Eco-Health Relationship Browser Notecards
&EPA	Double-sided, Elementary
United States	~
Agen?Ymental Protection	These materials are part of EPA Report #EPA/6oo/R-17/310.
Instructions:
1. Print out these Notecards DOUBLE-sided
color so that the categories are visibly distinct for
students (ecosystems in green, ecosystem services in
blue, and health outcomes in red).
2.
3-
4.
5-
in
Optional: If you have time, cut out and laminate the cards. If you
don't have time, students can just hold the paper cards in their
hands. You could also slide the pieces of paper into sheet protectors
for a quick lamination substitute.
Punch holes in the black circles on the Notecards (or, if in
sheet protectors, use the existing holes in the sheet protectors).
Using yarn or string, tie a loop (long enough to drape
the card around the neck) around trie Notecards.
Follow the instructions in the Lesson Plan: Connecting
ecosystems and human health.
Store for use in future years—just a one-time set-up!
(Elementary notecards, updated 9I8I2017)
I ^ I
Have time?
Laminate and
hole-punch the
notecards.
Don't have
time? Use
Sheet
Protectors!
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Urban Ecosystems
All information available from www.epa.gov/EnviroAtlas

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Urban
Ecosystems
An urban ecosystem, sometimes
referred to as a city, is a changing
system that contains both man-
made and natural environments.
Urban ecosystems provide their
own important services that add
to human well-being in those
urban areas.
All information
Air Quality
Water Quality
Urban
Ecosystems
Heat Hazard
Mitigation
Water Hazard
Mitigation
Recreation &
Physical
^ Activity j
available from www.epa.gov/EnviroAtlas

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Agro-Ecosystems
All information available from www.epa.gov/EnviroAtlas

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Agro-Ecosystems
•	An agro-Ecosystem is an ecosystem that
has been changed by humans to make
food, fiber for paper or fabrics, or
farming-based products.
•	An agro-ecosystem may contain crops,
wetlands, and wildlife habitats.
•	Agro-ecosystems are often popular for
recreation and with bird watchers and
hunters.
Water Quality
Aesthetics &
Engagement
with Nature
All information available from www.epa.gov/EnviroAtlas

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Forests
All information available from www.epa.gov/EnviroAtlas

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Forests
•	Forests are made up of different
types of trees and plants based on
climate, location, and water.
•	Forests are often used for the
goods that they provide, such as
trees (timber) and paper.
•	Forests also clean pollution from
water and air.
•	Forests are also used for
recreation such as camping or
hiking.	All information
Air Quality
Recreation &
Physical
Activity i
Water Hazard
Mitigation
available from www.epa.gov/EnviroAtlas

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Wetlands
All information available from www.epa.gov/EnviroAtlas

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Wetlands
Wetlands are vegetated areas
covered by shallow water for all
or parts of the year.
Common wetlands include
coastal salt marshes, bogs, and
swamps.
Wetlands are used for recreation
such as canoeing/kayaking,
fishing, bird watching and
hunting.
Aesthetics &
Engagement
with Nature
Wetlands
Recreation &
Physical
Activity A
Water Quality
Water Hazard
Mitigation
All information available from www.epa.gov/EnviroAtlas

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ADHD
•	Attention-deficit hyperactive
disorder (ADHD) is the most
common disorder in children.
•	ADHD symptoms are a high
level of inattention,
hyperactivity, or both in
children and teenagers.
•	ADHD affects more than 2
million children.
Aesthetics &
Engagement
with Nature
ADHD
Water Quality
Recreation &
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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ADHD: Eco-Health
Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
ADHD / AESTHETICS & ENGAGEMENT WITH NATURE: Several studies suggest
spending time in nature has a positive effect on children with ADH D, meaning
that ADHD symptoms are reduced (Markevych et al., 2014; 11=1,932, Munich, Germany).
ADHD / RECREATION & PHYSICAL ACTIVITY: Children with ADHD experience
less symptoms following exercise in green environments (Faber et al., 2001; n=96, USA).
ADHD I WATER QUALITY: One study found that children exposed to a chemical
called Manganese in water showed more hyperactive behaviors (Bouchard et al., 2007;
n=46, Quebec).

