Ewan Hamnett, Retired GP

Gareth Morgan, Head of Education and Engagement, Wildlife Trust for Birmingham and the Black Country

Published in JHH16.1 – Nature connections

Just before I retired from general practice five years ago, I was asked by Birmingham City Council to promote activity across the city. Our health service is drowning in the consequences of the terrible triad of inactivity, obesity and unhappiness, all of which are arguably caused by increasing isolation, particularly in our most deprived citizens. We must reconnect people and allow them to become resilient rather than reliant. If we fail to do this then the consequences for both the individual, the NHS and the planet will be disastrous.

Ewan Hamnett

The education and engagement team at the Wildlife Trust for Birmingham and the Black Country aims to connect people with nature. The incredible and beautiful natural resources of our urban areas are rich in wildlife, on the doorsteps of 2 million people, and freely accessible. We need nature and nature needs us – but unless people have those inspiring experiences in our wild spaces, they will miss the opportunity to embed this in their life.

Gareth Morgan

There’s a good argument that when wildlife does well, we all do well Click To Tweet

The problem

It is a sad fact that we find ourselves in the midst of our planet’s sixth period of mass extinctions, called the Anthropocene extinction because it is due primarily to human activities. Globally, as populations of people and livestock overwhelm our other-than-human cousins, we have already lost 83% of all wild mammals and half of our plants (Bar-On et al, 2018).

Just as our ancestor hunters once eradicated the megafauna of the New World, the aggregated impacts of industrial agriculture and overfishing, rising human consumption and climate change now threaten to extinguish half of the world’s remaining biodiversity by the end of the century.

Are humans living well in this brief apex of planetary dominance? In the UK we spend 92% of our time indoors, watching TV for eight times as long as we exercise; our children fail to recognise 50% of common species (while identifying 80% of Pokémon characters); those that have the least access to nature also have the worst levels of physical health and mental wellbeing. Something is going wrong here, and clearly we need to make urgent changes to the way we live. But what will it take for us to collectively change course? Here are three facts that might help.

The first should make us sit up and be truly alarmed. The Inter – governmental Panel on Climate Change says that in order to avert catastrophe, we have 12 years to reduce our carbon emissions by 45%. If we don’t then within the lifetime of our children, life on Earth could become unsustainable. This is not some distant event and though even two degrees of warming would spell disaster in south east Asia and Africa, several forecasts show likely rises in excess of 3º by 2200. The global impact would be a devastating build-up of today’s already intensifying forest fires, floods, fighting and famine, accompanied by mass migration and dire conflict over dwindling resources.

The prospects

But the second and third facts should give us hope. The second is that rather than exponentially increasing, until the hungry population of the world has stripped out the last of Earth’s natural resources, the evidence is that birth rates will continue to slow down. If so, by the end of the century the world’s population will be levelling off at around 11 billion.

The third is that many of the changes needed for sustainability and good planetary husbandry will also be good for human health: spending more time outside, getting active, exploring the natural environment, ditching the car, observing and learning from nature, enjoying more plant-based diets, and connecting with others in communal wild spaces. These are prescriptions for health and happiness.

The wild perspective on wellbeing

There’s a good argument that when wildlife does well, we all do well. At the Wildlife Trust for Birmingham and the Black Country, this simple observation underlies our fight to protect and improve the wild spaces that are accessible to people who live in the conurbation. It also underpins our range of programmes that help people deepen their connection with their local natural environment. We believe that everyone deserves to live in a healthy, wildlife-rich natural world and to experience the joy of wildlife every day. This is why we tailor our people and wildlife activities to help people of all ages experience our wild spaces through a lifecycle of engagement.

• Nature tots programmes for 2 to 5-year-olds helps embed a love of wildlife that lasts a lifetime. A Wildlife Trust survey found 92% of parents think access to nature and wildlife is important for children but 78% of parents worry their children don’t spend enough time in nature. The earlier the connection is made, the easier it is to maintain.
• Environmental education activities for primary school children include our river rangers programmes, visits to our reserves and the new Wild Schools Roadshow we take into schools.
• Family activities are run at weekends and during every holiday, allowing children to experience and enjoy wildlife alongside their parents.
• John Muir Awards and Duke of Edinburgh volunteering enable secondary school-age children to discover, explore and conserve their local wild spaces.
• Our Wild Future provides a platform for young people aged 16–25 to train and develop their own ideas to improve our urban environment.
• All kinds of walks, talks and volunteering opportunities can be found by searching at bbcwildlife.org.uk/whats-on
• Health and wellbeing courses aim to inspire people to connect with nature where they live and to enjoy the benefits of their local natural environment.

These courses include a mix of talks, walks and hands-on practical activities that highlight the many mental and physical health benefits of getting out into nature. Based on the Five Ways to Wellbeing (see also Melanie Vincent’s article on page 29), the courses include:

• Learn – hands on learning about different environments including woodlands, meadows, canals and ponds
• Give – protecting local wild space by volunteering and practical conservation activity
• Take notice – how to be mindful in nature
• Be active – fitness through the walks and volunteering activity
• Connect – how to stay connected with nature and ways to join other groups locally
• Introduction to the health and well-being benefits of connecting with nature in the city, wherever you live
• How to build nature into your everyday life
• Where to find the wild spaces across Birmingham and the Black Country
• Explore – through wildlife walks, discovering locally accessible spaces to encounter the natural world.

