It is well known that the natural environment plays a positive role in people's health and wellbeing. In the UK there are major opportunities to ensure the environment plays a greater role in preventing and treating ill health, as well as promoting wellness. Further action will deliver benefits for people, for organisations responsible for health and for local economies.

This page is an ideal starting point for those wishing to explore this topic, whether they work within the core parts of the health system or beyond.

In partnership with the Centre for Sustainable Healthcare, Ecosystems Knowledge Network has run a series of local workshops to help initiate effective partnerships between organisations in the health sector and those who look after natural outdoor spaces. If you would like to arrange one in your area please contact us.

Starting points

• In 2018, University of Exeter Medical School adnd Defra published a detailed review of evidence, policy, practice and opportunities for the future in linking health and environment.
• The Institute for European Environmental Policy and Friends of the Earth Europe have published a summary of evidence relating to nature and health inequalities. 
• The Wildlife Trusts have published a summary of the literature on the wellbeing benefits from natural environments rich in Wildlife, prepared by the Green Exercise Research Team at the University of Essex.
• A Scottish Natural Heritage webpage outlines the contribution of natural heritage to people's health in Scotland, with links to evidence and practical projects and schemes.

Examples of local collaborations and partnerships

• The £0.5 million Connecting Actively to Nature programme in Devon and Torbay will help over 3,000 inactive people to discover the combined benefits of a more active lifestyle with the psychological benefits that being outdoors in nature brings. The project is part of the work of Devon Nature Partnership and using National Lottery funding from Sport England.
• The Mersey Forest has developed the Natural Health Service, operating in various locations in the Mersey area. It offers health commissioners a single point of access to a range of well-developed and evidence based natural environment focused products to help tackle a range of health and wellbeing issues. It is currently running three year Nature 4 Health programme. 
• Scotland's Green Exercise Partnership webpage contains links to a range of projects that prevent and treat health conditions. A briefing note published in August 2015 provides an overview of progress.

• Part of the Dorset Local Nature Partnership's Natural Choices programme, The Natural Health Service for Weymouth and Portland (England) project was a GP-led programme of activities in the natural environment to everyone in the Weymouth and Portland area with low risk mental health or low risk physical health issues. The Dorset Coast Forum led this work in partnership with charities (including the RSPB), GPs and public bodies. Funding was provided by the Dorset Clinical Commissioning Group, Dorset County Council, RSPB and the Olympic Legacy Fund.

• Exmoor National Park has commenced a 'Moor to Enjoy Project' with the Health and Wellbeing Boards of Devon and Somerset. 
• Branching Out is a national scheme run by Forestry Commission Scotland in association with NHS Boards in Scotland. It is designed to assist users of mental health services. The results of independent formal evaluations are available, along with a resource guide to help others set up similar schemes (follow the weblink above and see sections towards the bottom of the web page).
• Natural England funded eight pilots within a green exercise programme between 2008 and 2011. An evaluation report is available.
• The Wildlife Trusts throughout the UK have projects focused on health and the natural outdoors. Some of these are in collaboration with healthcare organisations.

The evidence base

Economics of the positive links between environment and health

• In 2005, a scoping study report for the Forestry Commission on the Economic benefits of accessible green spaces for physical and mental health was published.
• The impact of the Connswater Community Greenway Project in East Belfast on physical activity has been evaluated by researchers at Queens University Belfast. This includes estimates of the value of savings due to reductions in the occurrence of chronic diseases.
• The European Observatory on Health Systems and Policies has evaluated the economics evidence base for health promotion and disease prevention. While not addressing the specific question of improved access to the natural outdoors, it summarises the challenge of making an economic case for prevantative healthcare.

Introductions to evidence and good practice

General summaries

• Natural England has published a wide range of research reports on health and the natural environment. These include helping those with specific conditions (e.g. dementia) as well as measures to improve health at the level of whole communities. 
• The Landscape Institute has produced a position statement, Public health and landscape: creating healthy places, which sets out five principles of healthy places as well as introducing the evidence base on the topic.
• The Town and Country Planning Association and Public Health England have produced Planning healthier places; a report that provides an overview of how local authorities and their partners are putting this agenda into practice.
• The Natural solutions for tackling health inequalities report describes the evidence for the benefits of 'green spaces' to health and wellbeing outcomes. It includes a Forward by the Chief Executive of Public Health England.
• The Forestry Commission was a partner in the Active England Programme to increase community participation in sport and physical activity across England. The five Active England projects focused on increasing activity levels in woodlands and greenspace have been subject to an evaluation.

