrest and political inequality, decreasing levels of health and reducing rates of good education (Birdsong, 2015). Of these, income-related health inequalities are a key and immediate concern as they are a “matter of life and death, of health and sickness, of well- being and misery” (Marmot, 2010). Reducing inequality should therefore be a focus within the context of improving wellbeing in Surrey.
“equigenic” (Barton & Rogerson, 2017), meaning it is useful for “reducing socioeconomic health inequalities, facilitating activity and promoting better mental health and well-being” (p. 81). For example, a large international study conducted using data from 34 European countries demonstrated how the difference in mental health between people with high and low financial strain was reduced by 40% for those who had good access to green, natural areas, compared to those who did not (Mitchell, Richardson, Shortt, & Pearce, 2015). The results validate the potential for nature to help narrow the inequality gap and reduce several health issues associated with it.
Another reason we should be encouraging greater utilisation of local green space is due to the global change in lifestyles, of which Surrey is not exempt. This change, in which we are becoming detached from nature, has actually been named as a contributing factor in producing many mental and physical health problems. The Global Wellness Summit has argued that we are “bereft of nature” (2019, p. 51), linking to what Richard Louv (2005) has coined “Nature-Deficit Disorder”, a non-clinical term describing the state of being increasingly disconnected from the outdoors. He explains that the youth of today are the first generation to have grown up with technology, so their exposure to nature has suffered to a greater extent as a result. He also describes how many of the key issues facing the younger generation, such as mental health problems, ADHD and childhood obesity, can be accounted for, at least in part, by this change in lifestyle, which is negatively affecting young people as their brains are still developing. The rise in mental health problems in particular have been partly attributed to the lack of engagement with green space (The Natural History Museum, 2017). Nature- deficit disorder, which is increasingly being used in both scientific and layman domains, was named by the World Future Society in 2007 as one of the top 10 concepts that could impact and shape world health in the years to come. It emphasises the importance of reconnecting with nature to minimise the effects of many disorders, health problems and inconveniences that seem to have only recently become a serious problem within society (Louv, 2005).
The concept of ecotherapy, albeit relatively new, has been increasing in popularity over the past two decades. The results from preliminary data sets testing these interventions have begun to emerge, and all suggest that nature interventions are beneficial for those who take part. A report by Mind and the University of Essex (2013) evaluated “ecominds”, an ecotherapy scheme designed to help those with mental health problems through the use of nature interventions. Above all else, the results suggested significant improvements in mental wellbeing and self-esteem for those who took part. For example, on average, participants improved their wellbeing scores by 17% and self-esteem by 11% from before and after treatment. In addition, 76% reported improvements in their mood.
Mental wellbeing, self, esteem and low mood are all huge determinants of an individuals’ mental health. Therefore, the improvements in these areas have significant implications for treatment or prevention of disorders. In addition, an average of 10% improvement in social engagement was observed, with some individuals showing a change of almost 90%. General health also improved in 59% participants (University of Essex, 2013). The results are important because they demonstrate that increasing funding for these natural interventions are likely to pay off. Summarising statements of the report suggested “Ecotherapy initiatives have been proved not only to be successful at increasing mental wellbeing and building resilience but also to simultaneously produce other positive life outcomes; but there remains a lack of knowledge and acceptance among GPs (and other care providers)” as well as describing how “increasing support for a wide range of ecotherapy options for all sectors of society is also likely to produce substantial public health benefits and economic savings, and therefore should be promoted”.
Surrey Hills Directory
 Biodiversity & Landscape
 Health & Wellbeing
How nature can be used to improve wellbeing