Addressing food insecurity in Australia through education for sustainability.

Within Australia food insecurity affects an estimated 4 million people annually. Health promotion degrees traditionally prepare pre-service graduates to address food insecurity from a social determinants perspective, little consideration of integrating ecological determinants, however, has been noted. This is a significant problem considering unprecedented environmental challenges facing future food production. Education for sustainability (EfS) is purported to develop graduates who can respond to significant sustainability issues in the 21st century. This study examined the potential for health promotion degrees to utilize EfS to address food insecurity through an ecological lens. The study also illustrates why it might be valuable for academics to use such an approach. Semi-structured interviews with 15 Australian health and sustainability academics and document analysis of 26 associated teaching units was undertaken. Thematic analysis informed the data analysis process to provide meaning and insight into emerging themes. Academics were unaware of EfS or its potential for developing ecologically literate graduates. A lack of university commitment towards sustainability and knowledge and skills to implement EfS were identified as potential barriers. Academics, however, were ascribing to the central tenets used in EfS such as interdisciplinary thinking and reflective practice, demonstrating its potential use in health promotion. EfS, as a framework for incorporating an ecological perspective into health promotion degrees has not been fully realized. This study suggests capacity building of academics with regard to the use of EfS as an approach within health promotion degrees to address significant sustainability issues in the 21st century, such as food insecurity.

Health promotion and food insecurity: Exploring environmental sustainability principles to guide practice within Australia.

ISSUE ADDRESSED: The Australian health promotion sector has made significant advances in food security over the years through recognition of social and economic factors. The incorporation of ecological determinants within health promotion practice to address food insecurity, however, is uncommon. This paper explores the potential of health promotion to use environmental sustainability principles to guide the development of health promotion food security programs in Australia. METHODS: A mixed-methods approach guided by a pragmatic framework was adopted for this study. A national online survey (n = 61) and semi-structured interviews (n = 16) targeting Australian health promotion practitioners was utilised. Triangulation involved seven stages to develop points of convergence and corroboration of the data. RESULTS: Practitioners were adopting principles of environmental sustainability such as ecological integrity and biodiversity protection to guide food security practice. The use of such principles demonstrates their compatibility within health promotion practice. This study, however, reveals that environmental sustainability principles were a relatively new area of practice for health promotion practitioners. CONCLUSION: The possibilities for integrating health promotion and environmental sustainability principles are promising for addressing multifaceted issues inherent within food security practice. At present, a lack of principles exist for guiding the sector to address food security that is cognisant of both human health and the environment. SO WHAT?: This study indicates a lack of integration between environmental sustainability and health promotion principles to guide food security practice. It would be pertinent for the sector to consider the development of a set of principles that considers both health promotion and environmental sustainability to ensure future food security and planetary health. Capacity building of current practitioners and pre-service graduates around the use of such principles to guide practice could assist the sector in this process.

Nature-Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes.

Engagement with nature is an important part of many people's lives, and the health and wellbeing benefits of nature-based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature-based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature-based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.

Accessing Green Spaces Within a Healthcare Setting: A Mixed Studies Review of Barriers and Facilitators.

This review describes the facilitators and barriers impacting on passive access to green spaces within healthcare settings. A systematic mixed-studies review was undertaken to review the quantitative and qualitative evidence on access to green spaces within healthcare settings, as well as to review the methodological quality of the studies eligible for inclusion. A total of 24 articles met the inclusion criteria and were included in the review. The barriers to access were grouped into three themes: "awareness," "accessibility," and "comfort." The facilitators were grouped into 13 themes: "flora and foliage," "views," "water features," "sun, rain, fresh air, wind," "animal life," "diverse textures, heights, shapes," "lawn," "natural versus artificial material," "rest areas," "shade," "private areas," "play equipment," and "safety." These findings can be explained through multiple lenses, using existing theories on contact with nature and supportive garden design. In an era of elevated stress, patient admissions, and staff turnover in hospitals, and rising costs of providing healthcare services, the creation of settings conducive to health promotion, stress reduction, and faster recovery is relevant and timely. This article, which has collated over three decades of research evidence, is invaluable in addressing this issue.

