Article Text

Download PDFPDF

BlueHealth: a study programme protocol for mapping and quantifying the potential benefits to public health and well-being from Europe's blue spaces
  1. James Grellier1,2,
  2. Mathew P White1,3,
  3. Maria Albin4,5,
  4. Simon Bell6,7,
  5. Lewis R Elliott1,3,
  6. Mireia Gascón8,9,10,11,
  7. Silvio Gualdi12,
  8. Laura Mancini13,
  9. Mark J Nieuwenhuijsen8,9,10,11,
  10. Denis A Sarigiannis14,
  11. Matilda van den Bosch15,16,17,
  12. Tanja Wolf17,
  13. Susanne Wuijts18,
  14. Lora E Fleming1
  1. 1 European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Truro, UK
  2. 2 Faculty of Medicine, School of Public Health, Imperial College, London, UK
  3. 3 Psychology Applied to Health (PAtH), University of Exeter Medical School, Exeter, UK
  4. 4 Occupational and Environmental Medicine (OEM), Department of Laboratory Medicine, University of Lund, Lund, Sweden
  5. 5 Institute of Environmental Medicine (IMM), Karolinska Institute, Stockholm, Sweden
  6. 6 Department of Landscape Architecture, Estonian University of Life Sciences, Tartu, Estonia
  7. 7 OPENspace, Edinburgh College of Art, University of Edinburgh, Edinburgh, Scotland
  8. 8 Centre for International Health Research (CRESIB), Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
  9. 9 Centre for Research in Environmental Epidemiology (CREAL), Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain
  10. 10 Universitat Pompeu Fabra (UPF), Barcelona, Spain
  11. 11 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  12. 12 Fondazione Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC), Bologna, Italy
  13. 13 Istituto Superiore di Sanità (ISS), Rome, Italy
  14. 14 Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
  15. 15 Department of Forest and Conservation Sciences, Faculty of Forestry, University of British Columbia, Vancouver, BC, Canada
  16. 16 WHO European Centre for Environment and Health, WHO Regional Office for Europe, Bonn, Germany
  17. 17 School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
  18. 18 National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  1. Correspondence to Dr James Grellier; j.grellier{at}


Introduction 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.

Aims and methods 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.

Ethics and dissemination 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
  • public health
  • natural environment
  • well-being

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors JG, MPW, LEF and LRE drafted this manuscript on the basis of a grant proposal which was devised and written by MPW, LEF, MA, SB, MG, SG, LM, MJN, DAS, MvdB, TW and SW. All of the authors made substantial contributions to the Methods section of the draft manuscript, in which the conception and design of aspects of the work for which they are responsible in the BlueHealth project are described. Specifically: JG, LRE and MPW constructed the BlueHealth Conceptual Model; JG, LRE, MPW, MA, MG and MJN wrote the sections on Reviews and Secondary data analysis; JG, LRE, MPW, SB, MG, SG, LM, MJN and MvdB wrote sections on Primary data collection and analysis; and TW, SW and DAS rewrote the section on Informing urban planning policy and long-term strategy. All coauthors also contributed to the writing of the Introduction and Discussion sections. JG subsequently prepared a final version of the manuscript based on co-author contributions. All authors then read the final version, approved it for submission for publication and agree to be accountable for all aspects of the work.

  • Funding This work was supported by funding received from the European Union's Horizon 2020 research and innovation programme under grant agreement no. 666773.

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

  • Patient consent The research being conducted does not involve patients. As explained above, all work carried out within this programme of research that involves human subjects is reviewed by, and subject to approval from, relevant local ethics committees. Where applicable, informed consent will be obtained from study participants. All results from work that is conducted in this project involving human subjects will be anonymised and all relevant safeguards have been put in place to ensure that complete anonymity of all participants is preserved.

  • Ethics approval Throughout the BlueHealth project, ethics review and approval are obtained for all aspects of the study by the relevant local ethics committees before any work is conducted. Stakeholder engagement also involves citizens in many aspects of the project throughout.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.