Urban natural environments as nature-based solutions for improved public health - A systematic review of reviews

Increasing urbanisation, changing disease scenarios, and current predictions of climate change impacts require innovative strategies for providing healthy and sustainable cities, now and in the future. The recently coined concept, Nature-based solutions (NBS), is one such strategy referring to actions that are inspired by, supported by, or copied from nature, designed to address a range of environmental challenges. The objective with this article is to evaluate the evidence on public health benefits of exposure to natural environments and explore how this knowledge could be framed within the NBS concept. We conducted a systematic review of reviews following established methodology, including keyword search in several databases, predefined inclusion criteria, and a data extraction in accordance with the PICOS structure. We reviewed literature on associations between public health and natural environments in relation to pathways - sociobehavioural/cultural ecosystem services (e.g. stress and physical activity) and regulating ecosystem services (e.g. heat reduction) - or defined health outcomes (e.g. cardiovascular mortality). The results show that there is strong evidence for improved affect as well as on heat reduction from urban natural environments. These conditions may mediate the effect seen on cardiovascular disease (CVD)-related mortality by exposure to natural environments. By also reviewing existing literature on NBS and health, we phrase the results within the NBS context, providing guidelines on how public health and well-being could be integrated into implementation of NBS for resilient and liveable urban landscapes and health in a changing climate.