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Cited by 761Urban Green Space and HealthAsthma and respiratory diseasesGut microbiota and health

The DOI matches its Crossref record; 134 of the 135 references it cites were found in a registry or an index.

Regulation of the immune system by biodiversity from the natural environment: An ecosystem service essential to health

Open access
Rook, Graham A.·2013·Proceedings of the National Academy of Sciences
DOI 10.1073/pnas.1313731110PMC PMC3831972
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Abstract

Epidemiological studies suggest that living close to the natural environment is associated with long-term health benefits including reduced death rates, reduced cardiovascular disease, and reduced psychiatric problems. This is often attributed to psychological mechanisms, boosted by exercise, social interactions, and sunlight. Compared with urban environments, exposure to green spaces does indeed trigger rapid psychological, physiological, and endocrinological effects. However, there is little evidence that these rapid transient effects cause long-term health benefits or even that they are a specific property of natural environments. Meanwhile, the illnesses that are increasing in high-income countries are associated with failing immunoregulation and poorly regulated inflammatory responses, manifested as chronically raised C-reactive protein and proinflammatory cytokines. This failure of immunoregulation is partly attributable to a lack of exposure to organisms (“Old Friends”) from mankind’s evolutionary past that needed to be tolerated and therefore evolved roles in driving immunoregulatory mechanisms. Some Old Friends (such as helminths and infections picked up at birth that established carrier states) are almost eliminated from the urban environment. This increases our dependence on Old Friends derived from our mothers, other people, animals, and the environment. It is suggested that the requirement for microbial input from the environment to drive immunoregulation is a major component of the beneficial effect of green space, and a neglected ecosystem service that is essential for our well-being. This insight will allow green spaces to be designed to optimize health benefits and will provide impetus from health systems for the preservation of ecosystem biodiversity.

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Crossref · 10.1073/pnas.1313731110

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Research works printed but not linked: 3

  1. 10.1016/S0002-9270(99)00494-3 · DOI
  2. 10.1080/02770900903114572 · DOI
  3. CH Blackley Experimental Researches on the Causes and Nature of Catarrhus aestivus (Hay-Fever and Hay-Asthma) (Baillière Tindall and Cox, London, 1873).

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Metadata

Authors
Rook, G. A.
Affiliations
National Institute for Health and Care Research (GB)
Corresponding author
Rook, Graham A.
ORCID
Rook, Graham A.
Venue
Proceedings of the National Academy of Sciences
Publisher
National Academy of Sciences
Published
2013-10-23
Volume
110
Issue
46
Pages
18360-18367
ISSN
  • 0027-8424 (ISSN-L)
  • 1091-6490
DOI
10.1073/pnas.1313731110
PMC
PMC3831972
OpenAlex
W2051692047
Cited by
760
References
135
Citations by year
2026: 65 · 2025: 56 · 2024: 71 · 2023: 62 · 2022: 69 · 2021: 69 · 2020: 57 · 2019: 61 · 2018: 103 · 2017: 41 · 2016: 46 · 2015: 37 · 2014: 22
FWCI
4.15
Type
journal article
Language
en
Open access
Locations
  • Proceedings of the National Academy of Sciences (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
  • University College London
  • National Institutes of Health
Topics
  • Social Sciences › Urban Studies › Urban Green Space and Health
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords
immune regulation, biodiversity, ecosystem services, green spaces, old friends hypothesis, helminths, microbial exposure, inflammation, C-reactive protein, inflammatory cytokines, mental health, cardiovascular disease, green space design, biodiversity conservation
MeSH terms
Environment, Humans, Biodiversity, Adaptive Immunity, Hygiene Hypothesis, Microbiota

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