Improving Wellbeing and Environmental Stewardship Through Volunteering in Nature.

Environmental volunteering (EV) can provide a unique way to optimise the wellbeing of participants while fostering environmental stewardship. However, the potential of EV to create human health benefits remains an under-researched area. This study provides evidence for improved wellbeing and mood state for 32 participants from diverse backgrounds undertaking EV activities. Most participants also reported improved environmental stewardship with a greatly improved understanding of the environment and the need to conserve it. Other benefits included: 31% of those seeking work obtained it; and 50% joined a volunteer group at program completion. EV provides a unique mechanism to enhance the wellbeing of the participants, while conserving the environment.

'Ecological embeddedness' and Its Public Health Implications: Findings From an Exploratory Study.

Western culture over the last two centuries has become significantly ecologically 'dis-embedded', with nature increasingly reduced to resources for human use. The consequence is global environmental degradation, including accelerating climate change. Much recent research supports associations between nature contact and human health and well-being, and between feelings of nature-connectedness and pro-environmental attitudes and behaviours. The oft-cited Ottawa Charter for Health Promotion (WHO, Ottawa Charter for Health Promotion, 1986) emphasises human-environment inextricability; however public health discourse and response has not fully engaged with this recognition. This qualitative study explored the attitudes, motivations, and experiences-including formative influences-of six individuals whose behaviour was congruent with recognition of human-nature interconnectedness; such individuals may be understood as ecologically embedded. Key aspects of participants' experience, identified through grounded theory thematic analysis, were (i) connecting with nature (especially in childhood); (ii) seeing the threat and taking it personally; (iii) the nature of reality; (iv) dedicated beyond the ego-oriented self; and (v) sustaining the eco-centric self. The findings highlight the necessity for cross-sectoral advocacy at all levels of government policy development focused on recognition of human-environment connectedness, especially bridging health, planning and education policies affecting children. Only thus will both population health and ecological health on which population health depends be possible.

Expanding children's food experiences: the impact of a school-based kitchen garden program.

OBJECTIVE: Evaluate achievement of the Stephanie Alexander Kitchen Garden Program in increasing child appreciation of diverse, healthy foods. DESIGN: Comparative 2-year study. SETTING: Six program and 6 comparison primary schools in rural and metropolitan Victoria, Australia, matched for socioeconomic status and size. PARTICIPANTS: A total of 764 children in grades 3 to 6 (8-12 years of age) and 562 parents recruited. Retention rates at follow-up included 85% children and 75% parents. INTERVENTION: Each week of the school year, children spent 45 to 60 minutes in a garden class and 90 minutes in a kitchen class. PHENOMENON OF INTEREST: Program impact on children's willingness to try new foods, capacity to describe foods, and healthy eating. ANALYSIS: Qualitative data analyzed using inductive thematic analysis. Quantitative data analyzed using random-effects linear regressions adjusted for school clustering. RESULTS: Child and parent qualitative and quantitative measures (if never tried before, odds ratio 2.0; confidence interval, 1.06-3.58) showed increases in children's reported willingness to try new foods. No differences in articulation of food descriptions (program vs comparison groups). Qualitative evidence showed that the program extended its influence to healthy eating, but this was not reflected in the quantitative evidence. CONCLUSIONS AND IMPLICATIONS: Findings indicate program success in achieving its primary objective, meriting further program research.

Developing an exploratory framework linking Australian Aboriginal peoples' connection to country and concepts of wellbeing.

