Int J Public Health (2010) 55:59–69

DOI 10.1007/s00038-009-0069-z

REVIEW

Landscape and well-being: a scoping study

on the health-promoting impact of outdoor
environments
Andrea Abraham Æ Kathrin Sommerhalder Æ
Thomas Abel

Received: 10 January 2009 / Revised: 10 June 2009 / Accepted: 27 June 2009 / Published online: 19 September 2009
© Birkha¨user Verlag, Basel/Switzerland 2009

Abstract Introduction
Objectives The present literature review conceptualises
landscape as a health resource that promotes physical, An appealing landscape contributes to people’s health.
mental, and social well-being. Different health-promoting From a health promotion perspective, this popular and
landscape characteristics are discussed. general statement about landscape provokes a number of
Methods This article is based on a scoping study which questions on the more specific links between outdoor
represents a special kind of qualitative literature review. environments and health. One might ask how landscape
Over 120 studies have been reviewed in a five-step-pro-
source: https://doi.org/10.24451/arbor.13304 | downloaded: 8.10.2024

can promote health in its different dimensions, i.e. physi-

cedure, resulting in a heuristic device. cal, mental, and social well-being? How should landscapes
Results A set of meaningful pathways that link landscape look like to promote people’s health? And who might
and health have been identified. Landscapes have the benefit from a health-promoting landscape? There are three
potential to promote mental well-being through attention major challenges in addressing these questions.
restoration, stress reduction, and the evocation of positive First, ‘‘landscape’’ as an analytical term is difficult to
emotions; physical well-being through the promotion of define. The European Landscape Convention (Council of
physical activity in daily life as well as leisure time and Europe 2000) currently defines landscape as ‘a zone or
through walkable environments; and social well-being area as perceived by local people or visitors, whose visual
through social integration, social engagement and partici- features and character are the result of the action of natural
pation, and through social support and security. and/or cultural (that is, human) factors’ (Art. 1). According
Conclusion This scoping study allows us to systemati- to the CE’s convention, landscape develops in a procedural
cally describe the potential of landscape as a resource for manner through the interaction between nature and human
physical, mental and social well-being. A heuristic frame- beings. This is clearly different from former landscape
work is presented that can be applied in future studies, definitions which were influenced by a strong nature/cul-
facilitating systematic and focused research approaches ture dualism and an environmental determinism (Ingold
and informing practical public health interventions. 1992). Furthermore, landscape can be imagined as a con-
tinuum between ‘‘wild’’ nature and designed environment
Keywords Landscape · Well-being · such as urban and rural forests, green spaces, parks, gar-
Health-promoting behaviour · Resources · Scoping study dens, waters, and neighbourhood areas.
Second, in relation to health and well-being, open
questions remain concerning pathways of conscious per-
ception of the environment: How is landscape perceived,
A. Abraham ·K. Sommerhalder T. Abel ( ) experienced and used as a resource for healthy behaviour?
Division of Social and Behavioural Health Research,
Department of Social and Preventive Medicine,
Empirical as well as theoretical work suggests that land-
University of Bern, Niesenweg 6, scape is linked to a dual perception. On one hand,
3012 Bern, Switzerland landscape is experienced physically in a multisensory
e-mail: [email protected] manner, in particular through sight, hearing, touching, and
60 A. Abraham et al.

