TEO概念下自然环境对公共健康的主动促进框架

The active promotion framework of natural environment to public health based on TEO concepts

在健康中国战略的背景下,以创造支持性环境和实现社会公平正义为导向的“主动促进”,已成为风景园林学科在深化人与自然和谐关系上的新议题。为此,本文引入公共健康领域的“扩大、延伸、增强的机会理论”(即TEO,the theory of expanded,extended,and enhancedopportunities),利用该理论对现有“自然—健康”的实证成果进行梳理,提出了TEO概念下自然环境对公共健康的主动促进框架,在“健康绩效”和“健康公平”的核心目标下,从扩大自然接触的积极影响、增强环境体验的感知能力、和延伸社会协同的服务方向三方面阐述了促进过程中的关键路径。旨在获得不同蓝绿空间的要素资源对个体健康水平的最大促进绩效,采取多层设计与多元评价加强群体水平的健康公平,为未来健康人居环境的体制建构、利益相关者的共同参与、和规划管理政策的有效落地提供参考。

Content and dimensions of the concept of public health are one of the most critical and fundamental issues of urban planning and design discipline for overall economic and social development in modern cities.The COVID-19 outbreak has profound ramifications for multiple dimensions,ranging from the spatial-temporal features of human settlement in urban and rural areas,to the mode of producing and living style of the public,such as physical activity,mobility,as well as health disparities.These led to a rethink of structure and function of the built environment,and in this process,discussions on how to intervene the urban health problems for cities in China and overseas have been sharply concerned again since the First Industrial Revolution.Therefore,contribution of landscape architecture in the relationship between natural environment and public health has been encouraged to transform from the previous“passive intervention”approaches that focuses on the prevention and control of environmental pollution and human disease,to the“active promotion”approaches aimed at creating healthy supportive environment and achieving equity and justice.However,the distinctions of these approaches have not been clarified enough in current industry practices.Such a clarification would help to strengthen landscape strategies in the global plan of action on public health,and to deliver sound health outcomes for human society.To address this gap,this paper proposes a theoretical framework based on the“theory of expanded,extended and enhanced opportunities”(TEO),a conceptual model used for health behavior interventions in public health research field.In this framework,there is a complex interplay between various elements of the city system that highlights the harmonious existence of the man and the nature as well as the society.In order to better realize this intergrowth,we firstly demonstrate that a research paradigm with the goals of“health performance”and“health equity”is the core subject of the active promotion approaches.Health performance focuses on the material surroundings,which describes health benefits from various axes of physical,mental as well as social aspects.And health equity focuses on the immaterial environment,which presents the social reflection of health disparities and long-term development of health and well-being among different social groups.Then three key pathways are concluded.The first pathway is to expand the positive impact of natural exposure,as different types of natural environment(i.e.,green space and blue space)have showed potential to facilitate different health-related behaviors(e.g.,physical activity,stress reduction,social contact,etc.).In this line,national park system and urban green space system planning can actively respond to the emerging health needs of the public through structural optimization and functional reorganization with a perspective to the combination of multiple spatial scales,and that elaborate the natural exposure assessment with indicators of accessibility,availability and visibility.Notably,visibility is rated as an important motivation to increase opportunity of natural exposure for people,which provides a solution for the dilemma in metropolitan cities and high densities that vertical greening and roof garden are demanding coping strategies to ease the shortage of green space,and prospectively mitigate mental and psychological challenges in difficult working conditions.The second pathway is to enhance the perceptions of environmental experience,as high level of spatial quality has presented more potentials to strengthen cognitive emotions and autonomy of individual,and to partially alleviate health disparities in the process of health resource allocation.Thus,future studies are encouraged to focus on the relationship among health behaviors,green and blue landscape’s physical characteristics(e.g.,density,color,smell,texture,and spatial composition),cultural and spiritual meanings,as well as emotional perception produced by environmental experiences(e.g.,a sense of belonging,pleasure,and sublime).The third pathway is to extend the direction towards social collaborative service,as one with a lower socio-economic status(SES)is more likely to be disadvantaged in the lifelong health development.It is supposed that multi-related departments should cooperate with,support and participate in providing secondary compensation of health resources for those most vulnerable groups from a perspective of intersectionality,and implementing a binary evaluation system of subjective and objective SES to further understand the extent to which landscape attributes may promote the health status of vulnerable populations,and the cultural and gender differences in that.This study makes a significant contribution to current literatures and discussions on landscape architecture and public health in the context of creating a healthy supportive environment.The main findings provide insights into the construction and management of healthy human settlement,and inform planning professionals and policy makers who are attempting to make efforts for public health.