Do sex and gender modify the association between green space and physical health? A systematic review

A growing literature shows that green space can have protective effects on human health. As a marginalized group, women often have worse life outcomes than men, including disparities in some health outcomes. Given their marginalization, women might have more to gain than men from living near green spaces. Yet, limited research has deliberately studied whether green space-health associations are stronger for women or men. We conducted a systematic review to synthesize empirical evidence on whether sex or gender modifies the protective associations between green space and seven physical health outcomes (cardiovascular disease, cancer, diabetes, general physical health, non-malignant respiratory disease, mortality, and obesity-related health outcomes). After searching five databases, we identified 62 articles (including 81 relevant analyses) examining whether such effect modification existed. We classified analyses based on whether green space-health were stronger for women, no sex/gender differences were detected, or such associations were stronger for men. Most analyses found that green space-physical health associations were stronger for women than for men when considering study results across all selected health outcomes. Also, women showed stronger protective associations with green space than men for obesity-related outcomes and mortality. Additionally, the protective green space-health associations were slightly stronger among women for green land cover (greenness, NDVI) than for public green space (parks), and women were also favored over men when green space was measured very close to one's home (0-500 m). Further, the green space-health associations were stronger for women than for men in Europe and North America, but not in other continents. As many government agencies and nongovernmental organizations worldwide work to advance gender equity, our review shows that green space could help reduce some genderbased health disparities. More robust empirical studies (e.g., experimental) are needed to contribute to this body of evidence.

Automated summary

A growing body of literature suggests that green spaces have a protective effect on human health. Women, who often face marginalization, may benefit more from living near green spaces compared to men. However, there is limited research on whether the associations between green spaces and health outcomes are stronger for women or men. This systematic review aims to synthesize empirical evidence on whether sex or gender modifies the protective associations between green spaces and various physical health outcomes. The majority of the analyzed studies found that the associations between green spaces and physical health outcomes were stronger for women. Women also showed stronger protective associations with green spaces for obesity-related outcomes and mortality. The findings suggest that green spaces could help reduce gender-based health disparities.