Aboriginal people across Australia suffer significant health inequalities compared with the non-Indigenous population. Evidence indicates that inroads can be made to reduce these inequalities by better understanding social and cultural determinants of health, applying holistic notions of health and developing less rigid definitions of wellbeing. The following article draws on qualitative research on Victorian Aboriginal peoples' relationship to their traditional land (known as Country) and its link to wellbeing, in an attempt to tackle this. Concepts of wellbeing, Country and nature have also been reviewed to gain an understanding of this relationship. An exploratory framework has been developed to understand this phenomenon focusing on positive (e.g., ancestry and partnerships) and negative (e.g., destruction of Country and racism) factors contributing to Aboriginal peoples' health. The outcome is an explanation of how Country is a fundamental component of Aboriginal Victorian peoples' wellbeing and the framework articulates the forces that impact positively and negatively on this duality. This review is critical to improving not only Aboriginal peoples' health but also the capacity of all humanity to deal with environmental issues like disconnection from nature and urbanisation.

Health promotion and climate change: exploring the core competencies required for action.

Climate change poses serious threats to human health and well-being. It exacerbates existing health inequities, impacts on the social determinants of health and disproportionately affects vulnerable populations. In the Australian region these include remote Aboriginal communities, Pacific Island countries and people with low incomes. Given health promotion's remit to protect and promote health, it should be well placed to respond to emerging climate-related health challenges. Yet, to date, there has been little evidence to demonstrate this. This paper draws on the findings of a qualitative study conducted in Victoria, Australia to highlight that; while there is clearly a role for health promotion in climate change mitigation and adaptation at the national and international levels, there is also a need for the engagement of health promoters at the community level. This raises several key issues for health promotion practice. To be better prepared to respond to climate change, health promotion practitioners first need to re-engage with the central tenets of the Ottawa Charter, namely the interconnectedness of humans and the natural environment and, secondly, the need to adopt ideas and frameworks from the sustainability field. The findings also open up a discussion for paradigmatic shifts in health promotion thinking and acting in the context of climate change.

Growing community: the impact of the Stephanie Alexander Kitchen Garden Program on the social and learning environment in primary schools.

This article presents results from a mixed-method evaluation of a structured cooking and gardening program in Australian primary schools, focusing on program impacts on the social and learning environment of the school. In particular, we address the Stephanie Alexander Kitchen Garden Program objective of providing a pleasurable experience that has a positive impact on student engagement, social connections, and confidence within and beyond the school gates. Primary evidence for the research question came from qualitative data collected from students, parents, teachers, volunteers, school principals, and specialist staff through interviews, focus groups, and participant observations. This was supported by analyses of quantitative data on child quality of life, cooperative behaviors, teacher perceptions of the school environment, and school-level educational outcome and absenteeism data. Results showed that some of the program attributes valued most highly by study participants included increased student engagement and confidence, opportunities for experiential and integrated learning, teamwork, building social skills, and connections and links between schools and their communities. In this analysis, quantitative findings failed to support findings from the primary analysis. Limitations as well as benefits of a mixed-methods approach to evaluation of complex community interventions are discussed.

Incorporating sustainability into community-based healthcare practice.

There is now irrefutable evidence that climate change and increasing environmental degradation negatively affect population health. Healthcare plays an important role in addressing these emerging environmental challenges, considering its core aim is to protect and promote health. Preliminary research in Victoria, Australia, suggests that healthcare practitioners are endeavouring to factor in environmental concerns into their practice. Health promotion, an integral part of the healthcare system, is considered an area of practice that can support action on sustainability. Based on five qualitative case studies and key stakeholder interviews, this article explores key barriers and facilitators to incorporating sustainability into community-based healthcare practice. The findings demonstrate that despite multiple barriers, including funding and lack of policy direction, health promotion principles and practices can enable action on sustainability.

Volunteering in nature as a way of enabling people to reintegrate into society.

