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This report presents an overview of the key messages that came out of the research conducted within the BlueHealth project. In particular, it explains what is meant by "BlueHealth" research, what challenges society faces regarding urban "blue spaces", and how the urban environment can exploit blue infrastructure as a health and well-being resource. We show how an evidence base can be built up with primary studies, and then be implemented in practice with different kinds of interventions. This report is useful as a primer for a wide range of decision-makers, including those making policy, designing and planning our cities and towns, and working towards improved public health and environmental quality in the face of 21st century challenges.

The BlueHealth Toolbox is for planners, designers and other decision-makers responsible for blue spaces. The tools provide the means to make comparable assessments of urban blue spaces before and after any proposed changes. Such changes can include a wide range of interventions, from physical alterations to the environment to advertising campaigns that influence how people interact with it. The tools provide evidence about the quality of blue environments, as well as information about how people and communities use, perceive and interact with blue spaces. They also assess the state of people’s health and wellbeing. Together, this evidence can enhance urban planning and design. This Guidance document presents an overview of the tools and explains how they can be used by decision makers and planners in the service of evidence-based design.

The BlueHealth Toolbox is for planners, designers and other decision-makers responsible for blue spaces. The tools provide the means to make comparable assessments of urban blue spaces before and after any proposed changes. Such changes can include a wide range of interventions, from physical alterations to the environment to advertising campaigns that influence how people interact with it. The tools provide evidence about the quality of blue environments, as well as information about how people and communities use, perceive and interact with blue spaces. They also assess the state of people’s health and wellbeing. Together, this evidence can enhance urban planning and design. This Guidance document presents an overview of the tools and explains how they can be used by decision makers and planners in the service of evidence-based design., {"references":["Grellier J, White MP, Albin M, et al. BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe's blue spaces. BMJ Open. 2017;7(e016188):1-10. doi:10.1136/bmjopen-2017-016188","Wheeler BW, White MP, Stahl-Timmins W, Depledge MH. Does living by the coast improve health and wellbeing. Heal Place. 2012;18(5):1198-1201. doi:10.1016/j. healthplace.2012.06.015","Wheeler BW, Lovell R, Higgins SL, et al. Beyond greenspace: an ecological study of population general health and indicators of natural environment type and quality. Int J Heal Geogr. 2015;14:17. doi:10.1186/s12942- 015-0009-5","Nutsford D, Pearson AL, Kingham S, Reitsma F. Residential exposure to visible blue space (but not green space) associated with lower psychological distress in a capital city. Heal Place. 2016;39:70-78. doi:10.1016/j. healthplace.2016.03.002","de Vries S, ten Have M, van Dorsselaer S, van Wezep M, Hermans T, de Graaf R. Local availability of green and blue space and prevalence of common mental disorders in the Netherlands. BJPsych Open. 2016;2(6):366-372. doi:10.1192/bjpo.bp.115.002469","Völker S, Kistemann T. The impact of blue space on human health and well-being - Salutogenetic health effects of inland surface waters: A review. Int J Hyg Environ Health. 2011;214(6):449-460. doi:10.1016/j.ijheh.2011.05.001","Völker S, Kistemann T. Reprint of: \"I'm always entirely happy when I'm here!