Water is one of the most important physical, aesthetic landscape elements and possesses importance e.g. in environmental psychology, landscape design, and tourism research, but the relationship between water and health in current literature is only investigated in the field of environmental toxicology and microbiology, not explicitly in the research field of blue space and human well-being. Due to the lack of a systematic review of blue space and well-being in the various fields of research, the aim of this review is to provide a systematic, qualitative meta-analysis of existing studies that are relevant to this issue.
Benefits for health and well-being clearly related to blue space can be identified with regard to perception and preference, landscape design, emotions, and restoration and recreation. Additionally, direct health benefits have already been stated. The studies included in the review are mostly experimental studies or cross-sectional surveys, focusing on students as the subject group.
There is a need for more qualitative and multi-faceted, interdisciplinary studies, using triangulation as a method to achieve a resilient image of reality. A broader study design considering all age groups would contribute to identifying benefits for the whole of society. The inattentiveness to blue space makes it difficult to measure long-term effects of blue space on well-being. There is still little respect for water and health in planning issues, although salutogenetic health benefits can be identified. To close the gap regarding missing systematic concepts, a concept for assessing salutogenetic health effects in blue space is provided. Blue space is considered therein as a multi-dimensional term including four dimensions of appropriation, as well as at least five ontological dimensions of substantiality. The aim of the concept is to support researchers and practitioners analysing health effects in blue space.
The basis for any corporate development is the existence of water. Water is also considered to be one of the most important aesthetic landscape elements (Kaplan and Kaplan, 1989). An attractive landscape provideshealthand well-being to humans (Abraham et al., 2010). Green space is a common term for natural areas, but if there is a further division of green space, one can recognise that many areas are in fact blue (Gledhill and James, 2008). The critique, that water as an aspect of landscape is not thoroughly recognised in research, has already been stated in landscape ecology. In this field Lianyong and Eagles (2009) criticise the inattentiveness of academics towards ‘waterscapes’ and show a clear relationship between waterscapes and environmental health. The term ‘blue space’ summarises all visible surface waters in space as an analogy to green space, not as a sub-category. Except in landscape ecol-ogy this critique has not been formulated explicitly in research, despite the recent trend in practice in urban planning to consider water as an important element of landscape. This is expressed in the embodiment of settlement areas in which great importance is attached to water (Fagnoni, 2009; Syme and Nancarrow, 1992). Cities located by rivers or at lakes have a distinctive and unique physiognomy which creates their own, special character (Strauss, 2002). Since the 1980s there has been a clear trend in (urban) planning for waterfront revitalisation,towards water and sites containing water, providing access to blue space partly with expensive planning (BAFU and Schweizer Wanderwege, 2009; Desfor and Jørgensen, 2004;Harvey, 1991; Sandercock and Dovey, 2002;Wood and Handley, 1999; Wüthrich et al., 2003).
Health and well-being
In defining health, it has to be considered, that the term is a discoursive construction of society and policy makers (Bunton, 1997). Thus the definition can vary over time. In this review the health definitions of the World Health Organisation (WHO) are generally used. Primarily, the WHO defined health in 1948 as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). The influence of water on health was addressed at an international health care conference in 1978 in Alma Ata (WHO, 1978). Eight years later the Ottawa-Charter for Health Promotion declared health as “a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities” (WHO, 1986). The Charter was developed under the influence of Antonovsky’s concept of salutogenesis (1979), which, contrary to pathogenetics, takes account of the reasons and circumstances for the creation and preservation of health. The salutogenetic concept as the basis for health promotion considers individual and corporate resources for health, well-being and quality of life as central requirements to prevent health risks and potential illnesses (Antonovsky, 1998). The European Charter on Environment & Health (WHO, 1989) and the United Nations Conference for Environment and Development (UNCED) in Rio de Janeiro in 1992 also supported salutogenetic health promotion.
Despite striking results showing that blue space has manifold influences on human health and wellbeing, research in blue space is still at best a by-product of environmental psychology and environmental health research. Emotional and experiential responses to blue space have not yet been adequately recognised. Against this background and as an innovative take on therapeutic spaces in urban areas, we suggest introducing ‘blue’ as a new colour (both literally and metaphorically) into debates on environmental health and therapeutic landscapes.
Based on the results of the literature review addressing the certain, blue component of therapeutic landscapes, an innovative, two-dimensional matrix, comprising appropriative dimensions of places (experienced space, activity space, social space, symbolic space) and ontological dimensions of distinct substantialities (natural, built, humanistic, structuralist, post-structuralist, see Gesler, 1992, Classen and Kistemann, 2010) turned out to be a beneficial instrument for an improved understanding of the multifaceted, affective character and impact of landscape as a therapeutic, i.e. health-relevant entity. As the matrix is not specific for blue spaces, it may also prove worthwhile for wider applications.
A range of specific empirical and experimental settings could be identified for future work. Namely, more research needs to be carried out on the emotional and experiential response to blue space. The concept suggested may help both researchers and practitioners analysing the health effects of blue spaces. It remains a challenge to stretch the concept to marine environments, which have not been included into this paper.
Urban environments, although the everyday environment for most of us and therefore important for any goals towards health promotion, are underrepresented in currentliterature on blue therapeutic landscapes. Health benefits could clearly be identified, but there is still little respect for water and health in urban planning issues. There is a need to introduce the prospective findings from environmental health research concerning blue spaces into urban planning and landscape architecture.