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Aggression
Aggression is shown in many ways,
emotional ways like anger or
irritation, or physical acts like hitting.
All ages and types of people can feel
aggression but it is more common for
men between the ages of 20-30.
Aesthetics &
Engagement
with Nature
Aggression
Recreation &
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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Aggression: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
AGGRESSION / AESTHETICS & ENGAGEMENT WITH NATURE: People who had
more nearby nature reported fewer acts of aggression and violence against
others. Nearby nature was related to lower levels of aggression against
partners and aggression against children (Kuo et al., 2001; n=i45, Chicago). Also, taking a
walk outdoors can reduce feelings of anger by nearly 8%(Peacock et al., 2007; n=20, UK).
Running outdoors can reduce feelings of hostility by 80% (Harte et al., 1995; n=io males,
Australia).
AGGRESSION / RECREATION & PHYSICAL ACTIVITY: Study participants
reported less feelings of anger after participating in physical activity (Pretty et al., 2005
n=263, UK).	/

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Anxiety
Anxiety is worrying too much
about everyday things. It can
affect normal daily behavior.
There are different types of
anxiety.
Problems related to anxiety
are the most common mental
illness in the United States,
affecting 18% of adults.
Aestnetics &
Engagement
\jjwth Nature/
Anxiety
Air Quality
Recreation
Physical
Activity
Heat Hazard
Mitigation
All information available from www.epa.gov/EnviroAtlas

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Anxiety: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
ANXIETY / AESTHETICS & ENGAGEMENT WITH NATURE: Spending time in green space and
exercising outdoors can lower anxiety; this effect is increased by the presence of water.
(Shin et al., 2013; n=i39 young women, Korea).
ANXIETY I RECREATION & PHYSICAL ACTIVITY: Exercising reduces feelings of anxiety. How
hard and long you exercise, as well as location while exercising (indoor or outdoor; natural
or other view), affects howmuch anxiety is lowered. (Pretty etai., 2005; n=ioo,uK).
ANXIETY I HEAT HAZARD MITIGATION: The number of anxiety and stress-related disorders
often increases during extreme heat events. (Hansen etal., 2008; 11=1.16 mill., Adelaide, Australia).
ANXIETY / AIR QUALITY: A study in California showed that higher levels of ozone in the air
caused an increase in anxiety levels. (Evans et al., 1988; n=i,002 adults, Los Angeles, California).

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Asthma
Air Quality
Asthma is a disease of the airways that \^y
makes breathing difficult. Inflammation
of the air passages narrows the airways
that carry oxygen to the lungs.
Both children and adults have asthma.
Asthma affects 24.6 million Americans.
All information available from www.epa.gov/EnviroAtlas

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Asthma: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
ASTHMA I AIR QUALITY: When air pollution increases, the odds of having an
asthma attack are higher.
A study in Taiwan showed that high levels of total particles in the air can
increase the odds of having asthma by 32% (Wang et al 1999; n=i65,i73 adolescents, Taiwan).
ASTHMA / WATER HAZARD MITIGATION: Dampness and mold in the home
show an association with higher reported asthma symptoms in people. Events
like flooding that increase dampness and mold in the home may increase
asthma symptoms.
In Canada, scientists determined that the odds of asthma for children increased
29% when dampness and/or mold were in the home (Dales et al., 1991; 11=13,495, Canada).

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Cancer
•	Cancer is the growth of abnormal
cells in the body.
•	Anyone can develop cancer, but it
is more common as people grow
older.
•	Cancer is the second most
common cause of death in the
United States with 1,600 deaths
per day
All information available from www.epa.gov/EnviroAtlas
Aesthetics S
Engagement
with Nature
Cancer
Air Quality
Water Quality
Water Hazard
Mitigation

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Cancer: Eco-Health
Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
CANCER / AESTHETICS & ENGAGEMENT WITH NATURE: Spending 10+ hours a week outside
has been linked to an increased risk of skin cancer. (Asteii-Burtetai., 2013^=267,072, Australia).
CANCER I WATER QUALITY: Death from stomach cancer was 82% more likely in areas with
contaminated water from Chromium than in areas without contaminated water. (Beaumont et
al., 2008; Liaoning Province, China).
CANCER / WATER HAZARD MITIGATION: While looking at the connection between floods
from Hurricane Agnes (1972) and numbers of certain cancers, researchers found that the
most flooded areas had a greater number of cases of Leukemia and Lymphoma. The rate in
the flooded area was 32/100,000 while the rate in the rest of upstate New York was
24^4/100,000 (Janerich et al., 1981; n=io million, Western and Upstate New York).
CANCER I AIR QUALITY: Each increase of 10 micro-g/m3 of fine particulate air pollution was
associated with an 8% increase in deaths from lung cancer (Pope metal., 2002; n=5oo, 000, usa).

