Page - 453 - in Biodiversity and Health in the Face of Climate Change

453 related to physical activity and obesity remain inconclusive, possibly because of study design and confounding variables such as socio-economic factors, which need to be considered carefully when designing studies (Kabisch Chap. 5, this volume). Some specific biodiversity-health associations are negative, especially with regard to allergies and vector-borne diseases (Damialis et  al. Chap. 3, Müller et  al. Chap. 4, this volume), whereas effective spatial planning and management actions can mitigate these effects (Elmqvist et  al. Chap. 18, Heiland et  al. Chap. 19, this vol- ume). There is also some evidence of the positive effects of biodiversity on mental health and well-being (Marselle et  al. Chap. 9, this volume). Importantly, this vol- ume also considers spiritual well-being (Irvine et  al. Chap. 10, this volume), which to date has been subject to little attention. Management of biodiversity could there- fore form a globally important natural health service. By reviewing and synthesising the available literature and recent findings, the authors in this volume develop an evidence base for how biodiversity can contribute to physical, mental and spiritual aspects of health and well-being. Importantly, the volume starts to further develop the theory of biodiversity-health relationships (Marselle Chap. 7, this volume), a necessary component for future studies. The authors identify the different mechanisms for biodiversity-health pathways by building on existing work (e.g. Hartig et  al. 2014; Markevych et  al. 2017; Potschin and Haines-Young 2011; van den Bosch and Ode Sang 2017). As this is an emerg- ing research area, it was at times challenging for some chapters to relate to primary data and analyses where all three topics − biodiversity, health and climate change  – were assessed together. Similarly, while the contributions draw on expertise from different disciplines, an additional challenge encountered was moving beyond anal- yses of green space in general to focus on the specific contribution of biodiversity in particular, for which few studies exist to date, although research has grown in the past decade (e.g.  Aerts et  al. 2018; Fuller et  al. 2007; Dallimer et  al. 2012; Lovell et  al. 2014). To foster further research, the chapters identify knowledge gaps and areas for new research avenues as well as improvement through enhanced or better aligned indicators and metrics (de Vries & Snep, Chap. 8, this volume). These met- rics should also link to existing policy targets in public health and nature conserva- tion (Davies et  al. Chap. 12, Korn et  al. Chap.14, MacKinnon et  al. Chap. 16, this volume). We need to move further in our research efforts to quantify the benefits and risks that biodiversity provides for human health, and how interaction with plants and animals shapes our physical, mental and spiritual health and well-being as well as societal and cultural practices. Studies have started to explore dose-response rela- tionships of nature and health (e.g. Cox et  al. 2017; Shananhan et  al. 2015), which need to be further expanded in order to foster our understanding of the impact of duration and exposure of contact with biodiversity on health. This knowledge is required to aid development of ‘health treatments’, both through natural resource management interventions via configuration of green and blue spaces and through active social interventions, such as health walks (Marselle et  al. 2014; Cook et  al. Chap. 11, MacKinnon et  al. Chap. 16, Hunter et  al. Chap. 17, all  this volume). Importantly, unravelling the different mechanisms requires a targeted and innova- tive study design and consideration of confounding factors to account for different 20 Biodiversity and  Health in  the  Face of  Climate Change: Perspectives for  Science…