Larger scale estimates of avoided health costs

The Trust for Public Land (USA) has calculated the annual avoided costs of health care associated with levels of physical activity in parks across 10 US cities and counties. Values ranged from $4 million to $69.4 million (Wolf and Robbins 2015). Further general estimates of the health benefits of living in areas with good greenspace accessibility and trees show aggregate values for the whole US population ranging from $2.7 billion to $6.7 billion (Table 67.3).

The health benefits from increased physical activity by sedentary people can be measured in economic terms. The annual value of decreased morbidity and mortality from a 1 percent unit reduction in the percentage of sedentary people in the UK was estimated at $1.91 billion (a mean of $3223 per additional active person per year). This figure is reduced to $637 million if older people are excluded. Seventy percent of the benefit comes from reduction of coronary heart disease (CHD). There is evidence for psychological benefits in both recovery from, and prevention of, mental illness, but there is insufficient quantitative evidence for an economic analysis (Willis and Crabtree 2011).

Economic evaluation methods used to assess greenspace exercise health benefits for specific conditions

Estimates of reduction of health costs by lowering the incidence of disease indicate huge potential savings to health care budgets. For example, reduction of cardiovascular conditions (CVD)

Table 67.3 Range of potential annual cost savings and increased income associated with human health and well-being benefits derived from urban nature elements (including urban open space and greening activities) in millions of US dollars (2012)

Benefit (geographic range)

Minimum S

Maximum S

New-born health (USA)



Attention deficit hyperactivity disorder (USA)






Crime (USA)



Cardiovascular disease (UK, USA)



Alzheimer's disease






Source-. After Wolf et al. (2015)

in Quebec, Canada between 2020 and 2050 in terms of death rates of individuals suffering from CVD decreasing directly, would be worth over C$66 billion in 2012 dollars — a significant figure for Quebec, whose gross domestic product is under C$400 billion (Boisclair et al. 2018). A major key to achieving such a reduction would be outdoor exercise in which urban greenspace would play a significant part. Quantifying the value of that part and distinguishing its impact from that of exercise in an indoor gym remains a challenge. Two alternative ways of looking at this issue are to assess park-based interventions that improve the attractiveness of greenspaces to encourage greater use, and to use the willingness-to-pay method to assess how much an individual values avoiding death or disability from a particular condition (Table 67.4). Park and greenway trail improvements have been found to attract enough additional walkers and cyclists to yield benefits worth 1 to 4 times more than the cost of making that improvement (WHO Europe 2017).

The health improvement cost curve

The consultant company PwC has developed a model that compares value of money of different interventions using big data and enhanced computing with evidence tailored to local circumstances in order to provide health commissioners with a clear road map to deliver improved public health in their locality. Interventions are ranked in order of cost-effectiveness for a given locality. The approach places actions such as a city-wide cycling program and woodland activities in the context of other more cost effective interventions such as brief advice to pregnant mothers and combination nicotine replacement therapy (which involves both long-acting and short-acting therapies that target different cravings: Hsia et al. 2017). Having urban greenspace activities ranked in this way puts the value of greenspace in the overall public strategy framework (Valuing Nature Programme 2017).


The health benefits of exercise in urban greenspace are a significant part of the overall ecosystem services provided by urban nature. Valuation of ecosystem services in urban areas has concentrated on the overall environmental significance of urban nature (Elmqvist et al. 2015) and has seldom attempted to indicate the contribution of urban nature to human health and well-being in terms of health care costs. Attention has to be paid to using appropriate

Table 67,4 Valuation techniques used for specific well-being and health benefits from urban greenspace


Economic evaluation method used

Reduced mortality

Willingness to pay (WTP) to avoid mortality risk: depends on the age of the person involved.

Reduced morbidity

WTP to avoid death and injury:

  • • Reducing risk of CHD and stroke, based on the cost of CHI): $16,443 person in 2005 in the UK.
  • • Colon cancer hospitalization costs were $4854 per person.
  • • In addition to treatment costs, factors such as loss of working time have to be taken into account.

Psychological benefits

No data available in 2011. The Connswater study helped people with mental health issues, but no specific data have been presented. Many statements of the effective ‘restorative benefits’, but they have yet to be quantified in monetary terms.

Air pollution reduction by urban trees

In WTP terms, Powe and Willis (2004) suggested that the value of the air pollution absorption by woodlots of over 2 ha is around $1,200,000 per year (smaller woodland patches not included).

Willis and Crabtree (2011) comment that the health benefits of woodland and greenspace may be much greater than the UK Department of Health’s approach to estimating the health benefits of air quality improvements suggests.

Source: Complied from diverse sources

methodologies to evaluate those health benefits in monetary terms. The quality adjusted life years (QALY) approach is familiar to public health professionals and strengthens the arguments that ecologists and green infrastructure managers can use in improving the health and wellbeing of their local communities. The process involves a degree of convergence of thinking between ecological and landscape scientists and social care and public health specialists. It would be enhanced by appropriate engagement with local people and greater understanding of the values perceived and cherished by local residents.


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