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Cardiovascular Disease
Cardiovascular diseases are
diseases that affect the heart and
blood vessels.
There are many factors that
cause these diseases like diet,
exercise, smoking, etc.
Cardiovascular diseases are the
leading cause of death
worldwide.
Aesthetics &
Engagement
with Nature ¦
Cardiovascular
Diseases
Air Quality
Heat Hazard
Mitigation
All information available from www.epa.gov/EnviroAtlas

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Cardiovascular Disease:
Eco-Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
CARDIOVASCULAR DISEASES / AESTHETICS & ENGAGEMENT WITH NATURE: Study
subjects walking in a forest had lower heart rates than those walking in an urban area (Leej,
et al., 2014; n=48, Japan).
CARDIOVASCULAR DISEASES I RECREATION & PHYSICAL ACTIVITY: The chance of
hospitalization and heart disease or stroke were lower among adults with a lot of greenness
around their home compared to those in neighborhoods with less greenness (Pereiraetai.,2012;
n=i,4i5, Perth, Australia).
CARDIOVASCULAR DISEASES / HEAT HAZARD MITIGATION: Extreme temperature changes
can increase the risk of being hospitalized and the risk of death from cardiovascular disease
(Chen et al., 2014; n=i26,925, 6 Cities in China).
CARDIOVASCULAR DISEASES / AIR QUALITY: Studies show that cardiovascular-related
events, such as heart attack and stroke, are connected with increases in particulate matter
in the air. (Prescott et al., 1998; n=450,ooo, Edinburgh), (Miller et al., 2007; n=65, 893, USA), (Wordley et al., 1997; n=428,ooo,
Birmingham, UK).

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Cognitive Function
Cognitive function is a person's ability to
think and process thoughts, including
things like memory, learning new things,
speech, and reading.
Cognitive function can be harmed as
people grow older or have head injuries.
Alzheimer's is a disease that makes
cognitive function worse. It is the 5th
leading cause of death among Americans
over 65.
Aesthetics &
Engagement
with Nature
Cognitive
Function
Air Quality
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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Cognitive Function: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
COGNITIVE FUNCTION / AESTHETICS & ENGAGEMENT WITH NATURE: A view of nature
from a high school cafeteria window was found to help students do better in school.
Views with lots of trees and larger classroom windows also helped students do better
in school (Matsuoka, 2010; ri=i01 schools, Michigan).
COGNITIVE FUNCTION / RECREATION & PHYSICAL ACTIVITY: School-aged children who
were in a 12-week physical activity program were more on-task in school (Mahar etai., 2006;
11=243 children, North Carolina).
COGNITIVE FUNCTION / AIR QUALITY: Higher air pollution levels have been linked to
lower cognitive functioning in both children and older adults (caideron-Gardduenas etai., 2008;
n=i8, Mexico) (Power et al., 2010; n=68o, USA).

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COPD
Chronic Obstructive Pulmonary Disease
(COPD) is a disease of the lungs that
makes it difficult to breathe. This
includes chronic bronchitis, which is
constant irritation of the airways, and
emphysema, which includes damages
to the lung's air sacs.
4 million people around the world have
COPD. Mostly COPD affects people
between 65-84 years old.
Aesthetics &
Engagement
with Nature
COPD
Air Quality
Heat Hazard
Mitigation
All information available from www.epa.gov/EnviroAtlas

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COPD: Eco-Health
Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
COPD I AESTHETICS & ENGAGEMENT WITH NATURE: Walking in green settings instead
of city settings has been shown to increase lung health in senior women (Lee & Lee 2013; n=62,
Korea).
COPD I AIR QUALITY: Emergency room admissions for chronic bronchitis and
emphysema increased by 31-39% after more sulfur dioxide (502) than normal was put
into the air (Ponka&Virtaneni994; n=2,807, Helsinki, Finland).
COPD I HEAT HAZARD MITIGATION: During a July 2006 heat wave in Portugal, a 1°C
increase in average temperature was associated with a 5.4% increase in hospitalizations
due to COPD for the entire population, with a 7.5% increase for women. The greatest
number of people were in the hospital on the fourth day in a row of extreme heat
(Monteiro etal., 2013).

