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Evidence for Green Social Prescribing and Nature Based Health Interventions

The health and social benefits of exposure to green spaces are accepted globally, but are not easily accessible for everybody.

We know that people who could most benefit from increasing their time in nature are less likely to have the opportunity to do so.

The key evidence for NBHIs includes the following.

1)  Reduced risk of physical ill health. Evidence shows improvement in many common physical health factors[20]:    

  • Reducing heart rate

  • Reducing cholesterol

  • Reducing blood pressure

  • Improving ability to fight off common diseases (improved immune systems)

  • Reducing obesity

2)  Reduced risk of mental ill-health[7]. This includes improvements in a range of problems such as:

  • Depression and anxiety

  • Better mood and better sleep

  • General wellbeing

3)  Reduced feelings of loneliness and connectedness[2]

We know that people living in more deprived areas are likely to benefit more than affluent people from nature-based health interventions and that green social prescribing might help to mitigate health equity[22].

Evidence to support nature-based activities in Lothian and Scotland

An evaluation of green health partnerships in Scotland can be found here. Although the partnerships were established just before the COVID-19   pandemic, they achieved their aims of developing more than 550 green health opportunities, holding 440 capacity building activities and facilitating 63 referral pathways.

A summary of the evaluation resulted in 6 recommendations focused on improving the acceptance and effectiveness of GSP. The recommendations can be found here. 

Another pilot study in Edinburgh involving five GP practices was conducted between September 2020 and June 2021 during the COVID-19 pandemic.  The team of GPs and other health practitioners were highly supportive of GSP.

“Nature Prescriptions is an effective, low-cost health intervention that has no negative side-effects, is able to support a range of physical and mental health conditions and is entirely complimentary to traditional medicative treatments as well as social prescribing approaches” (Bradley, 2022).

Other practitioners in Midlothian carried out a pilot project during the COVID-19 pandemic and found they had a big impact on the health of people who took part.  People reported feeling less isolated, improved confidence and better sleep (Robertson, 2022).  Since then, a link to GSP has been launched on MidSpace (an online source of information for mental health and well-being) that provides referral information and locally available activities. 

Pilot Project

How do NBHIs improve health outcomes?

Like other complex health care treatments there is often no simple answer to how it works, for whom and in which circumstances. The components of any NBHI may interact in many ways.  For instance, being in nature has been linked to the following outcomes.

  • Being more physically active

  • Feeling of escape and getting away

  • Having space to reflect

  • Improved confidence in ability and empowerment

  • Having a purpose to do something

  • Sharing social experiences

  • Reconnecting with childhood memories of being in nature[15]

The exact reason for improvement in health are difficult to fully explain but some of the pathways have been investigated.  For instance, a map of the possible pathways for the benefits of mental health linking activities, mechanisms and resulting health benefits can be found here. (new tab)