A universal standard for health-promoting places. Example of assessment – on the basis of a case study of Rahway River Park

The purpose of this paper is to contribute to development of approaches to the evaluation of the design of public open green spaces (POS). This paper presents a universal standard for the design of health-promoting urban places. The standard is a conceptual framework which was developed after visiting over one hundred public parks and therapeutic gardens in Europe and the United States. The universal standard is a simple and effective tool that can be used by both professional designers and non-professionals to improve the health-promoting qualities of open green spaces. Rahway River Park, designed by Olmsted Brothers in 1925, serves as a case study.


Introduction
The COVID-19 crisis highlighted human need to engage in open green spaces in cities. Current pressures due to urbanization have impacted the health and well-being of many people. Scientists confirm that everyday contact with nature is crucial for mental and physical health [1], [2]. Public parks can become places for mental and physical regeneration, physical activity, and social contacts. Green public spaces can act as therapeutic landscapes. Numerous researchers from various fields, e.g., environmental psychology, medicine, sociology, architecture, landscape design, and urban planning, have already described the main qualities of therapeutic landscapes [1], [2]. However, application of scientific approach is still needed [3]. The purpose of this study was to contribute to the development of methods of the evaluation of the design of public open green spaces (POS), particularly concerning therapeutic qualities of landscape for the promotion of the health of their users. The identified gap in knowledge results from the fact that existing quality assessment tools measure the physical activity infrastructure and sustainable solutions, while the therapeutic qualities of public open green spaces are rarely measured. This universal standard could be used to evaluate public open green spaces (POS), encompassing practical implications of design recommendations and the justification of specific choices to facilitate the promotion of public health. It was developed after performing scoping literature review and on-site observation of over a 100 of POS in various countries (France, Poland, Sweden, and the USA). Gesler (1996) defined therapeutic landscapes as places where "physical and built environments, social conditions and human perceptions combine to produce an atmosphere which is conducive to healing [4]." However, individual perceptions of therapeutic landscapes may vary. Erwin Zube (1987) noticed that experience, personal utility functions, and social and cultural contexts were involved in shaping perceptions and responses to landscapes [5]. The landscape is 'a product of the human mind, and of material circumstances' [6]. Spaces that are perceived as therapeutic by one person could be experienced as unsettling by another [7]. However, there are examples of places well-known for their enduring potential to promote healing, for example, Lourdes in France, St. Anne de Beaupre in Quebec, Canada, Epidaurus in Greece, and Bama village in China [8]- [11]. In practice, the term therapeutic landscapes usually refers to specific places of established salutogenic reputation. The term health-affirming landscapes is more extensive and refers to more common places that unite the qualities of therapeutic landscapes to influence people's physical, mental and spiritual healing [12].

Literature overview
Both health-promoting places and therapeutic landscapes have therapeutic attributes. Though therapeutic landscapes are places which have an established reputation as well-known places of healing, the spiritual and symbolic aspects giving them an additional advantage. Material aspects alone can create human-friendly public spaces, but social conditions are needed to create health-promoting places, while spiritual and symbolic aspects further define therapeutic landscapes (Fig. 1).

Healing contact with nature
Many researchers consider therapeutic landscapes as the presence of nature in the form of 'green' or 'blue' materialities [14]. Natural physical beauty is treated as a determinant of a salutogenic environment [15], [16]. Contact with nature can improve well-being and reduce stress level [17], [18]. Even watching nature can have a reassuring effect on patients before surgical operations and speeds up the post-surgery recovery [19]. Results of medical researches have shown that watching nature can stimulate significant physiological reactions within a few minutes, i.e. can cause changes in the electrical activity of the brain, blood pressure, heart, and the muscular system [19], p 91].
Therapeutic landscapes provide an opportunity to slow down and gain a sense of being present and attentive to the world [7]. Healing has been linked to the fact that people have opportunity to focus on something other than their current problems. Therefore, elements which engage attention, stimulate senses, and provoke interest are attributed to therapeutic landscapes [20]- [22]. The human mind needs an optimal level of complexity and thrives in a sensory-rich environment [17,[23][24]. An experience of overcoming controllable danger, i.e., climbing a mountain, or crossing a river, demands full focus and provides a feeling of accomplishment [22], [25].