AIMS: Those who experience emotional and behavioural difficulties or mental health problems, are unemployed or bereaved, or have been in trouble with the law can be socially marginalized and can become isolated from their families, community and wider society. This paper explores the role of active hands-on contact with the environment through a general environmental volunteering programme and through a targeted therapeutic volunteer programme, highlighting how these two approaches can potentially aid some marginalized people to reintegrate into society. METHODS: This study draws on concepts from the well-being and social capital literatures and refers to two separate pieces of research: Study 1 was based on general environmental volunteering primarily in northern England and southern Scotland; and Study 2 focused on mental health participants at Meanwhile Wildlife Garden in London. Ethnographic and interview data were gathered from participants as a means to understand the benefits they gained from their voluntary involvement. The participants all volunteered to undertake the activities they were involved in and chose outdoor nature activity as opposed to other activities. RESULTS: There is self-reported and observed evidence from and of participants in these studies that contact with nature can be beneficial to a range of excluded groups; also the studies show that the learning and curative processes that take place in green spaces can provide benefits in terms of social reintegration of vulnerable young people and adults. Three key themes of particular relevance to the marginalized participants were identified as: (1) improving relations with others and nature; (2) working alongside others who are different; and (3) developing social and employable skills. Active hands-on engagement allows people to work at their own pace, since these approaches are not target focused, and skills and social networks can be developed slowly. Practical engagement in environmental conservation work is one approach that may provide people with a new role, identity, skills and social networks. This paper argues that volunteering in nature has the potential to provide a shared purpose for people, independent of gender, age, physical ability, mental functioning, socioeconomic status or knowledge of environmental management. However, it is recognized that particular people may and do experience barriers to engaging with and enjoying the natural environment. CONCLUSIONS: Volunteering in nature may be particularly effective for those who would like to be outdoors and have more contact with nature yet need specific encouragement and supported/led activities to participate.

Rediscovering nature in everyday settings: or how to create healthy environments and healthy people.

It is estimated that half of the world's population now live in urban environments. Urban living necessitates a removal from nature, yet evidence indicates that contact with nature is beneficial for human health. In fact, everyday urban places, such as where people live, study, and work, provide opportunities to bring nature back into cities to contribute to positive, healthy environments for people and to foster the human-nature connection. The inclusion of more nature in cities could have additional environmental benefits, such as habitat provision and improving the environmental performance of built environments. In the context of climate change, outcomes such as these assume further importance. This article explores how common urban places can foster links between people and nature, and generate positive health and well-being outcomes. We achieve this by exploring nature in the everyday settings of schools and residential housing.

"If the land is healthy ... it makes the people healthy": the relationship between caring for Country and health for the Yorta Yorta Nation, Boonwurrung and Bangerang Tribes.

This article reports on research undertaken with members of three Indigenous groups in Victoria, Australia, to explore the health and wellbeing implications of caring for Country (defined as having knowledge, sense of responsibility and inherent right to be involved in the management of traditional lands). The research findings provide a better understanding of this key determinant of the health and wellbeing of Indigenous people in the context of public health where there are few existing published studies assessing this relationship. Thirteen traditional custodians(1) and local Indigenous environmental workers were interviewed. This qualitative study involving semi-structured interviews identified that caring for Country offers great benefits, including building self-esteem, fostering self-identity, maintaining cultural connection and enabling relaxation and enjoyment through contact with the natural environment. Results generated indicate that caring for Country may offer a means of improving the current poor health status of Indigenous Australian peoples.

Older people's relationships with companion animals: a pilot study.

When older people enter residential care facilities, disruption to social networks may occur, with detrimental effects on health and wellbeing. This article reports on a study undertaken in an aged care facility in Melbourne, Australia, that explored the potential for a visiting companion animal programme to improve the health and wellbeing of residents and to promote their capacity for building relationships. Results back assertions in the literature that companion animals foster relationships by giving people opportunities to interact with others, but further study is needed to verify the link.

Health and well-being naturally: 'contact with nature' in health promotion for targeted individuals, communities and populations.