smelling: Landscape, from this perspective, is a conglom- Methods

erate of different types of ‘‘scapes’’, such as soundscape
(Adams et al. 2006; Atkinson 2007; Carles et al. 1999; Ge As a particular method in qualitative literature reviews,
and Hokao 2005; Gidlo¨f-Gunnarsson and O¨ hrstro¨m scoping studies have distinct characteristics (Arksey and
2007; O’Malley 2005; Badger et al. 2000). Unlike systematic
O’Connor 2008; Raimbault and Dubois 2005; Yang and reviews, they address broader topics and topic areas, in
Kang 2005) and smellscape (Porteous 1990). On the other which many different study designs might be applicable
hand, landscape is also a matter of individuals’ perceptions (Arksey and O’Malley 2005). This approach was suitable
and trajectories: this means that landscape as an analytical to identify the relevant and often non-standardised pieces
concept is characterised by an inherently dialectical rela- of evidence of the health-promoting effects of landscape.
tionship between physical reality and metaphoric and Table 1 displays the major characteristics that were fol-
social construction. The same landscape can, from this lowed in the present study:
point of view, be perceived completely different. The Five steps were involved in collection, evaluation, and
explanation for this lies in the fact that landscape is linked presentation of the literature. First, we defined the research
to meaning, identity, attachment, belonging, memory, and focus as well as specific inclusion and exclusion criteria
history (Augenstein 2002; Davenport and Anderson 2005; for the literature search. By focusing on the links between
Frumkin 2003; Oreszczyn and Lane 2000; Parsons and landscape and physical, mental and social well-being, we
Daniel 2002; Rishbeth and Finney 2006). included all literature presenting theoretical or empirical
Third, although a relatively large body of multidisci- approaches on a health-promoting impact of landscape. We
plinary evidence exists about the health-promoting impact only included studies from industrialised countries and
of landscape in industrialised countries (St Leger 2003; excluded all literature focused on environmental hazards
Maller et al. 2006), current evidence seems too scattered to (noise, air pollution, etc.) and their pathogenetic impact, as
draw any specific or sound conclusions. The challenges of well as studies on agricultural use of landscape which are
a literature review are the lack of consistent definitions and related to food, foodscapes, and material well-being.
systematic concepts in this research field. With a method- Foodscapes have been excluded here because they refer
ological approach called ‘‘scoping study’’, we aim at primarily to the distribution of commodities. As such they
overcoming these challenges and to map out criteria for are directly linked to retail mechanisms and market struc-
landscape as a resource for better health and well-being. tures which make them distinctly different from our
The scoping study presented in this paper is character- conception of landscapes.
ised by its resource-oriented perspective on the links
between landscape and health. It is focused on human
perceptions and behaviours related to different character-
istics of landscapes and does not include studies on
environmental risks for health. To our knowledge, no such Table 1 Characteristics of scoping studies according to Arksey and
focused review is available today. Current literature O’Malley (2005)
reviews on landscape and health focus either on the links • Identification of all relevant literature regardless of methods and
between ‘‘wild’’ nature and health (Frumkin 2001; Health study designs applied
Council of the Netherlands 2004; Maller et al. 2006) or • Non-linear, iterative, and reflexive process
• No quality assessments of studies reviewed
between the built environment and health (Jackson 2003).
• Presenting account of existing literature with an analytic framework
Our main interest, however, lies on the spaces of landscape or thematic construction
which are situated between ‘‘wild’’ nature and built • 5-step framework
environment. 1. Definition of research focus, inclusion and exclusion criteria for
Against this background, this paper first provides a the literature search
scoping study of publications on the health-promoting 2. Identification of all relevant studies, literature reviews and reports
influence of landscape. Second, drawing on this overview, in electronic databases, key journals, reference lists of earlier
studies, and topic-related expert networks and organisations with
we propose a new heuristic framework to link landscape selected key words
and health in a way that is amenable to health promotion 3. Selection of literature to be closely reviewed in a comparative and
research and practice. The current findings illustrate how consensus orientated team process, determination of further
the three dimensions of health—physical, mental and inclusion and exclusion criteria
social well-being—are promoted through designed, 4. Full-text reading and charting of literature in a descriptive-
construc- tional, and aesthetic aspects of landscape. The analytical way
results of this study might be used as a basis for specific 5. Collation, summary, structuring and report of reviewed literature
research projects and interventions that address landscape
as a health resource.
A scoping study on the health-promoting impact of outdoor environments 61