Specific health issues

• Natural England's report, Greening Dementia, on the barriers and benefits facing dementia sufferers in accessing the natural environment. The report shows how access to local greenspace can have a positive effect on sufferers’ quality of life.
• Natural England published a review of nature-based interventions for mental health care was published in February 2016.
• MIND, a charity championing mental health, has produced guidance on ecotherapy.
• In July 2016, Natural England published a series of evidence briefings relating to the links between health and the environment. See the briefings on mental health, obesity, physiological health and physical activity.

Green prescriptions and social prescribing

• The natural environment can play an important part in social prescribing - connecting patients with non-medical sources of support within the community. In January 2017, Natural England published Good practice in social prescribing for mental health: The role of nature-based interventions. 
• The Centre for Sustainable Healthcare has produced a simple two page infographic summarising the logic and evidence for making use of the natural outdoors for improving people's health. See Prescribing Green Space - is it important? It is written for GPs but is useful for all healthcare professionals and others.

Responding to public health objectives

• The UK Department of Health provides an interactive online tool to share the first set of baseline data for 39 of the 66 Public Health Outcomes Framework indicators for England. Data from the Monitor of Engagement in the Natural Environment is complemented by other evidence on the benefits of the natural environment for health, which can help support the production of Joint Strategic Needs Assessments and Health and Wellbeing Strategies.
• The public health outcomes framework for England (2016 - 2019) sets out desired outcomes for public health and how these will be measured. It includes Indicator 1.16 ‘Utilisation of green space for exercise/health reasons’.

Resources for particular environmental settings

Woodlands

• Forest Research has produced Trees and Woodlands: Nature’s Health Service, a guide to information and evidence in support of the idea that the use and enjoyment of woodlands and green spaces improves people’s health and well-being. It is designed for both for public health professionals and environmental professionals throughout the UK. Forest Research has also produced reviews of Peri urban woods and people's health and well-being and Urban health and health inequalities and the role of urban forestry. A briefing note (2014) set's out a role for the Public Forest Estate in England for reducing physical inactivity.

The rural environment

• The Institute of Rural Health has produced a review of evidence relating to health, wellbeing and the natural environment. This was undertaken for the Countryside Council for Wales (now Natural Resources Wales). While focused on the Welsh context, the report contains guidance that is applicable elsewhere. It gives suggestions for how health and well-being is incorporated into the work of organisations with a traditionally ‘environmental’ remit.

Urban greenspace

• The report Policies to improve the UK’s urban green spaces, produced by Policy Exchange in 2014, suggests a wide range of proposals to improve local green spaces, including the creation of Park Improvement Districts and a social prescribing audit (where GPs refer patients to non-clinical sources to support mental and physical health).
• In 2014, The Royal Institute of British Architects has produced a report that highlights the importance of design of urban areas, including investment in green infrastructure, in improving people's health.

Around healthcare facilities

• The NHS Forest is a UK-wide project coordinated by the Centre for Sustainable Healthcare. Among the project’s central aims are to improve the health of staff, patients and communities through increasing access to green space on or near to National Health Service land. 
• The Forestry Commission has produced a guide on the design of outdoor spaces around healthcare facilities.

Analytical tools

• The US Environmental Protection Agency has produced the EnviroAtlas Eco-Health Relationship Browser to demonstrate the links between ecosystems, the services they provide, and how those services may affect people.
• WHO/Europe’s Health Economic Assessment Tool (HEAT) for walking and cycling is an online resource to estimate the economic savings resulting from reductions in mortality as a consequence of regular cycling and/or walking. It enables users to estimate the value to health of new infrastructure, policies or programmes.

Forums and networks

• The Green Excercise Partnership in Scotland links together the work of various public bodies, including the NHS.
• Natural England convenes a National Outdoors for All Working Group serving England.
• The Beyond Greenspace website serves as a forum for discussion of health and the outdoors.