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BMJ Open. 2017 Jun 14;7(6):e016188. doi: 10.1136/bmjopen-2017-016188.

BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe's blue spaces.

Author information

European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Truro, UK.
Faculty of Medicine, School of Public Health, Imperial College, London, UK.
Psychology Applied to Health (PAtH), University of Exeter Medical School, Exeter, UK.
Occupational and Environmental Medicine (OEM), Department of Laboratory Medicine, University of Lund, Lund, Sweden.
Institute of Environmental Medicine (IMM), Karolinska Institute, Stockholm, Sweden.
Department of Landscape Architecture, Estonian University of Life Sciences, Tartu, Estonia.
OPENspace, Edinburgh College of Art, University of Edinburgh, Edinburgh, Scotland.
Centre for International Health Research (CRESIB), Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Centre for Research in Environmental Epidemiology (CREAL), Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain.
Universitat Pompeu Fabra (UPF), Barcelona, Spain.
CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Fondazione Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC), Bologna, Italy.
Istituto Superiore di Sanità (ISS), Rome, Italy.
Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece.
Department of Forest and Conservation Sciences, Faculty of Forestry, University of British Columbia, Vancouver, BC, Canada.
WHO European Centre for Environment and Health, WHO Regional Office for Europe, Bonn, Germany.
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.



Proximity and access to water have long been central to human culture and accordingly deliver countless societal benefits. Over 200 million people live on Europe's coastline, and aquatic environments are the top recreational destination in the region. In terms of public health, interactions with 'blue space' (eg, coasts, rivers, lakes) are often considered solely in terms of risk (eg, drowning, microbial pollution). Exposure to blue space can, however, promote health and well-being and prevent disease, although underlying mechanisms are poorly understood.


The BlueHealth project aims to understand the relationships between exposure to blue space and health and well-being, to map and quantify the public health impacts of changes to both natural blue spaces and associated urban infrastructure in Europe, and to provide evidence-based information to policymakers on how to maximise health benefits associated with interventions in and around aquatic environments. To achieve these aims, an evidence base will be created through systematic reviews, analyses of secondary data sets and analyses of new data collected through a bespoke international survey and a wide range of community-level interventions. We will also explore how to deliver the benefits associated with blue spaces to those without direct access through the use of virtual reality. Scenarios will be developed that allow the evaluation of health impacts in plausible future societal contexts and changing environments. BlueHealth will develop key inputs into policymaking and land/water-use planning towards more salutogenic and sustainable uses of blue space, particularly in urban areas.


Throughout the BlueHealth project, ethics review and approval are obtained for all relevant aspects of the study by the local ethics committees prior to any work being initiated and an ethics expert has been appointed to the project advisory board. So far, ethical approval has been obtained for the BlueHealth International Survey and for community-level interventions taking place in Spain, Italy and the UK. Engagement of stakeholders, including the public, involves citizens in many aspects of the project. Results of all individual studies within the BlueHealth project will be published with open access. After full anonymisation and application of any measures necessary to prevent disclosure, data generated in the project will be deposited into open data repositories of the partner institutions, in line with a formal data management plan. Other knowledge and tools developed in the project will be made available via the project website ( Project results will ultimately provide key inputs to planning and policy relating to blue space, further stimulating the integration of environmental and health considerations into decision-making, such that blue infrastructure is developed across Europe with both public health and the environment in mind.


epidemiology; mental health; natural environment; public health; well-being

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: All authors report grants from European Union Horizon 2020 programme (grant number 666773), during the conduct of the study.

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