Changes in self-perceived health of individuals with chronic illness: the relevance of green space in the living environment

Abstract

Study objectives: Green space has been associated with a wide range of health benefits, yet nearly all studies on the subject are cross-sectional in design. To investigate the health-promoting potential of green space, this longitudinal study analyzes change in self-rated health of chronically ill persons in relation to the amount of green space in their living environment. A synchronized exploration of green space and chronic illness will provide a unique perspective on the health-promoting potential of natural environments.

Design: 1,318 people with one or more medically diagnosed chronic disease(s) have participated in a panel study, reporting their general health for 2, 3, or 4 years. The percentage of green space (urban green space, agricultural space, natural green space) was calculated for each 4-digit postal code. Linear regression analysis was conducted to investigate the relationship between green space and health change among the study population. Potential moderating effects of this relationship were explored and the main effect of social capital on health was investigated through stratified analyses by level of urbanity and age.

Main results: The analysis found no relationship between the amount of green space in the 4-digit postal code and change in perceived health among this population of individuals with chronic illness. A significant and positive main effect of social capital on change in health was discovered. The positive influence of social capital was most robust in strongly urban areas and for individuals between the ages of 40-64.

Conclusions: It is possible that subjective measures of health, like the self-report, do not reflect true change in health due to issues of response shift. Change in health among chronically ill individuals may be more accurately measured through subjective measures. The unexpected finding of a positive impact of social capital on change in perceived health is significant. Health-promoting effects of social capital should continue to be explored, especially with regard to the quality of life and wellbeing of individuals with chronic illness.