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. 2019 Nov 12;10:5005. doi: 10.1038/s41467-019-12631-6

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Flowchart of calculation pathways for health services value of protected areas. Seven-block flowchart of calculation pathways for health services value of protected areas, showing three major pathways. History, frequency, and intensity of protected-area visitation (block 1) affects mental health and quality of life of park visitors (block 3), but these are also affected by demographic and socioeconomic factors, physical health factors, and non-park greenspace use (block 2), which must therefore be controlled for. Costs (block 4) can be linked to mental health either via quality-adjusted life years (yellow boxes), individual cost components (black lines), or direct correlation with park visit patterns (red lines). Cost reductions (block 6) also depend on national healthcare funding systems (block 5). The health services value of protected areas (block 7) is the net reduction in aggregate costs of poor mental health, derived from visitation to protected areas. The three pilot studies presented here use the $/QALY pathway, shown in yellow boxes, with three different measures of park use (block 1)