Growing evidence suggests that access and exposure to water bodies or blue spaces can provide a variety of health and well-being benefits. Attempts to quantify these 'blue-health' benefits have largely focused on coastal environments, with freshwater blue spaces receiving far less attention despite over 50% of the global population living within 3 km of a body of freshwater and populations living in landlocked areas having limited coastal access. This critical review identifies opportunities to improve our understanding of the relationship between freshwater blue space and health and well-being and outlines key recommendations to broaden the portfolio of emerging research needs associated with the field of blue-health. Recognising fundamental distinctions in relationships between health outcomes and access and exposure to freshwater versus coastal blue space is critical and further research is required to determine the mechanisms that link exposure to freshwater blue space with tangible health outcomes and to understand how such mechanisms vary across a range of freshwater environments. Furthermore, methodological improvements are necessary as spatial approaches adopted to quantify access and exposure to freshwater blue space often fail to account for the unique physical characteristics of freshwater and come with a variety of limitations. Based on the findings of this review, a suite of research needs are proposed, which can be categorised into three broad themes: (i) establishing a freshwater blue-health methodological framework; (ii) advancing the empirical freshwater blue-health evidence base; and (iii) promoting freshwater blue-health opportunities. When taken together, these research themes offer opportunities to advance current understanding and better integrate freshwater blue space into the wider nature-health research agenda.
Keywords: Blue-health; Green space; Health-promotion; Nature exposure; Public health.
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