Second, all relevant original studies and literature thematically along the three dimensions of health, namely
reviews from peer-reviewed journals and scientific reports physical, mental and social well-being. Based on the
were identified in the following sources: results from all five steps we developed a heuristic
• electronic databases (Web of Science, Pub Med, central framework (see Fig. 1). This framework was derived from
online catalogue of the Swiss university libraries); the data and underwent a communicative, consensual
• single key journals relevant in areas that relate to validation process (Bauer and Gaskell 2000; Kvale 1995;
landscape and health promotion; Lamnek 2005; Steinke 2003) with external experts
• reference lists of earlier studies; working in the area of landscape and health. Figure 1
• topic-related expert networks and relevant illustrates the different ways landscape might promote
organisations. mental, physical, and social well- being and might be used
as heuristic device in future studies.
Keywords for the literature search were selected from
two broad areas: landscape and health. For landscape,
keywords such as landscape, healthy environment, healthy
Results
place, nature, city, urban, rural, wood, forest, park and
garden were used; for health, keywords such as health,
The following section presents an overview on studies that
well- being, quality of life, restoration, stress recovery,
illustrate the mechanisms through which landscape serves
mental health, physical activity, social capital and social
as a resource for people’s health-promoting activities. The
support were used as search terms. All possible two-word
results are divided into three subsections each focusing on
combi- nations of single terms from both areas were
mental, physical, and social well-being.
employed.
In total, we found about 500 studies, reviews and
Mental well-being: landscape as a restorative
reports related to our research focus. All studies were
collected and systematised using a bibliography-managing
software (EndNote®). In their book ‘The experience of nature: a psychological
In the third step, the literature to be closely reviewed perspective’, Kaplan and Kaplan (1989) laid the theoretical
was selected by two members of the research team (AA, foundation for explaining landscape’s potential influence
KS) in a comparative and consensus orientated process. on cognitive attention restoration. They established four
The limitations in research resources required us to select characteristics for restorative environments (Kaplan and
only the most relevant items. Thus, further exclusion cri- Kaplan 1989; Kaplan 1995a, b). First, restorative envi-
teria were applied: Studies that focus on isolated elements ronments enable people to get some distance from their
of landscape like single buildings, functions of buildings, daily life. Second, they attract people’s attention without
indoor environments, and those that address the therapeutic being exhausting. Third, they enable constant discovery of
impact of certain landscape aspects in health care settings new things, mostly compatible with already existing
were excluded. Yet, studies focusing on built environment information about the environment. Fourth, they are in line
in terms of public places such as meeting points or streets with the intentions of their users, i.e. the environment
were included. We further excluded the literature that was enables the users to do what they want to do. Herzog et al.
published before 1995 except basic literature reviews. At (1997) added that these kinds of environments contribute
the end of this step, 123 studies, reviews and reports to attention restoration in terms of clarifying and ordering
remained for full-text reading and for inclusion in the thoughts and of reflecting on personal goals and vital
review. matters.
In the fourth step, the data were charted. According to Other studies included in our review have highlighted
Arksey and O’Malley (2005), charting ‘describes a tech- the fact that a natural landscape is more restorative than an
nique for synthesising and interpreting qualitative data by urban one. Hartig et al. (2003) showed that walks in natural
sifting, charting and sorting material according to key landscapes have a stronger effect on the ability to con-
issues and themes […]’. This methodical step was con- centrate than urban walks. This goes with other studies that
ducted in a descriptive-analytical way. For this purpose, emphasised that people prefer natural landscape such as
the literature was analysed and sorted according to each beaches, waters, forests, parks, and mountains for recovery
study’s key results and design (see Table 2 for an extract of from mental fatigue (Korpela and Hartig 1996; Korpela
the reviewed studies). Following the principles of a et al. 2001; Staats et al. 2003; Staats and Hartig 2004).
scoping study, no systematic assessment of the quality of Furthermore, as the literature suggests, public open spaces
evidence was sought. used for public entertainment and sports have an interme-
In the fifth step, the reviewed literature was collated, diate restorative effect in contrast to natural settings, which
summarised and reported. Results were structured have a high restorative potential, or urban settings, which
Table 2 Overview of the literature on the health-promoting influence of landscape

62
Health dimension Health-promoting
landscape effect Landscape characteristics Study design Author(s)

Mental well-being Attention restoration and recovery from

mental fatigue Natural landscapes such as beaches, Conceptual accounts/literature Health Council of the Netherlands (2004); Frumkin
waters, forests, parks, mountains reviews (2003, 2001); Kaplan (1995a, b); Kaplan and Kaplan
Availability of public open spaces used (1989); Maller et al. (2006)
for public entertainment and sports Survey-studies (cross-sectional Herzog et al. (1997); Korpela and Hartig (1996);
studies, longitudinal studies) Korpela et al. (2001); Tennessen and Cimprich
(1995)
Experimental studies Berto (2005); Hartig et al. (1996, 2003); Kuo (2001);
Staats and Hartig (2004); Staats et al. (2003)
Recovery from stress Landscape perceived as pleasant, i.e. Conceptual accounts/literature Frumkin (2001); Health Council of the Netherlands
landscape contains visual stimuli such reviews (2004); Maller et al. (2006)
as moderate complexity and richness
of natural elements like waters or Survey-studies (cross-sectional Gidlo¨f-Gunnarsson and O¨ hrstro¨m (2007)
vegetation studies, longitudinal studies)

