Research objectives

• Identify key published quantitative and qualitative research on measuring the mental, physical, social and cultural health benefits of recreational visits to forests and woodlands;
• Review studies in terms of: robustness of methodology, key findings, relevance to Scotland, consideration of equality groups;
• Synthesise key findings from research identified as robust and relevant, highlighting areas of agreement and disagreement between the results of different studies, identifying areas in need of further research to fully understand the health and well-being, and social and cultural benefits of visits to Scotland’s forests.
• Identify and categorise recent approaches to monitoring the health and well-being benefits focusing on visits to forests and woodlands, but also covering blue and green spaces in general;
• Review these recent approaches in terms of: strengths and limitations, applicability and relevance to the Scottish context, and practical considerations, such as resources needed and cost effectiveness considerations.
• Make recommendations for a long-term monitoring strategy for the health and well-being benefits of visits to Scotland’s forests.

Findings

There is strong evidence that visits to forests deliver a wide range of health and well-being benefits, as well as social and cultural benefits. The benefits include:

• Supporting physical health, including by providing an attractive space facilitating people to be more physically active
• Alleviating stress and symptoms of depression and anxiety
• Supporting general well-being and happiness
• Facilitating social contacts and improving connection to nature

The extent to which visits to forests deliver these benefits is influenced by a range of factors:

• Dose and Exposure – A higher dose of nature, in the form of more frequent or longer visits, typically delivers greater benefits. More vigorous activities, such as brisk walking, cycling or jogging, deliver greater physical health benefits.
• Forest Characteristics – More biodiverse locations can provide greater well-being and immune response benefits.
• Individual circumstances and characteristics – societal, socioeconomic, cultural and environmental conditions can affect factors such as health status and income. These in turn can affect how strongly an individual responds to nature and the benefits obtained.

Measuring Health, Well-being, Social and Cultural Benefits

There is significant overlap between the domains of health. Mental health is important for supporting physical health and vice versa. However, single indicators to measure overall health are often focused towards physical health and can fail to capture fully the importance of mental health and well-being. The use of multiple indicators covering different health domains is best in quantifying the diverse health benefits and to provide a more comprehensive understanding.

There is no consensus on what constitutes ‘gold-standard’ indicators to use for different benefits and contexts. However, cost-effectiveness, specific policy needs, and the extent to which an indicator captures a broad conceptualisation of its health domain make certain health metrics more suitable than others. Recommended indicators include:

• Physical Activity (PA) Levels – these are closely aligned to physical health, are comparable across activities and feature prominently in this field. There is also emerging research on monetising physical health benefits based on PA levels.
• Life Satisfaction – this is widely used and is a key component of the Office for National Statistics’ recommended well-being measures. It has been used often for monitoring mental health in the environment and is an effective measure of population-level subjective well-being.
• Social and Cultural Mixed-Methods – A mix of indicators can be used including the Nature Connection Index (NCI) which is used to assess the relative importance of nature to people. The Pro-Nature Conservation Behaviour Scale can be coupled with the NCI as there is evidence of a positive association between nature connection, pro-environmental behaviours and wellbeing. Qualitative methods such as semi-structured interviews/focus groups can be combined with all of the above approaches to gain in-depth insights into motivations, benefits and experiences of forest visits. Other studies highlight some of these benefits.

Recommendations on Monitoring Approaches

To monitor these benefits from visits to Scotland’s forests effectively, we recommend a best-practice ‘in-depth’ approach and highlight key questions for inclusion. A less costly ‘intermediate’ approach is also noted, which may prove more feasible depending upon the level of resources available. Both approaches involve surveys.

In-depth Approach – We recommend a bespoke longitudinal survey with a large, representative sample of participants. A sample size of 5,000 respondents would deliver a demographically representative Scottish sample covering all protected equality characteristics.

Questions should cover duration of visits and frequency of visits over a given time period to understand the effects of exposure and to scale up benefits.

Questions on types of activities conducted and activity duration provide the foundation for estimating physical health benefits. This data can also be readily used to quantify impacts in terms of Quality-Adjusted Life Years (QALYs), a standardised health measurement that can be readily monetised.

A question on Life satisfaction should be included for a broad understanding of well-being benefits. In addition, including questions to measure mental health and well-being on the Short Warwick-Edinburgh Mental Wellbeing Scale would provide additional insight for understanding benefits associated with improvements in psychological functioning.

Social and cultural benefits could be addressed through similar questions included in Public Opinion of Forestry (POF) England that address social and cultural benefits, alongside the inclusion of open-ended questions for qualitative feedback. A quantitative metric, the Nature Connection Index could be used. Inclusion of an opt-in question to take part in focus groups or interviews would offer an opportunity to collect further qualitative data and gain in-depth insights into social and cultural benefits.

For comparison of benefits between visits to different sites, questions could be included to ask participants what type of woodland they last visited, as well as a list of what facilities were present on the site that they visited.

Socioeconomic questions should be included to cover areas including income and health status as well as sex, age, relationship status and education level. Controlling for these factors is important for understanding causality when using health indicators, especially for mental health and well-being benefits. Questions on ethnicity, religion and number of children in households are less important for understanding health and wellbeing causality but may be important inclusions for improving understanding about access to forests and the distribution of benefits.

The above could potentially be complemented by monitoring of biomarkers, e.g. cortisol, before and after a visit.

An online panel, rather than using telephone or household data gathering may be more cost-effective.

Intermediate Approach – A less costly approach would be to add additional questions to an existing survey to improve monitoring. If this approach were adopted, we would recommend adding questions to POF Scotland. A limitation of POF Scotland is the survey’s relatively small sample size of just over 1,000 (in 2017), limiting its potential to separate out results for different equality groups. To address this last issue the sample size should be increased at least to 2,500.