Integration of cross-sectoral preventive measures into health policy.

A key example of effective cross-sectoral integration is Scotland’s Natural Health Service programme [33]. The programme involves the collaborative development of action plans with partners across various sectors to achieve two main objectives: increase public awareness of the use and benefits of green health as part of daily life and integrate nature-based health promotion initiatives and structured interventions into routine health and social care policy and practice.

The success of this approach has been illustrated by the four pilot Green Health Partnerships which have shown how improving cross-sectoral collaboration can enable greater use of local green space as a health-promoting resource [34]. In its three-year evaluation, the Green Health Partnerships reported that 548 opportunities for green health activities. A total of 445 awareness-raising and capacity building activities were delivered to health, social care and green health delivery staff, engaging 19,637 individuals, In addition, 63 referral pathways were established by which green activities can be prescribed or recommended, 300 public information and promotion activities were delivered, and the Green Health Partnerships were referenced in 58 local policies and plans. For example, the Green Exercise Partnership established the NHS Greenspace Demonstration Project to show how improvement to NHS outdoor spaces—which comprise over half of NHS Scotland’s estate—could be delivered in practice, while assessing the benefits of this investment for health and wellbeing, biodiversity, and climate change [35]. The programme demonstrates that the mental health benefits of nature can be maximised through collaboration across sectors and integrated planning from the outset recognising the interdependence of human health, social systems, and natural environments.

Urban greening and rewilding.

Urban settings require particular attention for preventive measures, as they often struggle with declining biodiversity and higher temperatures due to the urban heat island effect. These challenges are often compounded by an extractive mindset towards nature and biodiversity, which treats the natural environment primarily as a resource to be exploited rather than a system to be protected and restored. Such perspectives can undervalue the broader health, social, and environmental benefits of biodiversity and urban greenspaces. Addressing these challenges requires approaches that recognise the interconnectedness of human wellbeing and ecological systems.

The protection of green spaces should be prioritised to encourage regular interaction with nature among local communities, mitigate extreme heat and air pollution impacts, increase community level food security, and protect biodiversity [36]. Green infrastructure programmes, including London’s Rewilding, Nature Recovery, and Evidence programmes (which is restoring or creating 116 hectares of habitat for wildlife across 22 projects [37], should be designed to interlink responses to the climate and ecological emergencies with tackling disparities in living environments and health outcomes. In practice, this could involve initiatives, e.g., transforming unused land in urban centres into spaces for biodiversity, social connection, and food production. A study by Stanford University’s Natural Capital Project explored how urban farms and food forests in San Antonio, Texas—a city of 1.5 million residents—could transform underutilised land into social and ecological hubs [38]. Their findings suggest such projects in that city alone could provide enough food annually to feed nearly 314,000 households, along with $3.5 million in urban cooling benefits.

The advantages of such initiatives extend beyond food. Food forests can improve community health by increasing biodiversity, expanding access to fresh produce, increasing accessible green space, and providing opportunities for exercise and social connection. They also capture carbon, manage stormwater to reduce flooding, and provide natural cooling. Taken together, these initiatives show how urban greening can be effective to building healthier, resilient cities.

Importantly, development alone of biodiverse green spaces is insufficient to reap health benefits; the benefits from urban green spaces—particularly in new or underserved neighbourhoods—are maximised when the local community engage with these spaces through community-led events [39]. To enable this, barriers to engagement (e.g., safety concerns) and misconceptions (e.g., large green spaces are more beneficial) need to be sensitively tackled with local communities. The Future Parks Accelerator [40], a 3-year programme to support local authorities in improving their green urban spaces, highlighted how nine local authorities addressed these barriers. Among the approaches taken were Camden and Islington’s consultations with voluntary sector partners to understand the needs of underserved communities, Edinburgh’s participatory workshops with residents to determine which projects to run in local green spaces, and Plymouth’s social enterprise approach to support local businesses to start up and grow in green spaces. Potentially benefitting up to five million residents, evidence generated through these initiatives enabled local authorities to secure a combined £43 million in further investment for parks and greenspaces. Other impacts of the Future Park Accelerator programme includes demonstrating the role of urban green spaces as essential public infrastructure, strengthening the evidence base on the social, environmental, and health value of urban green spaces, developing practical guidance and recommendations to improve their accessibility and uptake and positioning green space at the heart of community life [41].

The social implications of urban greening and rewilding should also be considered [42]. Of particular concern is green gentrification, in which environmental improvements to an area can price out vulnerable residents. Urban greening and rewilding programmes should therefore be carried out in consultation with residents; for example, in several US cities, redevelopments are scrutinised by design review boards that include community members and external pro-bono specialists, to ensure that changes to the neighbourhood will benefit existing residents [43]. The Right To Grow movement [44], which requires local authorities to enable community creation of gardens for food and nature on public land, is an example of how local greening can directly serve local residents, with decisions on how the land is used placed in their hands. Additionally, urban greening and rewilding programmes should be developed alongside improved housing policies that provide existing residents with security—for example, community land trusts and cooperative housing models can and have been used to secure housing for community members in areas undergoing greening [43], thus ensuring social and ecological wellbeing. There is a need to make greater use of routinely collected longitudinal data to evaluate the impacts of urban greening and rewilding schemes. Scenario based modelling studies should be conducted to assess the potential impact of urban rewilding programs on local communities and to ensure that such schemes benefit existing residents. Future research should examine the impact of environmental improvements on local demographics, housing affordability, and housing security, generating the evidence needed to inform policies that protect communities from displacement and ensure that the benefits of urban rewilding are shared equitably [45].

