Objective The proposition that green landscapes promote human health and well-being is widely accepted and supported by extensive empirical evidence. However, this consensus is often interpreted in an overly simplified way, as if “Greener is better”, regardless of landscape type, user characteristics, or social and cultural context. Such a one-size-fits-all understanding risks obscuring important disparities and unintended harms. In response to this concern, this study seeks to develop a more nuanced comprehension of the relationship between green landscapes, health, and well-being. Specifically, we aim to identify the conditions under which green landscapes may not only confer benefits but also generate limited, ambiguous, or even negative health outcomes, thereby challenging overly generalized claims in both research and practice.
Methods This study adopted a multi-step, empirical evidence-informed narrative review strategy. First, we conducted a thematic analysis of empirical and conceptual studies published mainly in the last 25 years in peer-reviewed journals indexed in Web of Science, Scopus, ScienceDirect, and related databases. The search strategy focused on the relationship between green landscapes and health or well-being, with attention to negative outcomes. Guided by an initial scoping of the literature, we identified three intersecting analytic dimensions as central: 1) biodiversity within green landscapes (e.g., species richness, vegetation and wildlife diversity, ecological restoration); 2) socioeconomic, demographic, and cultural characteristics (e.g., gender, age, income, education, ethnicity, migration status, and cultural norms); and 3) perceived safety (e.g., visibility, spatial enclosure, maintenance, crime risk, and gendered experiences of fear). Second, we applied a structured coding scheme during the full-text review to extract information on environmental settings, types and spatial configurations of green space, biodiversity indicators, social and demographic variables, safety-related attributes, and health and well-being outcomes. Third, we synthesized the findings narratively across the three dimensions, with particular emphasis on identifying types of green landscapes and contextual conditions under which negative effects on health and well-being are most likely to occur.
Results The analysis indicates that the relationship between green landscapes and health is strongly context-dependent rather than uniformly positive. Higher levels of biodiversity are frequently associated with greater psychological restoration, aesthetic appreciation, and a stronger sense of connectedness to nature. However, under certain conditions biodiversity can also increase health risks. Inappropriate species selection and planting design may elevate allergenic pollen loads and exacerbate respiratory problems, while dense vegetation and overlapping human−wildlife habitats can facilitate human−animal conflicts or support disease vectors and pathogens. In addition, visually “messy”, enclosed, or overgrown vegetation is often perceived as neglected or unsafe, thereby reducing perceived safety and discouraging use. Socioeconomic, demographic, and cultural characteristics further mediate who accesses, uses, and benefits from green landscapes. Gender, age, income, education, and cultural background shape both reliance on nearby green spaces and sensitivity to their design, accessibility, and informal surveillance. Women and the elderly often depend more on proximate green areas but are also more affected by deficits in these qualities. More affluent groups typically enjoy greater proximity to high-quality green environments and have more leisure time to use them, whereas disadvantaged populations face educational, spatial, temporal, and cultural barriers and may be exposed to green-led gentrification, displacement, and isolation. As a result, the health benefits and risks associated with green spaces are unevenly distributed and may reinforce existing social and health inequalities. Finally, perceived safety is a critical contextual factor. Poor lighting, dense and visually obstructive vegetation, secluded paths, degraded facilities, and a lack of amenities, management, and active functions are associated with lower perceived safety and, in some contexts, higher crime risks. In certain neighborhoods, parks are linked to gang activity or gender-based violence, particularly deterring women and other vulnerable groups. Socio-racial dynamics and cultural beliefs can further transform potentially restorative environments into “scary spaces,” generating fear, anxiety, and avoidance rather than health benefits.
Conclusion The widely accepted proposition that “green landscapes promote human health and well-being” is, in general, valid. Our intention is not to challenge this important consensus, but rather to develop a deeper, more comprehensive, and more nuanced understanding of this issue. However, the effects of green landscapes need to be assessed more precisely from several perspectives. First, green landscapes encompass multiple types, and different kinds of green space may have distinct health effects, each with its own strengths and limitations. Second, the “people” served by green landscapes are themselves highly heterogeneous and should not be treated as a single, undifferentiated population group; the social, economic, demographic, and cultural characteristics of specific target populations should be fully taken into account. Third, we may need to adopt more non-linear and non-binary modes of thinking: the impacts of green landscapes on health and well-being are not a simple black-and-white issue. Fourth, we should be cautious about an absolutist anthropocentric perspective and give due weight to the broader effects of green space, especially its ecological effects. We argue that the various positive effects of green landscapes are likely coupled, and that these coupled effects constitute an important topic for future in-depth research. Finally, it should be emphasized that this study is a narrative review, which cannot quantify the number, proportion, or interrelationships of the different types of issues discussed. We look forward to future reviews that are more systematic and quantitative to further elucidate these questions. We hope this study can provide some new ideas for future research and practice on the health and well-being effects of green landscapes.
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