Page - 264 - in Biodiversity and Health in the Face of Climate Change

264 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 illus- trate 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 cogni- tion may also be moderated by naturalistic views: Kuo and Sullivan (2001) recorded reduced aggression associated with mental fatigue for residents in greener (nature- based) 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 dif- fused 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 activi- ties; (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 thera- peutic 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 participa- tion 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 pre- scribed 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 P. A. Cook et al.