Page - 112 - in Biodiversity and Health in the Face of Climate Change

112 In a number of studies, the positive association between urban green space and health outcome remained even after controlling for socio-economic confounders such as SES, area deprivation, household income or educational status. However, associations are not significant in all studies and partly disappeared when statistical models were adjusted for socio-economic and socio-demographic confounding variables. The strongest remaining significance was shown here for mental health and physical activity. A similar conclusion was presented by Kabisch et  al. (2017) for an association between urban greenness and health outcome for particular vul- nerable groups of children and elderly. Consistent results were also shown for phys- ical activity but not for overweight or obesity. We can conclude that results demonstrate a multi-factor association between socio-economic, socio-demographic and environmental/green factors and potential health outcomes. Socio-economic and socio-demographic factors are particularly relevant, and often explain health outcomes to a greater extent than green space availability only. Variables that relate to a lower socio-economic status of participants explain more negative health outcomes. However, for mental well-being, inequalities were smaller among urban residents who reported good access to green spaces, compared with those reporting less access. Similar results were also found for health outcome variables other than mental health. Mitchell and Popham (2008) found that, in gen- eral, populations that are exposed to the greenest environments were also identified to have the lowest levels of health inequality linked to income deprivation (for fur- ther discussion, see Cook et  al. Chap. 11, this volume). Further, the mediating effect of urban green space was highlighted for lower income or deprived groups (Flouri et  al. 2014; Mitchell et  al. 2015; Roe et  al. 2017). Some green space and health relationships appeared to be stronger for those living in low-income areas (Xu et  al. 2017). The mediating effect of urban green space may be particularly important for lower status groups. Chawla (2014) reported the importance of nature as a green refuge, with particular importance for children in the context of poverty and displacement. Reasons for some inconsistencies in the results of the potential association between urban green space health outcomes depend on the particular inclusion vari- ables. Some authors suggested that their results are different from other studies because of the non-inclusion of particular confounding factors such as environmen- tal and neighbourhood characteristics of deprivation, crime, air pollution, etc. (Pearson et  al. 2014). Furthermore, inconsistencies might be explained by the dif- ference in green space provision in urban areas in different case studies  (Richardson et  al. 2017a). 5.4.2 Implications for  Urban Policy and  Planning What can urban planning and policy-making learn from the studies discussed in this review? Goal 11 from the SDGs clearly states that creating green public spaces will be integratively linked to sustainable and safe urban development. But how is a N. Kabisch