Social bonds
The therapeutic properties of landscape depend on the social context of the place [4]. Even superficial social contacts can have a beneficial influence on human health [18], [26]- [30]. Green public spaces are conducive both to having strong relationship with the living environment, and to giving opportunities for social contacts [28]- [29], [31], [32]. Designers may have little impact on the social environment, but they can facilitate bringing people together. Jan Gehl has listed three categories of outdoor activities in the public areas: "necessary activities", "optional activities," and "social activities" (2011) [33]. "Necessary activities" are activities that the participants have no choice about, such as walking to school. "Optional activities" depend on the participants' desire to engage, such as going for a walk for pleasure. "Social activities" require engaging in contact with other people, such as children playing, friends talking, and passers-by briefly greeting each other. In a well-designed physical environment, the optional and social activities occur with high frequency. POS are places which can offer the possibility to restore mental health, as well as physical activity and social contacts.

Mental restoration
Salutogenic landscapes are often associated with places to rest in silence and solitude [19], [33]- [34]. Secluded gardens, which offer a sense of enclosure, have been mentioned in numerous researches over the years [20], [34], [35]. An interesting theoretical framework has been developed for the design of therapeutic gardens [36]. Many researchers have focused on the spiritual meaning of healing and the positive relationship between spiritual activity and health and well-being [14], [21], [37].

The importance of physical activity
Greenspace exposure is positively associated with moderate to vigorous physical activity and physical activity is directly linked to promotion of health and well-being [37]. A team of Japanese doctors led by Takehito Takano (2002) has already proven that a well-designed system of green areas encouraging walking is a factor which can directly affect the longevity of senior citizens [38]. According to Gibson's theory, affordances of an environment are what it offers to users (2014) [39]. Affordances are all the possible actions that may occur in a place, and the actions needed to be discoverable by the user. The promotion of health is one of the possible affordances of public open green spaces (POS) [41]. With careful design, healing affordances should be easily perceptible to users and public open green spaces would "tell people what to do with them", i.e., rest in silence and solitude, observe wildlife and other people's activities, engage in socializing with other people, play sports, etc. A recent study demonstrated the positive effect of a sensory garden on 'apparently well' people in the workplace [42].

Current frameworks for classifying parks
In this study, places are defined as public open green spaces (POS). POS are classified in the literature in many ways. The classification schemes are based on the size and distance to potential users, as well as their primary functions [42], [43].

Measure-oriented approaches to POS design
There are tools available for the assessment of a park users' physical activity levels, e.g., SoPARC, SoPLAY, or EARPS. These can be used to foster the quality and for improvement of the POS. However, they do not include the evaluation of restorative qualities. Thus, despite growing attention to this topic, there is a lack of specific tools that enable a structured analysis of therapeutic qualities of the POS.

Methods
This long-term study began in 2001 with the aim of systematizing the qualities of therapeutic landscapes. It was driven by the objective to develop a universal standard of health-promoting places which could be implemented in various cultural settings.
The study was carried out by the author on over a hundred (n=125) public open green spaces (POS) and private therapeutic gardens in Europe and the United States. The choice of the cities in this study resulted from personal experience. The list mostly includes cities where the author has lived, worked or studied. Therefore, it includes well-known parks in New York and Paris, as well as several parks in Poland. A full list of the parks and gardens is presented in Table 2. Public parks and therapeutic gardens visited during the field research. The POS were visited frequently, on multiple occasions, which allowed for repeated observations in different time frames to give a broader and deeper perspective on users' behaviour.
The aim was to visit and assess not only famous parks, but also less well-known places which have been referred to as favourite places of recreation by residents of the neighbourhoods. These human perceptions were treated as a social proof of the therapeutic qualities of a landscape.
This study has concentrated on determining what has worked well in the parks visited. The time spent in each of the public parks ranged from two to multiple hours. The length of stay usually depended on the size of a park and the number of its attributes. The data collection methods included study walks exploring the entire park territory, observation of users' activities and preferences, as well as unstructured interviews with park users.

Findings and analysis
During this study, a conceptual framework for a universal standard of health affirming places was developed in an iterative process. The first draft was gradually amended with new findings. The final draft of the standard is presented in Table 2. A universal standard for health-promoting urban places. The qualities were divided into five categories: 1. Sustainability, 2. Accessibility, 3. Amenities, 4. Design and 5. Placemaking. Those categories were used to organize the qualities of therapeutic landscapes in a legible manner.

Proposed methodology of assessment with the universal standard for health-promoting urban places
Each of the five categories includes sub-categories and individual attributes. The final draft of the universal standard of design for health-promoting places can be used for binary or detailed assessment. The binary assessment has only 2 categories (0;1): 0 -No, not observed. 1 -Yes, satisfactory. The maximum number of points for binary assessment are presented in Table 3. Maximum number of points for binary assessment. Simple manual calculation method was used to add the points. A customized Excel spreadsheet was used to verify the results.
The detailed assessment required a written explanation why the researcher thought that the attribute was present, satisfactory, and worthy granting a point. Proposed methodology for assessment of individual categories was provided in tables 4-8. Each of the tables provides the number of points possible to gain in each category for every individual feature as well as general description of requirements. For better clarity, the results of the assessment were grouped into five tables (Tables 4-8).
The standard consists of five categories.

