EnviroAtlas
www.epa.gov
Linking ecosystem services and human health:
The Eco-Health Relationship Browser
Laura E. Jackson1, Jessica L. Daniel2, Betsy McCorkle2, Alexandra Sears2, Kathleen F. Bush3
'ORD/US EPA, Research Triangle Park, NC, USA; 2Student Services Contractor, ORD/US EPA, Research Triangle Park, NC, USA;
3ASPH/EPA Environmental Health Fellow, ORD/US EPA, Research Triangle Park, NC, USA
Introduction
Ecosystems provide many nature-based goods and services that are beneficial to society. There is a large
body of research linking these ecosystem services to improvements in human health. The ecosystem
services that are most relevant to human health can be broadly categorized as: air filtration; biodiversity
conservation; climate stabilization; habitat maintenance; natural hazard mitigation; food, fuel and fiber
production; water filtration; water regulation; and the provision of aesthetic environments and
recreational opportunities. A review article summarizing this work was recently published in IJPH
(doi: 10.1007/s0003 8-013-0482-1).	
Results: The Eco-Health Browser
Objectives
(1)	Identify literature focused on the relationship between ecosystem services and human health.
(2)	Design an interactive, web-based tool highlighting the weight of evidence.
(3)	Make the information accessible to a wide audience.

Stage 1:
Google Scholar search terms
Health terms Environment Terms
Health Natural Environment
Mental Health Green space
Wellbeing Ecosystem Services
Well-being Open space
Social Nature
Physical Park (s)
Urban forest
Greenness
Wetlands
Stage 2:
PubMed & Science Direct search
terms
a)	Health + Green space; Greenness;
Urban forest; Natural environment
b)	Mental Health + Ecosystem service;
Greenness; Urban forest
c)	Wellbeing/Well-being + Greenness;
Urban forest
d)	Physical + Parks; Green space


Stage 3:
Targeted journals
Searched "health" and "green" within:
Landscape and Urban Planning;
Urban Forestry & Urban Greening;
Health & Place;
American Journal of Preventive
Medicine;
Environment and Behavior;
Journal of Environmental Psychology;
Journal of Epidemiology and Community
Health
Stage 4:
Targeted keywords
Category 1 + Category 2 + Category 3
a)	Ecosystem + Topic (T) + Human
health
b)	Ecosystem + Service (S1) + Human
health
c)	Ecosystem + Service (S2) + Human
health
The four stages of the systematic review
Screening Articles for the Browser
•	A four stage systematic review focused on
ecosystem services and human health was
conducted (see left)
•	The literature search was limited to peer-
reviewed journal articles published from 1
January 1990 to 31 December 2012
•	Gathered articles were then screened for
inclusion in the Browser
•	Preference was given to articles that were
published after 2000, with objectively
measured variables, and quantitative results
Article Exclusion
•	Inappropriate article type (e.g., book,
abstract)
•No reported consideration of ecosystem
services/natural stimuli/nature as the
exposure variable
•	No mention of a health outcome
•Lack of adherence to Browser structure
(e.g., review papers)
Stage 1:
Stage 2:

Stage 3:
Stage 4:
2012 Update:
Google
PubMed &

Targeted
Targeted
Repeat stages
Scholar
Science Direct

journals
keywords
3 and 4
n = 196
n = 17

n = 11
n = 46
n = 74
Total articles from
systematic review
n = 344
Met inclusion criteria
for systematic review
n = 225
Excluded based on
selection criteria
for the Browser
Total articles included in
Eco-Health Relationship
Browser
n = 169
Search results from the systematic review and
	screening for The Browser	
Results: Systematic Review
Number of relevant articles returned from
the systematic review from 1990 to 2012
7990 1994 1996 1998 2°00 2°02 2°04 2°0e 2°08 2°10 2°12
Year
• 344 potentially relevant articles were collected
for further review
• Results suggest an increase in attention to the
subject area, as the annual publication of
articles increased substantially from 0 to 75
from 1990 to 2012 (see left)
Journals publishing the most articles
identified in review of ecosystem services
and human health 1990-2012
•	Several journals published multiple articles;
between 4 and 17 articles were found in 12
journals (see right)
•	The majority of articles focused on either
buffering or health-promotional services
#'///////'
The Eco-Health Relationship Browser
www. epa. gov/ enviroatlas/enviroatlas-eco-
health-relationship-browser
There are four ecosystems in the Browser:
•	Forests
•	Urban Ecosystems
•	Wetlands
•	Agro-Ecosystems

Health Outcomes
There are over 30 health outcomes in the Eco-Health
Browser that relate to various ecosystem services.
These include the following:
Ecosystem Services
Health promotional services
•	Aesthetics and Engagement with Nature
•	Recreation and Physical Activity
Buffering Services
•	Clean Air
•	Clean Water
•	Heat Hazard Mitigation
•	Water Hazard Mitigation
•	Anxiety
•	Stress
•	Cognitive function
•	Low birth weight
•ADHD
•	Healing
•	Confusion
•	Fatigue
•	Self-esteem
•	Social relations
•	Mental Health
•	Birth Outcomes
Browser Pop-Up Box
•	Pop-up appears when user hovers over "+".
•	Article summaries capture the state of the
science on the selected link.
•	Includes citations, sample sizes, and study
locations.
•	Summaries allow reader to distinguish
between speculative and more well-established
results.
Discussion: Mechanisms for Observed Health Outcomes
Prevailing Mechanistic Theories
Engagement with
Nature
Stress Reduction
Ulrich 1993
Attention Restoration
Kaplan and Kaplan 1989
Nature Appreciation
Bratman et al. 2012
Social Interaction
Maas et al, 2008;
Barton and Pretty 2010
Decreased Cortisol and blood
pressure
(Hartig et al. 2003; Lee et al. 2011; Park et al. 2008;
Thompson Coon et al. 2011)
Improved attention and
cognitive function
(Hartig 2008; Kuo and Taylor 2004; Pretty et al.
2005; Taylor and Kuo 2009
Improved mood and mental
health
(Barton and Pretty 2010; van den Berg et al. 2010)
Increased social cohesion
(Coley et al. 1997;Kuo et al. 1998; Seeland et al.
2009)
An Example of Integrating Mechanistic Theories into the Browser
Attention
Restoration
Potential Mechanisms
Stress
Reduction
Ulrich 1983
¦	Directed attention
¦	Concentration tasks in
children with ADHD
¦	Attentional functioning
¦	Academic achievement
¦	ADHD symptoms
¦	Feelings of confusion
Acknowledgements and Disclaimer
This work was supported by US EPA Contracts EP-10-D-000808, EP-1 l-D-000186, and EP-11-D-
000529; and Cooperative Agreement Number X3-83388101 between the US Enviromnental Protection
Agency and the Association of the Schools of Public Health. Findings and conclusions do not
necessarily represent the official views of EPA or ASPH. We would like to recognize the contribution of
several individuals who reviewed the Browser during the beta-testing stage of development.
U.S. Environmental Protection Agency
Office of Research and Development
SEPA

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