Social Inequalities in Environmental Resources of Green and Blue Spaces: A Review of Evidence in the WHO European Region.

Steffen Andreas Schüle,Lisa Karla Hilz,Stefanie Dreger,Gabriele Bolte

doi:10.3390/ijerph16071216

Abstract

Residential green and blue spaces and their potential health benefits have received increasing attention in the context of environmental health inequalities, because an unequal social distribution of these resources may contribute to inequalities in health outcomes. This systematic review synthesised evidence of environmental inequalities, focusing on availability and accessibility measures of green and blue spaces. Studies in the World Health Organisation (WHO) European Region published between 2010 and 2017 were considered for the review. In total, 14 studies were identified, where most of them (n = 12) analysed inequalities of green spaces. The majority had an ecological study design that mostly applied deprivation indices on the small area level, whereas cross-sectional studies on the individual level mostly applied single social measures. Ecological studies consistently showed that deprived areas had lower green space availability than more affluent areas, whereas mixed associations were found for single social dimensions in cross-sectional studies on the individual level. In order to gain more insights into how various social dimensions are linked to the distribution of environmental resources within the WHO European Region, more studies are needed that apply comparable methods and study designs for analysing social inequalities in environmental resources.

Highlights

There is increasing attention in Europe to what extent social inequalities in health are related to unequal distributions of environmental burdens and resources, which are described as environmental health inequalities [1]
Many conceptual models have been developed in order to capture the multidimensional relationships between socioeconomic position (SEP), environmental exposures and health on various levels, for example on the small area or individual level [2]
To compare studies concerning operationalisation of green and blue spaces, measurement of SEP and type of analysis, we summarised the following data: resources assessed with distance or availability measures; single SEP measures or indices applied; and environmental inequalities analysed in a descriptive, bivariate or multivariate manner

Summary

Introduction

There is increasing attention in Europe to what extent social inequalities in health are related to unequal distributions of environmental burdens and resources, which are described as environmental health inequalities [1]. Many conceptual models have been developed in order to capture the multidimensional relationships between socioeconomic position (SEP), environmental exposures and health on various levels, for example on the small area or individual level [2]. According to Krieger et al, SEP combines actual economic and social resources with prestige-based characteristics that relatively position individuals, households or neighbourhoods in society [3,4]. This review refers to this concept of SEP comprising various socioeconomic characteristics with the additional consideration of further relevant social dimensions, such as gender, ethnicity or age. Is used in this review because the focus is on observable and measurable differences in environmental resources across social groups. The term ‘inequity’ integrates normative aspects assessing which differences are judged as unfair and unjust and need appropriate actions [5]

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Discussion

Conclusion