We have provided these courses for different groups, including young people at risk of becoming NEET (Not in Employment, Education or Training), people with mild to moderate mental health issues, adults with learning disabilities and young refugees and asylum seekers. We measure their impact using the Warwick Edinburgh Mental Wellbeing Scale (WEMWEBS) before and after these courses. The average impact for our courses was a significant plus 11.6 difference, with the highest reported impact being on ‘confidence’ (+1.4) and feeling good about yourself’ (+1.6).

Loneliness among older people is proven to be even more harmful than inactivity, obesity and smoking 15 cigarettes a day, so this spring we are launching our first health and wellbeing in nature courses for isolated older people in Walsall. We will include those living with dementia in the Making Connections programme which is being funded by Walsall Public Health and Protection. Time spent positively engaging with nature boosts health and wellbeing whatever our stage of life. Contact with nature is good for all ages, from the sensory and physical development of small children to the improved sleep, vitamin D levels and immune functioning of the elderly.

Diet, activity, obesity and sustainability

The carbon footprint of beef is massive. According to the BBC online climate change food calculator eating beef three times a week for a year is equivalent to driving a car 6,500 kilometres or heating an average house for 225 days, or taking five return flights from London to Malaga, and uses 4,625m² of land, equal to the space of 17 tennis courts. Even organically and locally produced beef has a carbon footprint at least 10 times that of most pulses, nuts and vegetables.

With type 2 diabetes now affecting around 9% of the UK population, treating it consumes around £9 billion of the NHS budget of £128 billion

If you are slim your chances of getting type 2 Diabetes are tiny but once BMI rises to over 35 the chances are 88 times higher. So obesity and type 2 diabetes go hand in hand, and only 30% of adult males in this country have a normal body weight. There’s more to the diet–sustainability link than this though. With type 2 diabetes now affecting around 9% of the UK population, treating it consumes around £9 billion of the NHS budget of £128 billion. The ecological and social impact of obesity and type 2 diabetes are huge: a GP practice with 10,000 patients will spend £1.5 million on diabetic care alone, and those visits to clinics, drug production and hospital treatments for diabetes-related diseases have their own carbon footprint.

A landmark study in The Lancet (Lean et al, 2017) showed that major weight reduction could put diabetes into remission. Of those who lost more than 15kg, 84% ceased medication and their blood sugar normalised.

Another hot tip for a longer life is eat more fibre. In a huge population study looking at 135 million patient/years of data, the people who ate more fibre-rich foods (such as lentils, beans and seasonal vegetables) had a reduction in’all-cause mortality’ (due to diseases like diabetes, heart disease, stroke and bowel cancer) of between 15% and 30% (Reynolds et al, 2019).

Nature, diet, activity and evolution

Our ability to break down starches into glucose and to store it as fat under the action of insulin has enabled the human race to flourish. It’s a gift of human evolution that lets us store fat for survival through droughts, famines, wars and diseases and so pass these resilient genes on. However, this talent and the accompanying ‘better feast just in case of famine’ instinct is counter-productive if the feast is permanently available, which is what has happened. Since the 1950s UK diets (with subsequent help from a burgeoning food industry) have become richer in carbohydrate, and the population’s overall activity levels started to fall as manual and household labour tailed off in the wake of mechanisation.

Though inactivity is partly to blame for our current health crisis, there is relatively less focus on it than there is on obesity. The latter is easily measured, whereas activity levels are more subjective, so its benefits are harder to prove except in large population studies like the enormous international European Prospective Investigation into Cancer and Nutrition Study (EPIC) study. This research actually showed that inactivity is twice as likely as obesity to shorten life (Ekelund et al, 2015). The study estimated that 676,000 deaths of European men and women in 2008 may have been attributable to physical inactivity whereas only 337,000 deaths were due to obesity (BMI >30). The activity effect was across the board and could not simply be explained by obese people being less active. Unsurprisingly, groups with higher levels of physical activity showed bigger impacts on all-cause mortality, but even moderate activity had a real impact: in fact the greatest reduction in risk was when the moderately active group was compared with those who were inactive.

Our conclusion

Healthcare is moving on from dealing with the time when its main target was infectious diseases, to dealing with the consequences of our modern day lives. Yet doctors are still kept busy medicating the long-term results of our unnatural lifestyles, even though all the evidence clearly shows that doctors and drugs are not the main determinants of health outcomes. It’s where you live, how you live and whether your education, wealth and early life allow you to have some say in these matters that make the real difference. With these limitations in mind what can each of us do for our own and others’ wellbeing, that at the same time enriches the planet we inhabit? The evolutionary messages seem clear: walk more and drive less, get together with others ideally in nature (and on nature’s behalf), eat less meat, more vegetables and more pulses.

Good for people; good for the planet.

References

• Bar-On YM, Phillips R, Milo R (2018) The biomass distribution on Earth. PNAS 115 (25): 6506–6511
• Ekelund U, Ward H, Norat T et al (2015) Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). American Journal of Clinical Nutrition 101(3): 613–621.
• Lean EJ, Leslie WS, Barnes AC et al (2017) Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet 391(10120): 541–551.
• Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Lorenga L (2019). Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. The Lancet 393(10170): 434–445.