1. Health inequalities in Edinburgh.
Cities are regarded as centres of prosperity, employment opportunities, education access, healthcare services and culture (Glaeser, 2011), but access to these services are not evenly distributed amongst all city residents.
Conditions such as cardiovascular disease, high blood pressure, obesity and type-2 diabetes are experienced more frequently within cities (Pretty et al., 2016) as a result of higher incidences of sedentary lifestyles (Dye, 2008), time indoors and on screens (Bratman et al., 2019). However, these problems are particularly pervasive amongst communities from low-income areas (Twohig-Bennett and Jones, 2018).
Oxgangs’ history dates back to the 1950s to provide predominantly council housing for skilled workers in the city (Flint and Casey, 2008). A programme of redevelopment and regeneration oversaw the construction of new flats in 2006, which was regarded as successful by residents despite their continued awareness of constrained residency choices, job access and financial resources (Batty et al., 2011).
According to the Scottish Index of Multiple Deprivation (SIMD), Oxgangs ranks in the top 10% “most deprived” areas in Scotland, ranking within a range of 2-4 out of 10 for “Health Domain Rank.” Criteria which contribute to these health outcomes are income, employment, health, education level, housing type, crime rate and geographic access, all of which are low-ranking on the SIMD (see Figure 1).
NHS Health and Wellbeing Reports (2010;2016) further detail multiple health factors which combine to give an overview of an average Scottish resident’s life expectancy and health outcomes which vary across local authority areas. These factors include:
• Number of patients with a psychiatric hospitalisation
• Adults claiming incapacity benefit/severe disability allowance
• Working age population claiming Jobseeker's Allowance
• Out of work benefits/child tax credit income deprivation
• Crime rate
• Population living within 500 metres of a derelict site
• Number of patients hospitalised after a fall in the home (65+)
According to Oxgangs’ area profile, all of the above factors ranked as “significantly worse” compared to the Scottish national average. Oxgangs’ more negative community health outcomes are highlighted if compared to Morningside, Oxgangs’ adjacent suburb which is one of Edinburgh’s most affluent and high-value areas that ranks in the top 10% “least deprived” areas according to the SIMD (2021), which obtains a “Health Domain Rank” of 10/10.
South Edinburgh’s health inequalities are a consequence of the inequitable distribution of power, income, and wealth (Phelan, 1995). Money is ultimately what provides the means to access goods and services that support healthy living, such as nutritious diet, good housing, and leisure activities (Morris et al., 2010).
This highlights how systemic injustices cannot be overcome with state intervention alone. A grassroots intervention is required in order to help Oxgangs’ residents overcome the negative health outcomes they disproportionately experience, for an improved quality of life.
4. Community recommendations.
Interaction with greenspaces needs to be increased and achieved in new and more meaningful ways by a greater percentage of Oxgangs’ residents, in order to achieve a transformative impact on their health outcomes and life quality (Ehnert et al., 2018).
In order to achieve this, I set out the following three community recommendations whereby local community actors and stakeholders can work together to implement and promote these health-enhancing nature-based initiatives over a long-term basis.
Recommendation 1 – Nature Prescriptions
Nature prescriptions are activities that are designed to help people connect with nature in personal, emotional and meaningful ways, in order to overcome or mitigate mental or physical health problems that typically stem from sedentary and indoor lifestyles (RSPB, 2018).
A leaflet and a calendar of nature-based activities (see Figures 6, 7 and 8) were developed by the NHS Scotland and the RSPB to signpost people to simple ways of connecting with nature that are specific to their local community, the urban context and season. Ideas include finding a favourite place in nature, listening to nearby birdsong, noticing the beauty of the surrounding landscape, getting to know a neighbourhood tree or helping local wildlife thrive (RSPB, 2018). Crucially, activities are accessible for all ages and mobility levels, flexible and free.
Its success in NHS Shetland resulted in its rolling out within 5 health-authority areas within Edinburgh by the Edinburgh and Lothians Health Foundation. Oxgangs’ proximity to many high-quality greenspaces positions it strongly as an area in which to implement the programme by the local Allermuir and Craiglockhart Health Centres.
They facilitate and encourage new ways for people to understand, engage and “notice” nature in a deeper and beneficial way (National Trust, 2021), which is vital for achieving health outcomes since the depth, length and type of experience matters greatly in determining true “connections” with nature and being able to obtain the array of physical and mental health benefits it plays host to (Myers, 2020).
It is important to point out here that nature prescriptions are a hybrid solution; they are geared toward the community, but inevitably include institutional actors (such as the NHS) for their implementation. Nonetheless, by virtue of being recommended by health professionals, nature prescriptions offer a legitimised consent pathway towards forms and frequencies of nature-engagement, which could be useful for individuals who may not have previously considered their take-up, especially in relation to overcoming personal health ailments.
In Oxgangs, nature-prescriptions calendars and leaflets can be printed and produced in multiple languages and formats to be more widely accessible for people with English as a second language or disabilities, and be widely distributed in local schools and community centres to enable their access by a wider pool of residents, so as to not require a pre-existing health condition for their take-up, or ensure health resources are not gate-kept by formal health institutions.
