'Blue health' for healthy aging? Urban blue spaces as potentially therapeutic landscapes for older people in Ahmedabad and Ruhr Metropolis

Abstract

In recent decades, increasing scientific evidence has emerged demonstrating the health benefits of exposure to surface waters called "blue spaces" in analogy to green spaces. Those health benefits mainly relate to positive effects on health behavior and physical and mental health and protective effects from environmental health threats. Despite increasing differentiation, research to date has only been able to clarify fundamental questions, which is why exploratory approaches to specific issues are still needed. This applies, among others, to the question of how 'blue health' manifests in old age, for example what influence age has on the experience of the blue space-health relationship and which health effects for this population group exist. Since demographic change and urbanization are two converging megatrends in the 21^st century, older people (aged 65 years and over) in cities make up one of the fastest growing population groups. Given the high levels of morbidity in old age and the need to act on healthy aging, older people could particularly benefit from health effects of blue spaces. <br/> This research investigates the relationship between blue spaces and older people's health and wellbeing using a multiple case study approach in two distinct urban contexts: Ahmedabad in India and Ruhr Metropolis in Germany. A participatory action research methodology called photovoice was applied which included participant observations and baseline surveys at two main research sites, photowalks (walking interviews incorporating photo elicitation), focus group discussions, stated preference choice experiments and key informant and expert interviews. <br/> The analysis shows that older people in both cases experience blue spaces as 'potentially therapeutic landscapes' and place high value on having access to those spaces in cities. Most preferred were larger blue spaces such as rivers and lakes as well as landscaped blue-green environments. Mental health benefits such as restoration and stress relief were ranked most important, followed by physical activity/sense of improved physical health and social interaction. The study identifies various factors influencing older people's urban blue space use as well as aspects and landscape elements that are perceived as age-friendly and health-enabling. Looking at the supply side, obstacles to accessibility, a lack of amenities and maintenance difficulties are major reasons causing misfits between older people's demands and needs and the actual blue space provision in both cases and represent key intervention points for urban planning and design. Overall, the results provide some tentative evidence on the determinants of success and failure in age-friendly urban blue space governance for health. Despite many challenges, the present findings are encouraging as they highlight that blue health futures across the world can be shaped for and with aging urban populations. For this purpose, this research provides concrete recommendations for action.