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Depression
Traits of depression include low mood,
loss of interest or enjoying things, and
less energy.
Women get depression twice as much
as men.
In people between 18-44 years old,
depression is the leading cause of
disability and premature death.
Aesthetics &
Engagement
with Nature
Depression
Recreation &
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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Depression: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
DEPRESSION / AESTHETICS & ENGAGEMENT WITH NATURE:
[1]	After running outdoors, study subjects reported feeling much less depressed-an 85% reduction
(Harte et al., 1995; n=io, Australia).
[2]	Taking a walk outdoors reduced depression by 6%, while walking indoors did not (Peacock etai., 2007;
n=20, UK (G).
[3]	The presence of parks or recreation facilities in the neighborhood was associated with a lower risk
of depression (Gariepy, etal., 2014; n=9,025, Canada).
DEPRESSION I RECREATION & PHYSICAL ACTIVITY:
[1]	Across 10 green exercise case studies, participants reported lower feelings of depression by over 2%
after physical activity (Pretty et al., 2005; n=263, uk).
[2]	The presence of parks or recreation facilities in the neighborhood was associated with a lower risk
of depression (Gariepy, etal., 2014; n=9,025, Canada).
[3]	Individuals walking in a forest had improved self-reported mood when compared to individuals
walking in urban areas (Lee etal., 2014; n=48,Japan).

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Fatigue
•	Fatigue is feeling tired and lacking
energy. It can be a normal response
to physical activity or emotional
stress but can also be a more
serious condition.
•	Any person can experience fatigue.
Fatigue
Recreation &
Physical
k Activity
Aesthetics &
Engagement
with Nature
All information available from www.epa.gov/EnviroAtlas

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Fatigue: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
FATIGUE / AESTHETICS & ENGAGEMENT WITH NATURE: Walking or running outdoors can
lower fatigue.
[1]	People who were physically active while in natural settings had higher energy levels
when compared with people who were not active and those who were active indoors
(Kinnafick and Thogersen-Ntoumani, 2014; n=40, United Kingdom).
[2]	People reported increased energy after walking outdoors, but exercising and viewing
nature through virtual reality had little effect (piante etai.,2oo6;n=n2, us).
FATIGUE I RECREATION & PHYSICAL ACTIVITY:
People who were physically active while in natural settings had higher energy levels when
compared with people who were not active and those who were active indoors (Kinnafickand
Thogersen-Ntoumani,2014; n=40, United Kingdom).

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Happiness
Happiness is an emotion that
people feel when good things
happen.
People who live in countries
with higher incomes and less
suffering have higher levels of
happiness.
Factors include quality of life,
friends, family, and job.
Aesthetics &
Engagement
with Na
Happiness
Air Quality
Recreation &
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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Happiness: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
HAPPINESS / AESTHETICS & ENGAGEMENT WITH NATURE: In a study using a phone app
to define happiness levels, people were happier outdoors in nature than in urban places.
Beach areas were the happiest places-about 6 points higher than an urban environment-
a difference like going out versus doing housework (MacKerron &Mourato 2013; n=2i,947, uk).
HAPPINESS I RECREATION & PHYSICAL ACTIVITY: Short periods of green exercise
improve self-esteem and mood. This improvement is greater around water and is true no
matter how long or how hard the exercise is (Barton & Pretty 2010; n=i,252, uk).
HAPPINESS I AIR QUALITY: In five countries, when nitrogen and lead air pollution levels
were decreased, happiness levels increased (weisch 2006).