Sustainability
This section is dedicated to assessments of the general characteristics of a local area (table 4). In the case of existing parks, most of these characteristics, e.g., place: area, location, surrounding urban patterns, are beyond the control of park designers. However, at the planning stage, decisions about the location of a park can be discussed. Design criteria should always be oriented on the location, its environmental characteristics, and landscape values.
Environmental characteristics (biodiversity, soil, water, and air quality) can significantly improve or undermine the therapeutic qualities of a location [46], [47].
This section includes all the aspects relating to the sustainable design of public parks: the protection of native fauna and flora and enabling the natural infiltration of rainwater and harvesting it for irrigation. Sustainable management of water and soil require special maintenance techniques and may limit the choice of plants, but it is beneficial for both our planet and people.

Accessibility
In the case of health-affirming urban places, the qualities of the entrances and pedestrian routes leading to the park are as important as the design of the park itself (table 5). This category could be called the 'walkability assessment' [47]. Universal accessibility, understood as addressing the needs of people with disabilities, is directly linked to the therapeutic potential of a park and the possibilities for the promotion of health.

Amenities
This section concerns sports and leisure equipment, as well as park facilities related to promoting physical and mental rejuvenation, encouragement of physical activities and moderate social contacts (table 6). A fourth category relates to the basic needs of park users, such as shelter, restrooms, drinking water, food, and places to sit and rest. It also includes properties that bring a sense of safety and security: the presence of guards, cleanliness, and maintenance.

Design
This section encompasses the distribution of functions within the park space and the organization of its grid of connections (table 7). It is important that the design of a park is comprehensible and the composition harmonious. Some attributes are important when it comes to engaging the interest of users, such as mystery, risk, and movement. A separate category is dedicated to multi-sensory stimuli and sensory paths.

Placemaking
The most important feature of a human-friendly landscape is a sense of safety and belonging of all users (table8). Public parks offer an ideal possibility for various kinds of social contacts for people from usually isolated and disadvantaged social groups (the elderly, disabled, etc.). Placemaking is related to the popularity of a park. Here, the attributes which relate to the promotion of moderate social contacts and human perceptions have been combined into one category.

Case study of Rahway River Park, NJ, USA
Rahway River Park in Union County, NJ, USA (Fig. 2) was chosen as a case study to demonstrate the way of using the universal standard. This park is well-documented in the history of landscape design and well-known internationally, as it was designed by the Olmsted brothers. Firstly, this place was recommended to the author by regular parkgoers who described it as a good place to disengage from the problems of everyday life. One of them described this experience: "After one hour spent in the park, the weariness of the daywork in front of the computer disappears. I come back home from this park with new energy." The research question was what makes this park a health-promoting place in terms of the architectural and landscape design? (Fig. 2-10).

Description
The park was created by the Union County (New Jersey) Parks Commission in 1921 as one of the neighbourhood parks in a county-wide continuous linear park system -Rahway River Parkway. It was designed by landscape architect Percival Gallagher, a partner at the Olmsted Brothers company. The park was created for the enjoyment and psychological health benefits it could provide for its users. This was the original idea of the park commissioners along with the landscape architects, and it represented a shift away from the City Beautiful Movement method of planning; to design more for people's health and well-being.

Assessment
The park was evaluated using the final draft of the universal standard of design for health-promoting places. Both a binary and a detailed assessment were performed. The binary assessment has only 2 categories (0;1): 0 -No, not observed 1 -Yes, satisfactory The binary assessment is reported under section points (Tables 9-13). The detailed assessment required a written explanation why the researcher thought that the attribute applies. The detailed observation required numerous visits to the park, studying the plans and maps of the park area, as well as scoping the literature evidence. For better clarity, the results of the assessment were grouped into five tables (Tables 9-13).
Rahway River Park was created to protect the natural scenic beauty of the area from development and possible destruction. One of the main early rules of Frederic Law Olmsted (1822-1903) was respect for scenery. This approach is still visible in the park.
The accessibility evaluation was carried out on one road -Parkway Drive -as it is the main access for pedestrians.
The beauty of the park is in the overlapping of nature and recreational activities within its boundaries. There are quiet places to sit and contemplate, observe wildlife or people from a distance. The park houses a variety of sport equipment and recreational amenities, including two circular loops frequented by joggers along with multiple sport fields. The park is cradled by the Rahway River, which serves as a backdrop and a natural buffer from the nearby houses to the north and west. The Rahway River Park forms part of a series of parkways along the Rahway River (Rahway River Parkway), (Fig. 3).
Surrounding urban pattern Suburban / urban tissue. Rahway River, Rahway River Cemetery, family houses 1. 2 Environmental characteristics 6/6 Soil quality Sufficient for recreational use.
No visible traces of pollution [49]. 1 Water quality Sub-optimal, according to the Water Quality Report [50]. 1

Air quality
Good, according to the Air Quality index (AQI) [51], good air circulation. The presence of the Rahway River influences the local microclimate. 1

Noise level
Moderate noise nuisance comes from traffic in Saint Georges Street adjacent to the park and slow traffic in Parkway Drive in the park itself.

