By Dr Sian de Bell & Julius Cesar Alejandre

31 March 2023 - 13:05

A young woman and a young man cycle along a tree lined path in a park on a sunny day.
Nature has been shown to have benefits for both physical and mental health and wellbeing.  ©

British Council

Dr Sian de Bell, Research Fellow at University of Exeter and Julius Cesar Alejandre, Doctoral Researcher at Glasgow Caledonian University talk about how nature prescribing can help keep us well and connect us to our natural environment.

According to the United Nations, most of the world’s population now lives in urban environments. For city dwellers exposure to poor air quality and noise pollution is common, and there is little chance to connect with nature. At the same time, rates of mental illnesses including anxiety and depression are rising worldwide, along with noncommunicable diseases such as obesity, cancer, and Type 2 diabetes. 

Nature has been shown to have benefits for both physical and mental health and wellbeing. This can happen through direct exposure to nature, by using a natural space for running, walking, or other activities. Benefits also occur from exposure that might not be as obvious, whether being able to see trees from a window or cycling along a towpath near a river on the way to work. Feeling connected to nature has even been linked to acting in environment-friendly ways, including recycling and supporting measures to address the climate emergency such as nature conservation.

The links between nature and health are increasingly considered when thinking about how to tackle social problems – from climate change to public health. This includes motivating people to have a relationship with the natural environment, providing and maintaining natural spaces where they live, and creating opportunities for people to benefit from nature. One area now being considered is how and whether nature could be used to improve health and treat health conditions.

Using nature to improve health and wellbeing

Social prescribing is one way of using the health benefits of nature. Healthcare professionals, such as doctors, might refer a patient to a community-based activity to improve their health and wellbeing. This could be taking part in arts-based activities or physical exercise. With increasing evidence that nature can benefit human health and well-being, many social prescribing schemes involve nature-based activities such as gardening, walking, surfing, open-water swimming, or nature conservation. For example, Branching Out is an outdoor programme led by Scottish Forestry for adults with mental health problems in Scotland. It provides a range of activities in woodland areas. These include physical activities, (such as health walks and tai chi); conservation activities (including rhododendron clearance and bird box construction); bushcraft (for example, fire lighting or shelter building), and environmental art (such as photography and willow sculptures).

Research into nature-based social prescribing activities has found that participants experience both physical and mental health benefits. Several reasons have been suggested to explain why these benefits occur. Some are to do with the effects of physical activity on the body or how activities such as nature conservation make people feel about themselves. Working on a conservation project could give a participant a sense of fulfilment through making a difference by caring for nature. The key to the success of nature-based social prescribing is the participants’ relationship with and experience of nature. The social aspect of these activities is important too, with reductions in social isolation and loneliness among participants. In England, the Wildfowl & Wetlands Trust runs the Blue Prescribing Project in partnership with The Mental Health Foundation. The project provides opportunities for people with poor mental health in Somerset and London to connect with nature in wetland environments. This has led to health and wellbeing benefits for participants, with every £1 invested in the Blue Prescribing Project found to yield £9.30 of ‘social value’.

The future of nature social prescribing

An important step in the social prescribing pathway is that of the link worker. Patients can be signposted to activities by their doctor or refer themselves directly, but for many, link workers help them find the right type of socially prescribed activities. In the UK, link workers are usually based in the community, where they work with patients to match them with an organisation and activity that is compatible with their needs and preferences. The conversations link workers have with patients can be important in helping them overcome reservations and they may perform other vital roles such as being a ‘buddy’ the first time someone tries out an activity. To help more people access social prescribing, NHS England is aiming to employ 1000 social prescribing link workers by 2024.

The UK Government has also expanded nature-based social prescribing programmes in England through NHS England, Sports England, and the National Academy for Social Prescribing. A similar investment has been made by the Scottish Government in Green Health Partnerships with NatureScot, Scottish Forestry, Public Health Scotland, the NHS, and other national partners in Lanarkshire, Ayrshire, Dundee, and the Highlands. With the aim to expand the partnership to other regions in Scotland, these programmes will be evaluated to give more information on what works for different types of patients, and why, to support the design of new nature-based social prescribing activities. 

The UK is currently leading the development of nature-based social prescribing, but there is increasing global interest with programmes being implemented in different countries, including the USA, Canada, Portugal, and Japan. However, nature-based social prescribing needs to be adapted so that it can work in different settings. This might involve finding sources of funding and forming partnerships with community-based and third sector organisations that could provide activities, as well as working with training providers to support the people who will deliver activities.

In the UK, a unique process to refer patients, involving the link workers mentioned above, has been developed but this might not work everywhere. There are some examples of projects using the health benefits of nature in Germany, such as Forest Bathing initiatives, which aim to support people’s wellbeing through mindful experiences in forests. These could be adapted to provide nature-based social prescribing in Germany, but it would be essential to work with health insurance companies to develop coverage for these activities. 

Overall, nature-based social prescribing schemes support public health, promote connection with natural environments, and could aid the development of pro-environmental behaviours. Their importance is increasingly recognised, and the growing number of these schemes will have benefits for both our health and our environment.

 The authors recently organised a workshop on Nature-Based Social Prescribing held in the British Embassy in Berlin, which was funded by British Council Germany and supported by the German Centre for Integrative Biodiversity Research and the University of Surrey.

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