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High Blood
Pressure
•	High blood pressure is when a
person's blood pressure is high most
of the time.
•	High blood pressure can lead to
problems including heart disease,
heart failure, and stroke.
•	Risk of high blood pressure increases
with age. It is also affected by things
like weight, smoking and stress.
Aesthetics &
Engagement
with Nature/
High Blood
Pressure
Recreation &
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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High Blood Pressure:
Eco-Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
HIGH BLOOD PRESSURE / AESTHETICS & ENGAGEMENT WITH NATURE: Exercising in
green environments or viewing natural scenes can lower blood pressure.
(Pretty et al., 2005; n=ioo [20/group], UK) (Hartig et al., 2003; n=H2, California).
HIGH BLOOD PRESSURE / RECREATION & PHYSICAL ACTIVITY: Exercise, including light or
moderate activity, can lower blood pressure by 3% to 7%. Exercising in green environments
might lower it even more. (Pretty etai., 2005; n=ioo, uk).
HIGH BLOOD PRESSURE / AIR QUALITY: Exposure to particulate matter and N02from cars
is Strongly associated with higher blood pressure (Brook etal., 2009; (1=31-50, Toronto, Canada & Ann
Arbor, Michigan).

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Longevity
•	Longevity, or life expectancy, is
the number of years a person
may live.
•	Life expectancy varies
depending on where you live,
medical treatments available,
nutrition and lifestyle.
•	Longevity has increased by four
years since 1990 around the
world.
All information
Aesthetics &
Engagement
,with Nature,
Longevity
Air Quality
available from www.epa.gov/EnviroAtlas

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Longevity: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
LONGEVITY /AESTHETICS & ENGAGEMENT WITH NATURE: People with low income had
lower levels of health inequality if they lived in green areas (Mitchell and Popham 2008; n=4.8
million +, England).
LONGEVITY I RECREATION & PHYSICAL ACTIVITY: People lived longer when there were
parks and outdoor green areas for recreation (Takano et ai., 2002; n=3,i44, Tokyo).
LONGEVITY / AIR QUALITY: A study looked at air pollution levels and life expectancy. The
study found that people live longer with less air pollution. (Mechier et ai., 2002; n=7oo million,
Europe).

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Aesthetics &
Engagement
with Nature
Low Birth
Weight
Air Quality
Recreation &
Physical
Activity •
Water Quality
All Information available from www.epa.gov/EnviroAtlas
Low Birth
Weight
•	A baby born with low birth
weight is less than 5 lbs 8 oz.
•	Around 30 million babies are
born with low birth weight
around the world.

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Low Birth Weight: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
LOW BIRTH WEIGHT I AESTHETICS & ENGAGEMENT WITH NATURE: Mothers who lived in
an area with trees were less likely to have babies with low birth weight. This may be caused
by lower stress levels because of green space, improved relationships, and increased
physical activity, all of which have been proven to affect infant birth weight (Donovan etai., 2011;
n=5,696, Oregon).
LOW BIRTH WEIGHT I RECREATION & PHYSICAL ACTIVITY: Refer to information above.
LOW BIRTH WEIGHT / WATER QUALITY: Atrazine is an herbicide that has a high level in
drinking water from May to September. There was an increased chance of low birth weight
where the last three months of pregnancy occurred whole or in part within the May-
September period. (Villaneuva etal., 2005; n=3,5io births, France).
LOW BIRTH WEIGHT / AIR QUALITY: Increasing total greenness and less air pollution in
mothers' homes has been linked to small increases in birth weight and slightly lower odds
of pre-term birth. (Laurent etal., 2013, n=8o,ooo; Los Angeles and Orange Counties, CA).