1
Forms of natural protection County park, part of the Rahway River Parkway. 1

Green and Blue Infrastructure
It is an important part of the green and blue infrastructure. The park is a part of the Rahway River Parkway -a green belt of parkland along the banks of the Rahway River.   Flat, no significant slope, (Fig. 4).

Human scale
The entire neighbourhood respects human scale; park interiors are cosy thanks to design and tree canopy. (Fig. 7-8

Salutogenic design 4/5
Optimal level of complexity Yes, the park was designed to offer both legible composition and optimal level of complexity, (Fig. 7-8

Discussion
Nowadays, city residents need the contact with nature more than ever due to rapid urbanisation and shrinking areas of natural habitats. The results of numerous studies showed that regular visits to urban parks can stimulate the mental and physical regeneration, create social bonds, and facilitate physical activities.
Rahway River Park -built a hundred years ago to promote the health and well-being of Union County inhabitants -scored 86%, that is 79 out of a maximum 91 points. This result indicates that this is a health-promoting place. The universal standard method used in this research has helped to distinguish the material, social, spiritual & symbolic qualities of the park. Addressing the points that were missing, as observed by the author, might help to make the park more welcoming to people who are seeking a spiritual retreat, horticultural therapy sessions, sensory paths, etc.
There are limitations to this Universal Standard, because it is tainted by the subjectivity of perception. For example, section 4. -Design -includes points that require a more subjective assessment. The simplified scale does not allow for the evaluation of the quality and intensity of a given attribute. To mitigate this drawback, the binary assessment used here (0, 1) could be replaced with numerical grades (e.g. 0-10 or 0-100%), which would allow for more precise assessment of given attributes. In the case of more detailed assessments, the problem of subjectivity may be slightly mitigated with more comprehensive descriptions of the assessed attributes.
Previous work addressed the physical activity infrastructure and sustainable solutions assessment, but it did not provide the methods for measurement of therapeutic qualities of POS. This universal standard could be used to evaluate and justify the design choices of public open green spaces (POS). It was developed after scoping literature review and on site observation of over a 100 of POS in various countries in Europe and the USA.
The main identified limitation in its use stems directly from the subjectivity of perception during assessment. While many therapeutic attributes can be assessed objectively, some are more subjective due to the fact that perception of therapeutic landscapes may vary. Therefore, this universal model should not be used as a tool for statistical comparison of therapeutic values of different parks, but rather as an assessment tool. The subjectivity of assessments could be mitigated by providing more detailed descriptions of specific attributes or assessments by a team of researchers.

Conclusions
This paper presents a universal standard for health-promoting places. It was developed using an iterative process, after a long-term study of over a hundred public parks and therapeutic gardens located in Europe and the USA. The case study of Rahway River Park demonstrates that the proposed standard can be successfully used to identify the health-promoting qualities of an open green space and to find the areas for improvement.
The universal standard presents a significant advancement in the field of research of urban design and landscape architecture, because it merges an evidence-informed approach with systematic field study. This universal standard is a valuable tool based on research evidence (EBD) and post occupancy evaluation (POE). It could be used to facilitate decision making, justify choices, and incorporate research evidence into urban planning. It could also help in the design of therapeutic POS, as well as support other strategies for urban regeneration.
This universal model should be developed further, for example by including new attributes or determining which of the attributes should become mandatory prerequisites. COVID-19 by forcing social distancing and lockdowns emphasized the need for open urban green spaces. Remote work from home, unemployment, and health insecurity can increase stress level. Open green spaces should provide the opportunity for mental and physical restoration, physical activities, and allow for at least a bit of social contact. Public parks have become a refuge during the time when many sports and recreational facilities were closed. The criteria 2.1 Accessibility, Distance to a park and a question: Is it possible to walk to a park? proved to be the most important during the confinement when it was not possible to use public transport.
As the research was conducted in only a few regions of the Northern Hemisphere, further studies in the wider community may be required, as well as further validation, discussion, and development, in order for it to become a truly universal tool.
Funding: This research received no external funding.

Conflicts of Interest:
The authors declare no conflict of interest.