Community centres could facilitate regular drop-in support groups where participants can meet and share experiences, ideas and recommendations, hold each other accountable and foster a collaborative element to what are often individual activities, to further encourage and sustain their take-up. Groups can be split by demographics or shared interests.
Recommendation 2 – Community Gardening
Oxgangs and Triangle Community Centres are hubs of holistic group and individually focused activities that are centred on exercise, cooking, socialising and creative activities. These are examples of vital community and social infrastructure provision that enhance Oxgangs’ residents’ social and cultural capital (Seyfang and Smith, 2007).
These centres are thus fantastically suited to implementing a nature-based dimension to the activities they already run to reinforce their health benefits and connect nature with locally defined interests to help embed increased greenspace access within participants’ everyday lives (Jones et al., 2013). Framing activities in terms of fun, leisure, creativity and socialising instead of mental and physical illness prevention can contribute to their appeal (Rankin et al., 2006).
‘Facilitated access’, such as organised transport to the Oxgangs or Triangle Community Centres, followed by a supported led activity, could be successful in reaching underrepresented groups, such as those with disabilities, whose day-to-day mobility may disproportionately increase the actual or perceived barriers they face in reaching their local community centres and greenspaces.
Horticulture in the Triangle Community Garden particularly promotes social inclusion and community-building (Diamant and Waterhouse, 2010). Gardening imparts multiple mental and physical well-being benefits to practitioners, usually ascribed to being out in the fresh air, exercise, doing something meaningful and mindful, and doing so alongside others (Sempik, 2010), hence why it is frequently described as “therapeutic horticulture” (Thomas, 2014).
Vegetable and herb growing sessions are a simple way to enact a care-giving responsibility that produce mental health benefits (Kimmerer, 2012). If combined with cooking classes which use community garden-grown produce that is fresh and healthy, nourishing meals become available that positively impact the community’s nutrition, as well as offer the opportunity to socialise, and learn skills such as food hygiene and budgeting (Spence and van Teijlingen, 2005). Surplus meals can be stored in a Community Fridge for other residents.
Activities could expand from vegetable growing to sowing flowers, maintaining wildlife habitats, woodcraft or pottery, or educational and themed activities such as “pollinator-friendly” workshops that incorporate useful and infrastructural elements such as composting workshops or building bee towers out of recycling waste, ideas which can expand to people’s own gardens and further enhance social cohesion (Seyfang and Smith, 2007). Activities span the indoors and outdoors so are accessible irrespective of season, weather, age or mobility level.
Construction of sheds, planters, fences or raised beds could be done in partnership with the grassroots youth group ‘YouthBuild Edinburgh’ which teaches construction and employability skills; this could not only help improve the civic amenity of Oxgangs’ local community centre, gardens and wider greenspaces for its people, but also enhance their environmental benefit (Pincetl, 2010).
Activities could culminate in an organised themed community open day within Colinton Mains Park, to showcase and highlight the development and potential successes of community garden focused activities, demonstrate their empowering social value and motivate more community members to participate (Morris and O’Brien, 2011).
Recommendation 3 – Conservation Activities
Community centres could collaborate with grassroots organisations and NGOs to implement larger-scale and transformative projects including ecological restoration activities such as tree planting, conservation management and meadow seeding, to enhance the health and ecological benefits that can be derived from Oxgangs’ local greenspaces.
Recent research points to the tangible and verifiable health benefits that are derived from restoration activities (Mills et al., 2017; Speldewinde et al., 2015) as a result of its interconnected pathways towards nature engagement, socialising, physical activity and doing something meaningful for one’s community (Jennings and Gaither, 2015).
If adapted to the community’s interests, integration of expertise and knowledge from external grassroots organisations such as the Edinburgh and Lothians Greenspace Trust could provide unique experiences for residents such as wildlife counts and identification days along the Braid Burn river walkway or Oxgangs Lochan, or mindfulness sessions using accessible and inclusive language within favourite nature spots which can facilitate long-term mental health improvements (Shanahan et al., 2019).
An NbS programme that only considers expert scientist and policy maker voices would not achieve an environmentally just and sustainable project (Pincetl, 2010), but their involvement could assist with fundraising, training or pro-bono consulting, which could be required if new green infrastructure is to be successfully deployed and managed (Pincetl, 2010). When expert knowledge is shared and strengthened by community actors such as “Friends Of” groups or using a “local champion” framework for specific knowledge gatekeeping, a top-down knowledge-power imbalance can be overcome, which supports the longevity and sustainability of more complex and long-term projects (Pretty et al., 2016).
Volunteer work is enjoyable and imparts multiple health benefits and is often an essential component of environmental programmes due to budget constraints (Townsend, 2006). However, voluntary upkeep of project must not become costly or burdensome on local residents. Their benefit must be obvious to the whole community to avoid being seen as problematic (Pincetl, 2010). Recruiting and delegating responsibility for such tasks can be complicated, so voluntary work uptake cannot be immediately expected (Pincetl, 2010), but could begin with Friends of groups, grassroots organisations, schools, universities and church groups, who can plan, fundraise for and partake in an organised voluntary programme that can fit into their varying routines and schedules.
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