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Mental Health
•	Mental health is the overall well-
being of a person's state of mind.
Dealing with stress and working
in your community show good
mental health.
•	Mental and behavioral disorders
can affect 25% of people at some
time during their life.
Aesthetics &
Engagement
\with Nature
Mental Health
Heat Hazard
Mitigation
Water
Recreation &
Physical
Activity
Water Hazard
Mitigation
All information available from www.epa.gov/EnviroAtlas

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Mental Health: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
MENTAL HEALTH / AESTHETICS & ENGAGEMENT WITH NATURE: People who live near
green spaces and/or spend time in green environments report better mental health
Overall (There are 12 articles that show this connection on the EnviroAtlas Eco-Health Browser).
MENTAL HEALTH / WATER HAZARD MITIGATION: A study found that 48% of adults in
flooded households had mental problems in the nine months following the flood,
compared to only 12% of adults in non-flooded households (Reacheretal., 2004^=467, Lewes, England).
MENTAL HEALTH I RECREATION & PHYSICAL ACTIVITY: Following an outdoor nature-
based recreation experience, veterans had better attention and sense of peace (Duvaiiand
Kaplan 2014; n=98, Michigan, US).
MENTAL HEALTH I HEAT HAZARD MITIGATION: Compared to non-heat wave periods,
there was a 17.4% increase in hospital admissions for dementia during heat waves (Hansen et
al., 2008; n=i.i6 million, Adelaide, Australia).

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Mortality
•	Mortality means death. The
number of deaths is a good
indicator of the health level in a
country.
•	The number of deaths is affected
by levels of heart disease, cancer,
other diseases, and crime.
All information available from www.epa.gov/EnviroAtlas
Air Quality
Heal Hazard
Mitigation
Water Quality
Mortality
Recreation &
Physical
k Activity .
Water Hazard
Mitigation

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w Mortality: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
MORTALITY / AIR QUALITY: A study of six cities found that an average of 3% fewer people
died when there was less particulate matter (small particles in the air). This decreased death
rate is like saving 75,000 people per year in the U.S. (Laden etai., 2006; n=8,096,6 u.s. cities).
MORTALITY / WATER QUALITY: In Greece where a water supply was contaminated with
Chromium, deaths were 98 times what were expected (Linos etai., 2011; n=i3i,ooo, viotia, Greece).
MORTALITY / WATER HAZARD MITIGATION: In the 12 months following the Bristol Floods
of 1968, there were 87 deaths among the 209 households affected, compared to 58 deaths
in those same households in the 12 months prior to flooding—that's a rise of 50%. No
significant difference was found in the non-flooded homes (Benneti97o; n=77o, Bristol, England).
MORTALITY I RECREATION & PHYSICAL ACTIVITY: In a study of men aged 25-74, those
whose energy output in walking, climbing stairs, and playing sports totaled 2000 or more
kilocalories per week had a 28 percent lower death rate (from all causes) than less active
men (Paffenbarger et al., 1986; n=i2,936 men aged 25-74; USA).
MORTALITY / HEAT HAZARD MITIGATION: During a 1995 summer heat wave event in
Chicago, there were 514 heat-related deaths and 696 extra deaths during the month of /
^	July (Whitman et al., 1997).	

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Obesity
•	Obesity is a disease characterized by
being very overweight with a person
having a body mass index (BMI)
over 30.
•	BMI is figured out by comparing a
person's height and weight.
•	Around the world, obesity has more
than doubled since 1980.
Aesthetics &
Engagement
with Naturey
Obesity
Air Quality
Recreation
Physical
\ Activity
All information available from www.epa.gov/EnviroAtlas

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Obesity: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
OBESITY / AESTHETICS & ENGAGEMENT WITH NATURE: If you live in a home with at least
100 meters of greenspace around it, you are less likely to be overweight or obese (Dadvand et
al., 2014; n=3,i78, Sabadell, Spain)
OBESITY I RECREATION & PHYSICAL ACTIVITY: Studies found that people who exercised
had lower BMI scores. As the amount of physical activity increased, BMI scores decreased.
(Tudor-Locke et al., 2010; n=5,ooo adults, USA).
OBESITY I AIR QUALITY: Children may be at greater risk for childhood obesity if their
mothers are exposed to polycyclic aromatic hydrocarbons (PAHs) during pregnancy. In this
study, the more a mother was exposed to PAHs, the larger her child was during childhood
(Rundle et al., 2011; n=702, New York).

