Green cities, healthy cities: urban greenspaces, mental health and well-being in low- and middle-income countries

Exposure to urban greenspaces promotes a variety of mental health and well-being benefits. However, much of the evidence for these benefits is biased towards highincome countries, and cities in low- and middle-income countries (LMICs) remain understudied. Given the increasing burden of mental ill-health associated with urbanisation in LMICs, there is a clear need to better understand the role greenspaces play in mitigating mental ill-health. Here, I examine the evidence-base of the mental health and well-being benefits of greenspaces in LMICs and explore the pathways of such relationships in Kathmandu (Nepal), one of the fastest growing low-income cities in Asia. I further assess links between greenspace exposure and mental health in Kathmandu and test a novel scale tailored specifically to the contributions of greenspaces to human well-being in Nepal. Based on a scoping review of the existing evidence, I find that urban greenspaces can support multiple mental health and well-being outcomes in LMICs. However, knowledge about poorer countries remains limited. Using a sequential mixedmethods study design in Kathmandu reveals that greenspaces are linked to mental health through pathways such as reducing harm (exposure to air pollution and heat), restoring capacities (attention restoration, stress reduction), building capacities (encouraging physical activity, fostering social cohesion) and causing harm (human– wildlife conflicts, gender discrimination). While I found no consistent relationship between measures of greenspace exposure and well-being in a cross-sectional household survey in Kathmandu, findings support associations with physical activity and social cohesion, which were best supported by moderate levels of biodiversity. By taking an interdisciplinary approach, this thesis provides evidence that greenspaces can play a pivotal role in reducing the burden of mental ill-health in the understudied context of LMICs through a variety of pathways. Greater efforts to increase the quantity, quality and accessibility of greenspaces may help addressing current health inequalities in LMICs.