Easy access to green areas with lower Experimental studies Hartig et al. (1996, 1999, 2003); Laumann et al. (2003);
sound levels from road traffic Parsons et al. (1998); Ulrich et al. (1991, 2003)
Positive emotions Landscape perceived as pleasant Survey-studies (cross-sectional Herzog and Chernick (2000); Kaplan (2001); Korpela
Open and accessible forests studies, longitudinal studies) et al. (2002); Kuo and Sullivan (2001b); Kuo et al.
Perceived amount of open space and (1998)
vegetation (urban landscapes) Experimental studies Cackowski and Nasar (2003); Kuo and Sullivan
(2001a); Staats et al. (1997)
Qualitative studies Milligan and Bingley (2007)
Physical well- Physical outdoor activity in cities Daily life: Conceptual accounts/literature Frank and Engelke (2001); French et al. (2001);
being reviews Frumkin (2003); Frumkin et al. (2004); Health
Access to and presence of physical
activity-promoting facilities Council of the Netherlands (2004); Kaspar and
Bu¨hler (2006); McCormack et al. (2004); Pikora
General functionality of urban districts et al. (2003); Popkin et al. (2005); Powell (2005);
(e.g., sidewalks, traffic regulation, Sallis and Glanz (2006)
bicycle and walking paths)
Survey-studies (cross-sectional Addy et al. (2004); Ball et al. (2001); Booth et al.
Leisure time: studies, longitudinal studies) (2000); Cervero and Duncan (2003); Craig et al.
Land-use-mix (2002); Giles-Corti and Donovan (2002); Gordon-
Street connectivity Larsen et al. (2006); Humpel et al. (2004a ,b); Lee
et al. (2001); Leslie et al. (2005); Li et al. (2005);
Traffic safety (e.g. pedestrian zones) Neff et al. (2000); Ozguner and Kendle (2006);
Aesthetically appealing landscapes Payne et al. (2002); Pikora et al. (2006); Saelens et
Trust in neighbours, active neighbours al. (2003); Titze et al. (2005); Wendel-Vos et al.
(2004)
Nearby parks, playgrounds and sport Qualitative studies Coen and Ross (2006); Eyler et al. (1998); Wilbur et al.
fields (2002)
Access to places for physical activities
Physical outdoor activity outside cities Aesthetically appealing rural green

A. Abraham et al.
Conceptual accounts/literature Gasser and Kaufmann-Hayoz (2004)
landscapes (e.g. forests) reviews
Survey-studies (cross-sectional Baur and Gilgen (1999); Swiss Federal Office for the
studies, longitudinal studies) Environment (1999); Lamprecht and Stamm (2002);
Marti et al. (2002); Pretty et al. (2005a)
Experimental studies Pretty et al. (2005b)
A scoping study on the health-promoting impact of outdoor environments 63

have a low restorative potential (Herzog et al. 1997). The

Brown and Jameton (2000); Frumkin (2003); Frumkin

Baum and Palmer (2002); Irvine et al. (1999); Milligan

et al. (2004); Hancock (2001); Health Council of the
Netherlands (2004); Maller et al. (2006); Twiss et al.

et al. (2004); Rishbeth and Finney (2006); Wakefield

Stigsdotter and Grahn (2004); Sullivan et al. (2004);

Fredrickson and Anderson (1999); Pohl et al. (2000);

restorative potential of natural landscapes was also dem-

Armstrong (2000); Booth et al. (2000); Coley et al.

