Chronic conditions and the environment
***AK IS PRESENTLY WORKING ON THIS SECTION***
The problem: In section \ref{479675}, we reviewed the extent to which the wellbeing of individuals is impacted on by the local environment and the mechanisms through which these impacts may be realised. Here we consider the impacts of increasing urbanisation as well as the impacts of the environment on people living with chronic conditions, and opportunities through which wellbeing may be improved in these individuals. Increasing urbanisation of the modern world has increased risk for the development of chronic and noncommunicable conditions including high blood pressure, diabetes and obesity with implications for cardiovascular disease, cancer and stroke \cite{Shanahan_2015,Dye_2008}. A recent systematic review of twelve eligible studies on up to 43 million individuals observed that areas with higher residential greenness were associated with reduced risk for mortality from cardiovascular disease. Other researchers expect more psychiatric disorders to arise from the direct and indirect effects of climate-related disasters relating to the disruption to food supply and damage to community wellbeing \cite{Berry_2009,Hayes_2018}. Critically, the number of people experiencing psychological trauma following a disaster actually exceeds those with physical injury by 40–1 \cite{j2007}, and weather related disasters have increased by 44% since the year 2000 \cite{Watts_2018}. It is also worth bearing in mind here that chronic physical and mental conditions are highly comorbid, further impacting on and contributing to further deteriorations in community health and wellbeing.
The moderators: It is important to acknowledge here the potential impacts of several major moderators of the relationship between the natural environment and wellbeing. These include personal orientations to nature, socioeconomic disadvantage and culture.
BRIEFLY DESCRIBE STUDIES ON EACH as per https://academic.oup.com/bioscience/article/65/5/476/324489 and more recent studies. Unfortunately, people living with chronic conditions XXX
Potential solutions: a variety of potential
Berks study regarding upward spiral of change lfrom one visual to community. To environmental action
INTERVENTION STUDIES OR ONLY CORRELATIONAL FINDINGS???