When blue spaces turn brown: understanding the influence of poor water quality on blue health (dis)benefits

Water environments, or blue spaces, such as rivers, lakes, reservoirs and coastal waters are an important natural resource that support biodiversity, underpin food and energy production, supply drinking water, promote tourism, enable recreational opportunities and provide a range of public health benefits (Stosch et al., 2017). Regarding recreation and outdoor pursuits, access and exposure to blue spaces can deliver a broad range of health benefits, e.g., social interactions, mental wellbeing, physical exercise, that together are recognised as ‘blue-health’ benefits (McDougall et al., 2020). The quality of water associated with these diverse ‘blue spaces’ is therefore crucially important for a broad range of catchment stakeholders.

Blue-health is increasingly seen as a significant benefit of ‘green infrastructure’ and an important outcome of our ‘Natural Health Service’ provided by the environment. The types of environment that people engage with as they live and work are important determinants of ill health and disease (Hartig et al., 2014). While blue health benefits of spending time at the coast are well recognised (Gascon et al; 2017), the role of inland blue space environments in promoting health and wellbeing benefits is less well understood (McDougall et al., 2022). This is partly due to the breadth of sensory attributes (e.g., aesthetic properties of the waterbody, aesthetic properties of the waterside surroundings, soundscapes, smells), associated with different types of inland blue space. These sensory attributes of inland blue spaces are dynamic, which raises further questions of how environmental and climate changes may influence the range and magnitude of health and wellbeing benefits provided by blue space environments because of, for example, increased water pollution or challenges of emerging pollutants.

Recently, sewage discharges into UK surface waters have received significant media attention with increased recognition of the frequency and magnitude of spills raising public awareness of the risks posed to water quality and downstream ecological and public health. This has been coupled with a series of record fines for some UK water companies for major sewage leaks and other pollution incidents. During 2020, in England alone, there were over 400,000 sewage discharges from 80% of combined sewer overflows (CSOs) monitored, totalling in excess of 3 million hours of discharge (Defra, 2022). This has attracted strong criticism from campaign groups, water quality experts and public health professionals who are increasingly concerned that CSOs are being used to regularly dispose of untreated sewage into receiving waters even during times of little to no rainfall. Heightened public awareness of sewage pollution and a growing appreciation of the risks from inappropriate wastewater discharge to freshwater ecosystems has coincided with increased numbers of people choosing to explore and value local environments as a resource for promoting their health and wellbeing in response to lockdown restrictions that were in place during the COVID-19 pandemic. Importantly, the main argument in support of licenced CSO spills (i.e., those occurring during wet weather) is that this activity poses minimal direct risk to human health through exposure to faecal pollution because people are less likely to swim during heavy rainfall, when pollution would be diluted by high flows; however, this fails to recognise the potential disbenefits on health and wellbeing for the ‘hidden majority’ who engage with blue spaces in non-immersive ways. For example, do the health and wellbeing benefits associated with blue space exposure diminish, or have negative health outcomes, when waterside users: are exposed to visible water pollution signatures and evidence of washed-up and trapped sewage-related debris on riverbanks and shorelines; become increasingly aware of reduced aquatic biodiversity associated with impacted waters; and encounter smells typical of sewage effluents? In other words, when blue spaces turn brown, what happens to their health and wellbeing promoting potential and are those impacts short-lived or long-lasting?

The overarching aim of this studentship, therefore, is to provide critical data on the importance of water quality associated with blue space environments for promoting health and wellbeing benefits. Specifically, the research objectives are to:

1. Determine how different types and levels of water quality and pollution associate with measures of wellbeing across different blue space user groups;
2. Use a mixed methods approach to characterise how exposure to short- and longer-term changes in water quality influence perceived health and wellbeing (dis)benefits;
3. Investigate via scenario analysis and choice experiments how variations in water quality of blue spaces, driven by land use and climate change, can impact on their blue-health benefits, as perceived across different blue space user groups.