\" Urban blue enhancing human health and well-being in Cologne and Düsseldorf, Germany. Soc Sci Med. 2013;91:141-152. doi:10.1016/j. socscimed.2013.04.016","Gascon M, Zijlema W, Vert C, White MP, Nieuwenhuijsen MJ. Outdoor blue spaces, human health and well-being: A systematic review of quantitative studies. Int J Hyg Envir Heal. 2017;4(8). doi:10.1016/j.ijheh.2017.08.004","MacKerron G, Mourato S. Happiness is greater in natural environments. Glob Environ Chang. 2013;23(5):992-1000. doi:10.1016/j.gloenvcha.2013.03.010","White MP, Pahl S, Ashbullby KJ, Herbert S, Depledge MH. Feelings of restoration from recent nature visits. J Environ Psychol. 2013;35:40-51. doi:10.1016/j.jenvp.2013.04.002","Annerstedt M, Jönsson P, Wallergård M, et al. Inducing physiological stress recovery with sounds of nature in a virtual reality forest - Results from a pilot study. Physiol Behav. 2013;118:240-250. doi:10.1016/j. physbeh.2013.05.023","Schipperijn J, Ekholm O, Stigsdotter UK, et al. Factors influencing the use of green space: Results from a Danish national representative survey. Landsc Urban Plan. 2010;95(3):130-137. doi:10.1016/j. landurbplan.2009.12.010","White MP, Wheeler BW, Herbert S, Alcock I, Depledge MH. Coastal proximity and physical activity: Is the coast an under-appreciated public health resource? Prev Med (Baltim). 2014;69:135-140. doi:10.1016/j. ypmed.2014.09.016","Ashbullby KJ, Pahl S, Webley P, White MP. The beach as a setting for families' health promotion: A qualitative study with parents and children living in coastal regions in Southwest England. Heal Place. 2013;23:138-147. doi:10.1016/j.healthplace.2013.06.005","White MP, Bell S, Elliott LR, Jenkin R, Wheeler BW, Depledge MH. The health benefits of blue exercise in the UK. In: Barton J, Bragg R, Wood C, Pretty J, eds. Green Exercise : Linking Nature, Health and Well-Being. Abingdon, UK: Routledge; 2016:211","Völker S, Baumeister H, Classen T, Hornberg C, Kistemann T. Evidence for the temperature-mitigating capacity of urban blue space - A health geographic perspective. Erdkunde. 2013;67(4):355-371. doi:10.3112/ erdkunde.2013.04.05","Hajat S, Vardoulakis S, Heaviside C, Eggen B. Climate change effects on human health: projections of temperature-related mortality for the UK during the 2020s, 2050s and 2080s. J Epidemiol Commun Heal Heal. 2014;68(7):641-648. doi:10.1136/jech-2013-202449","Bengston DN, Fletcher JO, Nelson KC. Public policies for managing urban growth and protecting open space: Policy instruments and lessons learned in the United States. Landsc Urban Plan. 2004;69(2-3):271-286. doi:10.1016/j. landurbplan.2003.08.007","Ward Thompson C. Activity, exercise and the planning and design of outdoor spaces. J Environ Psychol. 2013;34:79-96. doi:10.1016/j.jenvp.2013.01.003","WHO. Health 2020: A European Policy Framework and Strategy for the 21st Century. Bonn; 2013. doi:10.1017/ CBO9781107415324.004","Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743-800. doi:10.1016/S0140- 6736(15)60692-4","McMichael AJ. Globalization, Climate Change, and Human Health. N Engl J Med. 2013;368(14):1335-1343. doi:10.1056/NEJMra1109341","Mishra HS, Bell S, Vassiljev P, Kuhlmann F, Niin G, Grellier J. The development of a tool for assessing the environmental qualities of urban blue spaces. Urban For Urban Green. 2020;49(January):126575. doi:10.1016/j. ufug.2019.126575","Kahila M, Kyttä M. SoftGIS as a Bridge-Builder in Collaborative Urban Planning. In: Geertman S, Stillwell JCH, eds. Planning Support Systems Best Practice and New Methods. Dordrecht: Springer Netherlands; 2009:389-411. doi:10.1007/978-1-4020-8951-0_19"]}