(1997); Kuo et al. (1998); Kweon et al. (1998);
Leyden (2003); Seeland and Ballestros (2004);
onstrated in an experimental study by Berto (2005), in
which visual confrontation with pictures of natural land-
scapes had a restorative effect on mental fatigue in
students. Such results are in line with findings of two
earlier studies, which measured the effect of a view of a
landscape on concentration (Kuo 2001; Tennessen and

Doyle and Krasny (2003)

Cimprich 1995). Our scoping study also reveals the
Waliczek et al. (2005)

Staats and Hartig (2004)

importance of low sound levels for rest and relaxation:
Gidlo¨ f-Gunnarsson and O¨ hrstro¨m (2007) point out

Sharpe (2005)
et al. (2007)
that

Ewert (1991)
people who have easy access to green areas, can reduce
(2003);

noise annoyances and thus become more relaxed.

Author(s)

Parallel to studies on the restorative impact on mental

fatigue, other studies included in our review have demon-
strated a similar effect when it comes to stress reduction.
Ulrich et al. (1991) showed that when people look at a
studies, longitudinal studies)

studies, longitudinal studies)

Survey-studies (cross-sectional

Survey-studies (cross-sectional
Conceptual accounts/literature

natural landscape, immediate, unconsciously released

emotional reactions significantly affect their stress recov-
ery. These effects concern their attention, conscious mental
Experimental studies
Experimental studies

Qualitative studies
Qualitative studies

processing, behaviour and physiological reactions. While

looking at a landscape that is perceived as pleasant, neg-
Study design

reviews

ative feelings and thoughts—which were previously

induced by negative stress exposure—are replaced by
positive feelings such as interest, cheerfulness and calm-
ness (Hartig et al. 1996). As the literature shows, this
reaction takes place when the landscape contains particular
walkable, serve multiple purposes
Sufficient level of safety, attractive,

visual stimuli such as a moderate complexity and richness

of natural elements like waters or vegetation (Hartig et al.
1996). Indicators for a positive effect are lower physio-
Landscape characteristics

logical excitation in terms of lower pulse rates and lower

Community gardens

Rich in vegetation

emotional arousal (Laumann et al. 2003; Parsons et al.

‘‘Wild’’ nature

1998; Ulrich et al. 1991, 2003). However, reviewed studies

assume a difference between the effects of natural and
urban landscapes: Hartig et al. (2003) pointed out that
Parks

study participants taking a walk in the woods yielded lower

emotional and physical stress levels when compared to
those taking an urban walk.
Some studies in our review indicate that views of a
natural landscape promote people’s ability to express
Collectively experiencing nature

positive feelings like joy and satisfaction more easily

(Hartig et al. 1999; Kaplan 2001; Korpela et al. 2002).
More specifically, open and accessible forests are
Social integration
Health-promoting

suggested to enhance positive emotions more than dense

landscape effect

and less accessible forests (Milligan and Bingley 2007;

Staats et al. 1997). With respect to the positive impact of
landscape on general mood, Cackowski and Nasar (2003)
showed that a pleasant landscape contributes to higher
Table 2 continued

frustration toler- ance, whereas other authors found that

Health dimension

Social well-being

lower crime rates and feelings of safety in cities are

associated with con- structional conditions (e.g. the
perceived amount of open space, level of vegetation)
(Herzog and Chernick 2000; Kuo et al. 1998; Kuo and
Sullivan 2001a, b).
64 A. Abraham et al.

Fig. 1 Heuristic framework on

the health-promoting impact of
landscape
... mental well-being through
attention restoration
stress reduction
evoking positive emotions

Landscapes = ... physical well-being through

natural or designed environments promote ... promotion of physical activity in

in urban and rural areas cities
promotion of physical activity
outside cities

... social well-being through

social integration
collectively experiencing nature

Physical well-being: walkable landscape importance of providing basic constructional conditions to