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Respiratory
Symptoms
Respiratory symptoms include
coughing, difficulty breathing, or
rapid breathing.
Respiratory symptoms can affect
any person but women are more
likely to develop a long-term
cough.
Some factors are COPD, allergies,
smoking and others.
Aosfh.?'ic? X
with Nature
Air Quality
water Hazard
\ Mitigation
Respiratory
Symptoms
Recreation &
Physical
Activity
All information available from www.epa.gov/EnviroAtlas

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Respiratory Symptoms:
Eco-Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
RESPIRATORY SYMPTOMS / AESTHETICS & ENGAGEMENT WITH NATURE: Children who played in city
parks less than 5 hours a week were 52% more likely to be wheezing, coughing, sneezing, etc.
(Grazuleviciene etal., 2014; (1=1,489, Lithuania).
RESPIRATORY SYMPTOMS / WATER HAZARD MITIGATION: During the devastating 1988 flooding in
Bangladesh, 17.4% of doctors' visits were because of lung and airway infections (siddique et al., 1991;
(1=46,740, Bangladesh).
RESPIRATORY SYMPTOMS I RECREATION & PHYSICAL ACTIVITY: Children who played in city parks less
than 5 hours a week were 52% more likely to be wheezing, coughing, sneezing, etc. (Grazuleviciene et al.,
2014; n=i,489, Lithuania).
RESPIRATORY SYMPTOMS / HEAT HAZARD MITIGATION: During a July 2006 heat wave in Portugal, a 1°C
increase in average temperature more people than usual went to the hospital because they were having
trouble breathing. The greatest number of extra hospital visits happened on the fourth day in a row of
extreme heat (Monteiro et al., 2013).
RESPIRATORY SYMPTOMS / AIR QUALITY: If there was more ozone pollution in the air on a
spring/summer day, there was a higher risk of going to the hospital for respiratory disease (Burnett et al.,
1997; n=i6 cities, Canada).	/

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Aesthetics &
Engagement
with Nature
Self-Esteem
•	Self-esteem is used to describe a
person's overall sense of self-worth or
personal value.
•	Many experts think self-esteem is a big
part of human existence and plays an
important role in how a person feels
about themselves.
All information available from www.
?pa.gov/EnviroAtlas
Recreation &
Physical
Activity

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Self-Esteem: Eco-
Health Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
SELF-ESTEEM / AESTHETICS & ENGAGEMENT WITH NATURE: Exercising and walking
outdoors, and even viewing pictures of nature, can significantly improve self-esteem.
People who exercised in green spaces reported a 9% improvement in self-esteem after
the activity (Pretty etal., 2005; n=263, UK).
SELF-ESTEEM / RECREATION & PHYSICAL ACTIVITY: Participating in physical activity can
improve self-esteem. Scientists found that exercising in green spaces improved both
self-esteem and mood. This improvement increased with the presence of water and was
true regardless of how long or how hard the people exercised. (Barton and Pretty 2010; n=i,252,
UK).

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Stress
Stress is a normal feeling that can happen
because of an event or thought that makes
people upset or nervous.
While some stress is okay, too much stress
can have negative health effects, including
headaches, muscle pain, and rapid
breathing.
Stress can affect all people, however,
women and people who have lower incomes
or less education have more stress.
All information available from www.epa.gov/EnviroAtlas

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Stress: Eco-Health
Connections
Note: This is only a selection of the available evidence. More evidence is available in the Eco-Health tool in EnviroAtlas.
STRESS / AESTHETICS & ENGAGEMENT WITH NATURE: People who visited urban green
spaces more often reported lower levels of stress. Also, those who reported wishing to
be outdoors in green spaces more often suffered from higher levels of stress (Grahn and
Stigsdotter 2003; n=953, Sweden).
STRESS I RECREATION & PHYSICAL ACTIVITY: Study participants felt less stressed after
they visited a forest or park. Those who played sports while at the green space were less
stressed than those who relaxed or walked (Hansmann et al., 2007, n=i64, Switzerland).