This report presents an overview of the key messages that came out of the research conducted within the BlueHealth project. In particular, it explains what is meant by "BlueHealth" research, what challenges society faces regarding urban "blue spaces", and how the urban environment can exploit blue infrastructure as a health and well-being resource. We show how an evidence base can be built up with primary studies, and then be implemented in practice with different kinds of interventions. This report is useful as a primer for a wide range of decision-makers, including those making policy, designing and planning our cities and towns, and working towards improved public health and environmental quality in the face of 21st century challenges., {"references":["Solomon S. Water: The Epic Struggle for Wealth, Power, and Civilization. Harper Collins; 2011","EEA: State of Europe's seas Report No 2. Publications Office of the European Union; 2017","Bell S. Health and well-being aspects of urban blue space: The new urban landscape research field. Landsc Archit Spec Ed - Resilient Landscapes. 2019;26:113-119.","Grellier J, White MP, Albin M, et al. BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe's blue spaces. BMJ Open. 2017;7(e016188):1-10. doi:10.1136/bmjopen-2017-016188","ISCA/Cebr. The Economic Cost of Physical Inactivity.; 2015. doi:10.5040/9781492595731.ch-014","Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J. W., Patel, V., & Silove, D. (2014). The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. International Journal of Epidemiology, 43(2), 476–493. https://doi.org/10.1093/ije/dyu038","Jacob, D., Kotova, L., Teichmann, C., Sobolowski, S. P., Vautard, R., Donnelly, C., Koutroulis, A. G., Grillakis, M. G., Tsanis, I. K., Damm, A., Sakalli, A., & van Vliet, M. T. H. (2018). Climate Impacts in Europe Under +1.5°C Global Warming. Earth's Future, 6(2), 264–285. https://doi.org/10.1002/2017EF000710","Vousdoukas, M. I., Mentaschi, L., Voukouvalas, E., Bianchi, A., Dottori, F., & Feyen, L. (2018). Climatic and socioeconomic controls of future coastal flood risk in Europe. In Nature Climate Change (Vol. 8, Issue 9, pp. 776–780). Nature Publishing Group. https://doi.org/10.1038/s41558-018-0260-4","Scoccimarro, E., Fogli, P. G., & Gualdi, S. (2017). The role of humidity in determining perceived temperature extremes scenarios in Europe. Environ Res Lett. https://doi.org/10.1088/1748-9326/aa8cdd","Elliott, L. R., White, M. P., Sarran, C., Grellier, J., Garrett, J. K., Scoccimarro, E., Smalley, A. J., & Fleming, L. E. (2019). The effects of meteorological conditions and daylight on nature-based recreational physical activity in England. Urban Forestry & Urban Greening, 42(October 2018), 39–50. https://doi.org/10.1016/j.ufug.2019.05.005","Wheeler, B. W., White, M. P., Stahl-Timmins, W., & Depledge, M. H. (2012). Does living by the coast improve health and wellbeing. Health and Place, 18(5), 1198–1201. https://doi.org/10.1016/j.healthplace.2012.06.015","Hooyberg, A., Roose, H., Grellier, J., Elliott, L. R., Lonneville, B., White, M. P., Michels, N., De Henauw, S., Vandegehuchte, M., & Everaert, G. (2020). General health and residential proximity to the coast in Belgium: Results from a cross-sectional health survey. Environ Res, 184(February), 109225. https://doi.org/10.1016/j.envres.2020.109225","Garrett, J. K., Clitherow, T. J., White, M. P., Wheeler, B. W., & Fleming, L. E. (2019). Coastal proximity and mental health among urban adults in England: The moderating effect of household income. Health and Place, 59, 102200. https://doi.org/10.1016/j.healthplace.2019.102200","Gibbons, S., Mourato, S., & Resende, G. M. (2014). The Amenity Value of English Nature: A Hedonic Price Approach. Environmental and Resource Economics, 57(2), 175–196. https://doi.org/10.1007/s10640-013-9664-9","Elliott, L. R., White, M. P., Grellier, J., Rees, S. E., Waters, R. D., & Fleming, L. E. (2018). Recreational visits to marine and coastal environments in England: Where, what, who, why, and when? Marine Policy, 97(March), 305–314. https://doi.org/10.1016/j.marpol.2018.03.013","White, M. P., Wheeler, B. W., Herbert, S., Alcock, I., & Depledge, M. H. (2014). Coastal