make spaces for health-promoting physical activities as
The literature reveals that the way the urban landscape and user friendly as possible (Giles-Corti and Donovan 2002;
environment is designed and built is crucial for the level of Wendel-Vos et al. 2004). However, recent studies have
physical activity in daily life, work and leisure time clearly shown that many city dwellers in socially deprived
(Frumkin et al. 2004; Humpel et al. 2004a, b; McCormack areas lack access to places for physical activity (Coen and
et al. 2004; Powell 2005). Pikora et al. (2003, 2005) con- Ross 2006; Gordon-Larsen et al. 2006; Popkin et al.
sidered access to destinations, the presence of physical 2005).
activity-promoting facilities, and the general functionality As many studies in our review have illustrated, forests
of urban districts (e.g. sidewalks, traffic regulation) as play an important role when it comes to outdoor physical
aspects of landscape that promote and enable physical activity outside cities, including walking, hiking, kayaking,
activity. Further, constructional conditions are bicycle and and fishing. People use forests for physical activity mainly
walking paths for better walkability (Cervero and Duncan to recreate and exercise (Baur and Gilgen 1999; Gasser and
2003; Craig et al. 2002; Frank and Engelke 2001; Li et al. Kaufmann-Hayoz 2004; Lamprecht and Stamm 2002;
2005), land-use-mix, street connectivity, traffic safety (e.g. Marti et al. 2002; Pretty et al. 2005a, b; Swiss Federal
pedestrian zones), and an aesthetically appealing landscape Office for the Environment 1999). In order to be perceived
(French et al. 2001; Humpel et al. 2004a, b; Leslie et al. as an option for physical activity, rural green landscapes
2005; Saelens et al. 2003; Titze et al. 2005). In terms of must be aesthetically appealing to their users (Pretty et al.
physical activity in leisure time, our review illustrates that 2005a, b).
location and infrastructure, e.g. of a park, safety aspects,
and the absence of traffic, play an essential role (Ball et al. Social well-being: landscape as a bonding structure
2001; Booth et al. 2000; Neff et al. 2000). Addy et al.
(2004) found that people gain additional motivation for According to Armstrong (2000) and Leyden (2003), urban
regular physical activity when they trust their neighbours, parks and other public places can enhance social integra-
when they perceive their neighbours as active, and when tion if they facilitate social contacts, exchange, collective
they have the opportunity to use nearby parks, playgrounds work, community building, empowerment, social networks
and sport fields. and mutual trust. Also, socially integrative functions
As for social differentiation, studies have indicated that of landscape were found in studies with elderly people
the preferences and needs related to places as well as the (Booth et al. 2000; Kweon et al. 1998; Milligan et al. 2004)
access to places for physical activity vary according to and migrants (Rishbeth and Finney 2006; Seeland and
gender, age and ethnic background (Eyler et al. 1998; Ballesteros 2004). As the literature suggests, urban land-
Kaspar and Bu¨hler 2006; Lee et al. 2001; Payne et al. scape should provide a sufficient level of safety (e.g. park
2002; Wilbur et al. 2002). Authors have emphasised the controls), attractiveness, walkability, should serve multiple
A scoping study on the health-promoting impact of outdoor environments 65