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Image Captions

Image of 4 different rivers of varying quality


The student will deploy a combination of quantitative and qualitative research methods to enable data capture of blue-health benefits associated with inland water environments across different blue space user groups. The studentship will link together analysis of secondary data sources with participatory-based qualitative research methods and use of national-scale representative surveys. An evaluation of future potential impacts on blue space access, quality and health-promoting opportunities will be undertaken. Future landscape/climate change will likely influence rural and urban waters in different ways, both in terms of blue space quantity and quality. The studentship will use climate change projections to derive scenarios of future blue space usage and access and consider how different “catchment futures” might relate to health inequalities. Ultimately, we want to know how changes to inland water use might take shape (e.g., frequency of visits and wider promotion of blue-health benefits) under a series of future land use and climate-related scenarios. We will use a number of economic valuation methods, including revealed preference recreation demand models, and contingent behaviour and choice experiments (Hanley & Barbier, 2009), to show how blue-health benefits can be impacted by changes to the water quality status of inland waters and how this will vary across sites and across actual and potential users of inland water sites. Novel outputs from the studentship will help to inform and underpin future decision-making concerning the socio-economic, health and wellbeing value of inland waters and how to maximise the wider emotional, restoration, recreation and direct health benefits of these important blue spaces. Thus, the studentship will help to develop an action plan for protecting health and well-being benefits of water environments challenged by pollution.

Project Timeline

Year 1

In the first 4 months of the studentship you will develop a critical review of the literature. After engaging with the literature you will begin to learn key skills for survey design and choice-based experiments, and participate in key training opportunities. You will deploy a large-scale survey on perceived health and wellbeing (dis)benefits associated with varying levels of water quality and associated pollution events.

Year 2

In year 2 you will develop expertise in mixed methods approaches and learn skills in e.g., walking interviews, focus groups and participatory workshops to understand how exposure to short- and longer-term changes in water quality influence perceived health and wellbeing (dis)benefits. You will be encouraged to begin to draft chapters as you progress.

Year 3

In addition to writing up aspects of the research undertaken so far you will begin to develop a series of landscape/climate change scenarios and their implications for water quality of different inland blue spaces (rural and urban). You will investigate the impact of future landscape/climate change scenarios on public perception of the health and wellbeing (dis)benefits.

Year 3.5

The final 6 months will be used to interpret the outputs from the scenario modelling and to finalise the thesis with respect to writing up and refining further the drafts of chapters completed thus far.

& Skills

This studentship will provide a platform to build an interdisciplinary research career in environment and health, with a focus on nature-health interactions. The studentship will broaden the scope of the applicant’s skills base by providing specialist training in a range of quantitative and qualitative research methods. Extensive skill development in survey design and choice-based experiments will be complemented with training in a variety of participatory research methodologies.

References & further reading

Defra (2022). Event duration monitoring – storm overflows – annual returns. Available at: https://environment.data.gov.uk/dataset/21e15f12-0df8-4bfc-b763-45226c16a8ac.

Gascon, M., Zijlema, W., Vert, C., White, M. P., & Nieuwenhuijsen, M. J. (2017). Outdoor blue spaces, human health and well-being: A systematic review of quantitative studies. International Journal of Hygiene and Environmental Health, 220(8)

Hanley N & Barbier EB. (2009). Pricing Nature: Cost-Benefit Analysis & Environmental Policy. Cheltenham: Edward Elgar.

Hartig T, Mitchell R, De Vries S, Frumkin H. Nature and health. Annual Rev Public Health. 2014; 35: 207-228.

McDougall, C.W., Quilliam, R.S., Hanley, N. and Oliver, D.M., 2020. Freshwater blue space and population health: An emerging research agenda. Science of the Total Environment, 737, p.140196.

McDougall, C.W., Hanley, N., Quilliam, R.S. and Oliver, D.M., 2022. Blue space exposure, health and well-being: Does freshwater type matter?. Landscape and Urban Planning, 224, p.104446.

Stosch KC, Quilliam RS, Bunnefeld N & Oliver DM (2017). Managing multiple catchment demands for sustainable water use and ecosystem service provision, Water, 9, 677.

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