proximity and physical activity: Is the coast an under-appreciated public health resource? Preventive Medicine, 69, 135–140. https://doi.org/10.1016/j.ypmed.2014.09.016","Garrett, J. K., White, M. P., Elliott, L. R., Wheeler, B. W., & Fleming, L. E. (2020). Urban nature and physical activity: Investigating associations using self-reported and accelerometer data and the role of household income. Environmental Research, 190, 109899. https://doi.org/10.1016/j.envres.2020.109899","Korfmacher, K. S., Aviles, K., Cummings, B. J., Daniell, W., Erdmann, J., & Garrison, V. (2014). Health impact assessment of urban waterway decisions. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph120100300","Vert, C., Carrasco-Turigas, G., Zijlema, W., Espinosa, A., Cano-Riu, L., Elliott, L. R., Litt, J., Nieuwenhuijsen, M. J., & Gascon, M. (2019). Impact of a riverside accessibility intervention on use, physical activity, and wellbeing: A mixed methods pre-post evaluation. Landscape and Urban Planning, 190(March), 103611. https://doi.org/10.1016/j.landurbplan.2019.103611","Vert, C., Nieuwenhuijsen, M. J., Gascon, M., Grellier, J., Fleming, L. E., White, M. P., & Rojas-Rueda, D. (2019). Health Benefits of Physical Activity Related to An Urban Riverside Regeneration. Int J Environ Res Public Health, 16(462), 1–16. https://doi.org/10.3390/ijerph16030462","Vert, C., Gascon, M., Ranzani, O., Márquez, S., Triguero-Mas, M., Carrasco-Turigas, G., Arjona, L., Koch, S., Llopis, M., Donaire-Gonzalez, D., Elliott, L. R., & Nieuwenhuijsen, M. J. (2020). Physical and mental health effects of repeated short walks in a blue space environment: A randomised crossover study. Environmental Research, 188, 109812. https://doi.org/10.1016/j.envres.2020.109812","Plymouth City Council. (2019) Active Neighbourhoods Urban nature delivering healthier communities for people and wildlife Final Report (2016–2019).","BlueHealth Consortium. (2020) Urban regeneration: Teats Hill. https://bluehealth2020.eu/projects/urban-beach-regeneration/","BlueHealth Consortium. (2020) Urban coastline: Tallinn. https://bluehealth2020.eu/projects/tallinn/","BlueHealth Consortium. (2020) Urban canal: Tartu. https://bluehealth2020.eu/projects/anne-kanal/","Wuijts, S., Friederichs, L., Hin, J. A., Schets, F. M., van Rijswick, H. F. M. W., & Driessen, P. P. J. (2020). Governance conditions to overcome the challenges of realizing safe urban bathing water sites. International Journal of Water Resources Development, 00(00), 1–25. https://doi.org/10.1080/07900627.2020.1755617","Pilgaard, F. I. H., Östergren, P. O., Olin, A., Kling, S., Albin, M., & Björk, J. (2019). Socioeconomic differences in swimming ability among children in Malmö, southern Sweden: Initial results from a community-level intervention. Scandinavian Journal of Public Health, November 2018, 1–7. https://doi.org/10.1177/1403494818821478","Borja, A., White, M. P., Berdalet, E., Bock, N., Eatock, C., Kristensen, P., Leonard, A., Lloret, J., Pahl, S., Parga, M., Prieto, J. V., Wuijts, S., & Fleming, L. E. (2020). Moving Toward an Agenda on Ocean Health and Human Health in Europe. Frontiers in Marine Science, 7(February). https://doi.org/10.3389/fmars.2020.00037","Yeo, N. L., White, M. P., Alcock, I., Garside, R., Dean, S. G., Smalley, A. J., & Gatersleben, B. (2020). What is the best way of delivering virtual nature for improving mood? An experimental comparison of high definition TV, 360° video, and computer generated virtual reality. Journal of Environmental Psychology, 72. https://doi.org/10.1016/j.jenvp.2020.101500","Tanja-Dijkstra, K., Pahl, S., White, M. P., Auvray, M., Stone, R. J., Andrade, J., May, J., Mills, I., & Moles, D. R. (2018). The Soothing Sea: A Virtual Coastal Walk Can Reduce Experienced and Recollected Pain. Environment and Behavior, 50(6), 599–625. https://doi.org/10.1177/0013916517710077"]}