purposes (Baum and Palmer 2002; Leyden 2003) and be • attention restoration,
rich in vegetation (Coley et al. 1997; Kuo et al. 1998; • stress recovery,
Sullivan et al. 2004) to promote social integration. • evocation of positive emotions,
In a recent article the health-promoting impact of • physical outdoor activities in and outside cities,
community gardening was addressed: Among other bene- • social integration,
fits, community gardening was found to foster the
• collective experience of nature.
development of community networks, social support and to
motivate people for community engagement (Wakefield
et al. 2007). With their results the authors complemented How should landscape look like to promote people’s
findings from earlier studies about the health benefits of health?
community and private gardens (Armstrong 2000; Brown
and Jameton 2000; Doyle and Krasny 2003, Hancock In order to promote health, landscapes need to have certain
2001; Irvine et al. 1999; Stigsdotter and Grahn 2004; characteristics that influence human well-being directly or
Twiss et al. 2003; Waliczek et al. 2005). indirectly (see Table 2), and which turn them into ‘‘good
As our scoping study illustrates, collective nature places’’ for health (Frumkin 2003). Most important among
experience programmes have become popular in the fields these are easy access to natural landscapes and the avail-
of education, management and psychology over the last ability of nearby (green) public open spaces. Landscapes
20 years. The collective experience of nature in non-urban need to be perceived as pleasant and attractive for all
areas has been linked to various aspects of health: ‘[…] senses, and safe in terms of well-lit streets, presence of
wilderness experiences may be salutary because of the other people and sidewalks, which make people feel safe
benefits of companionship, being physically active, taking from crime and traffic dangers. Furthermore, neighbour-
a vacation, or meeting a challenge, and not because of hoods need to provide a general functionality (e.g. street
nature contact per se’ (Frumkin 2003). Besides individual connectivity, pedestrian zones, bicycle tracks) to promote
outcomes, (Fredrickson and Anderson 1999; Pohl et al. walkability: A walking-friendly design enables indepen-
2000), many of these programmes concentrate on the col- dence from automobiles and promotes healthy physical
lective experience of group dynamics. As we found in the behaviour through easy access. Landscapes also foster
literature, such programmes provide experience of equality healthy behaviour and emotional well-being if they offer
and community (Sharpe 2005), social decision-making and the possibility of meeting and engaging with other people
responsibility, social bonding and support (Fredrickson and in public open spaces.
Anderson 1999; Pohl et al. 2000), and feelings of being
protected (Staats and Hartig 2004). They further facilitate Who might benefit from a health-promoting landscape?
the building of integrative groups, collective solving of
spontaneously emerging problems and collective landscape Many of the studies reviewed emphasised that landscape
planning and design (Ewert 1991). should promote everyone’s health in daily life, suggesting
that all people should have access to health-promoting
landscapes at home, at work, and during leisure time. This
Discussion demand is clearly supported by the Ottawa-Charter’s call
to create supportive environments for everyone (WHO
In the field of health promotion, landscape should be 1986). However, there are apparent challenges to this:
understood to be a multi-faceted resource for physical, people’s landscape preferences, needs, and uses are
mental and social health and well-being. This is the general socially and culturally diverse. As documented in this
conclusion that can be drawn from the findings of the review, health- promoting landscapes are perceived and
present study. More specifically however, a synthesis of used differently by various social groups and are therefore
the results provides the first answers to the specific a group-specific matter. Moreover, not everybody has
questions raised at the beginning of this paper: equal access to health-promoting landscapes. Thus,
unequal access may function as a way in which inequalities
in the distribution of resources contribute to the
How can landscape promote health?
(re-)production of health inequalities. To cite just one case
in point: socially deprived people, who do not have access
Landscape might function as a spatial framework for to safe outdoor spaces for physical activity, are likely to
health-promoting activities in physical, mental, and social suffer more often from obesity than people with access to
realms. These activities are linked to health outcomes and such spaces (Gordon-Larsen et al. 2006; Popkin et al.
improvements such as: 2005). And in contrast, people who live in a safe
neighbourhood, which
66 A. Abraham et al.

provides a certain number of sport fields and which

a need to sharpen current landscape definitions, and to take
enables children to walk to school or go there by bike, are
into account that landscape is perceived with all senses.
physi- cally more active than other people (Sallis and
Literature on ‘‘soundscapes’’ (Adams et al. 2006; Atkinson
Glanz 2006).
2007; Carles et al. 1999; Ge and Hokao 2005;
From a health-promoting perspective, our findings pro-
Gidlo¨f-
vide strong additional and new support for understanding
Gunnarsson and O¨ hrstro¨ m 2007; O’Connor 2008;
landscapes as a health resource and health determinant Rai-
(Frumkin 2003; Maller et al. 2006). According to the mbault and Dubois 2005; Yang and Kang 2005) and
results of the present scoping study, the relationship ‘‘smellscapes’’ (Porteous 1990) call attention to this mul-
between landscape and health shows two main features: tisensory conceptualisation of landscape. Comprehensive
first, health-promoting landscapes contribute to healthy definitions of landscape which include multi-sensory
lifestyles in terms of physical activity and mental and aspects of perception are important also in terms of
emotional relaxation. Second, health-promoting landscapes empirical operationalisation of concepts, the evaluation of
promote the acquisition of resources for health such as their validity and comparability of study results.
social support, concentration and emotional stability.
Beyond these findings, the study provides an up-to-date Acknowledgments This literature review was partly funded by the
overview of the current literature and a new framework as Swiss Foundation for Landscape Conservation, the Swiss Society of
a heuristic tool. As such it may be useful for future Doctors for the Environment, the Swiss Federal Office of Public
Health, and the Swiss Federal Office for the Environment. We
research and practice to systematically explore and foster express our appreciation to these organizations for making our scoping
the health- promoting impact of landscape on mental, study possible.
physical and social well-being. Disciplines dealing with
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