ISSUE ADDRESSED: The increase in mental health disorders worldwide makes it important to recognise health promotion interventions that are effective, accessible and affordable. Although natural spaces are coming to be recognised as health-promoting settings for general populations, little is understood about the use of nature-contact in treatment and care for individuals experiencing ill-health. METHODS: This paper provides a summary of key research findings and presents a case study examining the self-reported health and well-being benefits of nature contact for a small clinical sample. The 'Spectrum of Interventions for Mental Health Problems and Mental Disorders' provides a conceptual framework for ordering current and future information relating to nature-based interventions. RESULTS: Evidence demonstrates that separately, physical activity, social connection, and contact with nature enhance human health and well-being. The case example illustrates how 'active', 'social' and 'adventurous' contact with nature may be combined within a treatment intervention to protect and enhance the health of individuals experiencing chronic mental, emotional and physical health difficulties. CONCLUSIONS: 'Contact with nature' constitutes a health promotion strategy with potential application in prevention, early intervention, treatment and care. Recommendations include further research to investigate the benefits of nature contact within existing interventions, and the impacts of 'active' and 'social' nature contact within tailored interventions for targeted individuals and communities.

Healthy nature healthy people: 'contact with nature' as an upstream health promotion intervention for populations.

Whilst urban-dwelling individuals who seek out parks and gardens appear to intuitively understand the personal health and well-being benefits arising from 'contact with nature', public health strategies are yet to maximize the untapped resource nature provides, including the benefits of nature contact as an upstream health promotion intervention for populations. This paper presents a summary of empirical, theoretical and anecdotal evidence drawn from a literature review of the human health benefits of contact with nature. Initial findings indicate that nature plays a vital role in human health and well-being, and that parks and nature reserves play a significant role by providing access to nature for individuals. Implications suggest contact with nature may provide an effective population-wide strategy in prevention of mental ill health, with potential application for sub-populations, communities and individuals at higher risk of ill health. Recommendations include further investigation of 'contact with nature' in population health, and examination of the benefits of nature-based interventions. To maximize use of 'contact with nature' in the health promotion of populations, collaborative strategies between researchers and primary health, social services, urban planning and environmental management sectors are required. This approach offers not only an augmentation of existing health promotion and prevention activities, but provides the basis for a socio-ecological approach to public health that incorporates environmental sustainability.

Rural sports and recreational injuries in Australia: what do we know?

OBJECTIVE: It is widely recognised that individuals residing in regional or rural areas have poorer health outcomes than those from metropolitan areas. Factors associated with these poorer health outcomes include geographical isolation, population declines, limited health care provision and higher levels of inactivity compared to urban areas. The mental, social and physical health of individuals and communities in rural areas can be improved through active participation in sport and recreation activities. Unfortunately, participation in such activities can potentially lead to injury. There is a suggestion that there is an increased risk of sports injuries in rural areas due to the lack of health professionals and coaching personnel, fewer available volunteers to organise and deliver sport, and the general attitude towards injuries in rural settings. RESULTS: There is very limited information about the number and types of injuries sustained during participation in sports activities in rural and regional settings. This is largely related to a lack of formal sporting structures and support mechanisms including research funding and trained personnel. CONCLUSION: A range of factors need to be implemented to improve safety for sporting and recreational participants in these areas. These include improved monitoring of injury occurrence, stronger promotion of safety initiatives and wider implementation of education strategies.

An ecological study of the relationship between social and environmental determinants of obesity.

There is growing concern with the increasing prevalence of obesity in industrialised countries, a trend that is more apparent in the poor than in the rich. In an ecological study, the relationship between an area measure of socioeconomic status (SES) and the density of fast-food outlets was examined as one possible explanation for the phenomenon. It was found that there was a dose-response between SES and the density of fast-food outlets, with people living in areas from the poorest SES category having 2.5 times the exposure to outlets than people in the wealthiest category. The findings are discussed.