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Aesthetics &
Engagement with Nature
People enjoy spending time outside. Studies show
that spending time outside can improve human
health and relationships.
Looking at nature even through a window or
photograph can calm anxiety.
Spending time in green spaces like gardens seems to
have health benefits beyond those of outdoor
exercise.
All information available from www.epa.gov/EnviroAt

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All information available from www.epa.gov/EnviroAtlas,
Aesthetics &
Engagement with Nature
Urban
Ecosystems
Vulnerable
Populations
Wetlands
ADHD
Social &
Community
Ties
Respiratory
Symptoms
Anxiety
Obesity
Aesthetics &
Engagement
with Nature
COPD
Low Birth
Weight
Longevity
Confusion
Healing
Cognitive
Function
High Blood
Pressure
Fatigue
Happiness

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Air Quality
•	If there is more industry, cities, and cars, there is
usually more air pollution.
•	Forests and other green spaces can lower the
amounts of many air pollutants, including carbon
monoxide and ozone.
•	Having good air quality reduces the amount of
respiratory illness.
All information available from www.epa.gov/EnviroAtlas

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Vulnerable
Populations
Urban
Ecosystems
Respiratory
Symptoms
Obesity
Arthritis
Mortality
Migraine
Air Quality
Low Birth
Weight
Longevity
Hospital
Admissions
Air Quality
A Tf p: /
Asthma
Birth
Outcomes
Bronchitis
:or!:<
Happiness
High Blood
Pressure
Cognitive
Function
All information available from www.epa.gov/EnviroAtlas,

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Water Quality
•	Water can be taken up by plants, animals, or soil
before it reaches a major body of water.
•	Using different types of plants and soil can help
stop contamination from reaching water supplies
and waters where people might swim or fish.
•	Water treatment systems can also reduce
pollution and illnesses.
All information available from www.epa.gov/EnviroAtlas

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Water Quality
NO
SWIMMING
BY RECOMMENDATION OF
COUNTY HEALTH OEPT
i
V \
1
All information available from www.epa.gov/EnviroAtlas,
Agro-
Ecosystems
Thyroid
Dysfunction
Urban
Ecosystems
Preterm Birth
Wetlands
Mortality
Water Quality
Low Birth
Weight
ADHD
Kidney
Malfunction
Cancer
Gastrointestin
al Illness

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Heat Hazard Mitigation
front
•	The urban heat island effect happens when cities
have higher heat in the day and do not cool down at
night because dark surfaces like roads take in heat
during the day and release it at night.
•	Heat waves can cause health issues, especially for
older people.
•	Green spaces such as street trees, parks, and green
roofs can help to prevent urban heat islands.
All information available from www.epa.gov/EnviroAtlas

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Urban
Ecosystems
Vulnerable
Populations
Anxiety
Respiratory
Symptoms
Cardiovascular
Diseases
Preterm Birth
Heat Hazard
Mitigation
Mortality
Heat Stroke
Hospital
Admissions
Mental Health
Kidney
Malfunction
Heat Hazard Mitigation
		back
All information available from www.epa.gov/EnviroAtlas

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Recreation &
Physical Activity
•	Regular physical activity is an important part of a
healthy lifestyle and adds to overall well-being.
•	Outdoor areas such as parks, forests, and urban green
spaces help people to do physical activities such as
walking, biking, and exploration.
•	Bodies of water also provide opportunities for
activities like canoeing, fishing, and water skiing.
All information available from www.epa.gov/EnviroAtlas

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Wetlands
liitan
Ecosystems
Vulnerable
Populations
ADHD
Respiratory
Symptoms
PTSO
Obesity
Recreation &
Physical
Activity
Mortality
Confusion
Mental Health
Low Birth
Weight
Diabetes
Recreation &
Physical Activity
Aggression

Cognitive
Function
Dmxbu on
Fatigue	High Blood
Pressure
Longevity
H.ipp.ress
All information available from www.epa.gov/EnviroAtlas

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Water Hazard
front
Mitigation
Some ecosystems can help reduce the negative effects
of extreme precipitation and weather events like
thunderstorms, hurricanes, or floods.
The absence of ecosystems such as wetlands and
forests, which help regulate water, may result in more
cases of extreme events like flooding, as well as
worsen the effects of events like hurricanes.
All information available from www.epa.gov/EnviroAtlas

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• •
Water Hazard
ROAD
CLOSED
Vulnerable
Populations
Urban
Ecosystems
Wetlands
Respiratory
Symptoms
Mortality
Asthma
Water Hazard
Mitigation
Miscarriage
Bronchitis

Hospital
Admissions
Mental Health
Gastrointestin
al Illness
All information available from www.epa.gov/EnviroAtlas

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