Liverpool’s green infrastructure strategy is proving that environmental provision such as open spaces will support wellbeing, and could have many lessons for other cities to learn from across the UK. Dr Paula Grey explains.

There are few golden rules in health policy on which most analysts agree, but the age old maxim that prevention is better than cure is probably the closest we get to a near universal consensus. Such an approach is also widely recognised to be better for the health service and its finite resources.

Agreeing which prevention measures work best is perhaps less straightforward. In recent years, however, we have seen mounting evidence that access to a better quality environment can play a significant part in reducing poor health outcomes and health inequalities.

It was with this in mind that Liverpool Primary Care Trust joined forces with the city council’s planning service to deliver a groundbreaking project whose aims included maximising the health benefits of the city’s green assets.

The initiative has seen the PCT jointly commission a comprehensive audit of all Liverpool’s green infrastructure – everything from individual trees and gardens to parks, coastal areas, open space, allotments, and the River Mersey.

Funded via a £60,000 area-based grant from the city’s Local Strategic Partnership, the Liverpool Green Infrastructure Strategy was published earlier this year. The audit was carried out by local environmental regeneration initiative the Mersey Forest team. It now forms a central part of Liverpool’s recently launched Decade of Health and Wellbeing, a broad coalition of partners and communities setting a strategy for reducing health inequalities.

The strategy will help to take forward the five ways to health and wellbeing:

  • Connect
  • Be active
  • Take notice
  • Keep learning
  • Give

The Mersey Forest team’s work means Liverpool now has a detailed environmental evidence base on which to help build health policies and strategies. Increasingly people are harnessing the ideas and using the data to develop their own projects and activities.

At the heart of the strategy is an innovative attempt to get the best outcomes from Liverpool’s green assets in the years ahead, by maximising their health, economic and social benefits. By understanding what green assets we currently have, where they are, and what function they are performing, we can ensure they are better used and managed in the future. It has also given us a better sense of how Liverpool’s “green lungs” contribute to the wellbeing of the city and its residents.

The PCT’s decision to participate in the strategy was based on national and international evidence of the role green infrastructure can play in improving health and wellbeing. The Liverpool Health is Wealth Commission, National Institute for Health and Clinical Excellence guidance, the Marmot review and the public health white paper all highlight the point.

The consensus is clear: high quality, well planned and managed green space delivers direct benefits to people’s health and wellbeing. It also ensures indirect benefits because of the activities and outcomes it promotes and enables. These include promoting better mental health, physical exercise, enhanced opportunities for outdoor play for children, food growing, and greater social cohesion through shared activities centred around common areas of green space.

Green infrastructure has also been demonstrated to improve air quality and reduce noise pollution and help us to adapt to climate change. This is predicted to be especially important as new pressures on the health of our local populations emerge because of global temperature rises.

Trees not only soak up CO2 but also help to cool urban environments by providing shade and evaporative cooling. The NHS Heatwave Plan highlights the need to plan for more green infrastructure to provide cooling in times of extreme temperature in our cities.

Other studies have shown direct links between green space and specific health improvements. A 2008 study carried out by the University of Illinois also showed how using green space could reduce the symptoms of young people suffering from attention deficit disorder.

For Liverpool, green infrastructure offers an opportunity for the city to tackle some of its biggest health problems including poor mental health, heart disease, diabetes and obesity. At the moment, the vital signs are not good. We have low life expectancy levels, the lowest wellbeing levels in the North West of England, and a population of whom 37 per cent are overweight.

A crucial and perhaps surprising finding of the Green Infrastructure Strategy has been the extent of the city’s green assets. The audit identified nearly two-thirds of Liverpool as green infrastructure, an asset worth £8bn.

However, it also highlighted some real inequalities in its distribution. Less than a quarter of the city enjoys access to 80 per cent of city’s green infrastructure and the north of the city is the area where GI is most needed, but most lacking. The city’s most affluent areas also have 18 per cent more green infrastructure than the poorest.

The strategy also recognises the direct link between a healthy population and greater health equity on the one hand, and successful communities and a thriving local economy on the other. Well planned and managed green infrastructure has the potential to link all these.

A good example is the strategy’s recommendation that planning applications for new developments should prioritise the need for people to be physically active as a routine part of their daily life. Where possible, the ambition is to use green infrastructure.

The strategy also recommends increasing green infrastructure in areas of health need and to incorporate it into the design of public spaces.

The city aims to protect its green spaces. More joint working is proposed between Liverpool City Council and the local health sector.

Having established a baseline of green space knowledge we have now put in place a network of partners for planning and delivering improvements. Our aim is clear: to improve the quality of local green space, widen access to it and maximise the health improvements associated with it.

Priority early-win actions we have begun to include:

  • The Discover Parks Programme in collaboration with Liverpool City Council’s parks department. The programme includes a new leaflet highlighting the location of Liverpool’s green spaces and information about activities as well as banners in parks explaining how people can use them to improve their health.
  • A food alliance aimed at promoting the use of green space to grow local food, which has engaged 40 local organisations.
  • Steps to ensure the land and buildings in our estate, and those owned by our health service partners, are put to good use. This has involved developing a Good Corporate Citizenship Sustainability Strategy, which includes actions to improve the green assets the PCT owns and manages and encourage NHS partners to do the same. At Alder Hey Children’s Foundation Trust, for example, the green space in the hospital grounds is being used to help promote the wellbeing and recovery of children and young patients at the Children’s Health Park.
  • A forum to manage the ongoing implementation of the strategy. This will include representatives from the PCT, planning service, Mersey Forest and community organisations.         
  • A programme to make better use of Everton Park as a community asset. This major park can provide many more benefits than it does at present, particularly for health and wellbeing. We are supporting more use of the park, providing green routes to link it to surrounding communities, supporting local community programmes like the Out of the Blue Festival and long term plans to make the park a major visitor attraction.
  • A developing programme of forest schools across the city which encourage physical activity and a more kinesthetic mode of learning for children. Research by Liverpool John Moores University shows that the forest schools have increased levels of physical activity and children show improved concentration and behaviour when back in the classroom.
  • Access to Nature – a lottery funded programme encouraging active use of the award winning Mab Lane Community Woodland, in the north-west of the city, through activities such as health walks and a green gym.

Shared benefits

The Green Infrastructure Strategy is the most comprehensive of its kind ever carried out in the UK. It has brought together two elements of the public realm – planning and health services – which don’t often collaborate.

This approach could easily be replicated in other areas. As health service providers look for cost effective ways to improve health outcomes, reduce health inequalities, and promote prevention, green assets must be part of the answer.

An audit like the Green Infrastructure Strategy is an essential starting point. It provides a solid evidence base to inform an entirely new approach to tackling the city’s challenges.

Ultimately, the strategy aims to help Liverpool to become a safer, healthier, more inclusive and enjoyable place to live. And perhaps that’s something else we can all agree on.

Find out more