Bringing nature to young people.

Children and young people, whose futures are impacted by the changing climate, shoulder an increasing mental health burden. A new approach is urgently needed, not just to treat poor mental health in this group, but to prevent problems from ever developing. The young people’s mental health crisis is complex, and effective prevention will require a multi-pronged approach, that addresses factors, such as inequality and deprivation, education, parental and family support, health and social care, access to activities and play, and opportunities for learning, development and growth alongside environmental quality and access to nature. Due to societal shifts towards urbanisation and digital technologies, children are increasingly disconnected from nature, with implications for their physical and mental health [46]. Reconnecting children and young people with the natural world has the benefit of improving their health while fostering environmental awareness. The Our Bright Future program [47], led by The Wildlife Trusts, took a cross-sector approach to this challenge, aiming to engage young people in the environment. More than 128,000 young people participated in the programme, which improved 3000 community spaces and created 350 nature-rich areas. Crucially, 86% of participants reported that taking part had improved their mental health, while 95% reported increased confidence.

However, programmes to bridge the gap between children and nature must consider inequity in green space access, with differences seen by socioeconomic status and ethnicity [48]. Integrating, nature-based activities within educational activities, while simultaneously improving the green spaces near schools, can ensure access to the natural world for children. School-based programmes, like the Children and Nature Programme [49], showcase the work that can be done between the education and environmental sectors to protect biodiversity and improve outcomes. Funding access to growing and cooking programmes like the Hackney School of Food [50] can further build upon this work by giving hands-on experience of food cultivation and land stewardship. The aims of such initiatives stretch beyond supporting mental health and wellbeing, improving school attendance, behaviour, physical health, and care and concern for the environment.

Embedding nature in health education.

There has been recent activity on bringing principles of sustainable healthcare into all medical school curricula [51]. In addition, some Royal Colleges have introduced sustainability criteria into their postgraduate curricula and developed networks for practising doctors to support their nature-based practice [52]. However, medical education on planetary health and its connection to human health varies across UK medical schools, with huge disparities in depth of coverage across institutions and training programmes [53]. The students of today are the healthcare leaders of tomorrow. The international student-led initiative The Planetary Health Report Card [54], which evaluates and improves planetary health content in health-professional schools, is a powerful illustration of the momentum and change these future leaders can inspire. Embedding the principles of environmental sustainability and biodiversity protection in all health education pathways, with central guidance and mandated learning outcomes [53], is a key step in ensuring joined-up, long-term thinking within healthcare about our natural environment and the health benefits it can bring. These curricula should be strongly evidence-based, regularly updated in line with the rapid pace of scientific developments in this field, and periodically evaluated to assess their impact on clinical practice. Indeed, developing sustainable and nature-focused leadership within the healthcare system is particularly important [55] while green initiatives—e.g., NHS Forest [56], which strives to improve healthcare green spaces and biodiversity—remain elective rather than mandated.

Grassroots initiatives.

Grassroot, community-led initiatives such as rewilding of local areas and rivers can have positive effects on the landscape and empower individuals to become active land caretakers, providing social and health co-benefits. Funding for such initiatives largely comes from charities, like Rewilding Britain. Non-profit organisations and wildlife trusts run projects to encourage connection to nature among young people, disadvantaged communities, and mental health service users, among others. Growing Communities, a non-profit organisation that aims to feed urban communities in a fair and sustainable way, shows the impact community-led initiatives can have. Among their projects is Dagenham Farm, the transformation of an ex-council nursery into a growing and learning site [57,58], which is now a self-sufficient organic farm. The farm has hosted various outreach projects, e.g., Grown in Dagenham [58], which taught hundreds of residents how to grow and cook food and offered specific sessions for residents with mental health issues. Such projects and organisations should be encouraged, empowering communities to care for their environments and themselves.

Increasing public awareness of nature’s mental health benefits.

While many people view nature as important in their lives, there is limited public understanding of the mechanisms through which it supports mental health. Nature exposure can mitigate physiological stress, support cognitive development [59], reduce loneliness [60], anxiety, and depression [61], reduce air pollution and extreme heat and support a healthy gut microbiota [62]. Yet these multiple benefits are not well understood by many. A campaign to help people recognise these benefits within their everyday lives could have significant public health impact, especially at a time of rapid urbanisation and digitisation which are reducing opportunities for direct contact with nature and, amplifying our disconnection from it. This phenomenon has been described as the ‘extinction of experience’, referring to the progressive loss of everyday interactions with the natural world [63].

Green social prescribing.

Green social prescribing is a way that the NHS already integrates the health of the population with the natural environment outside of the hospital setting. These programmes encourage participation in nature-based interventions, e.g., walking schemes and community gardening projects. The practice can support mental and physical health, promote social inclusion, protect biodiversity through conservation projects and habitat creation.

However, the green social prescribing programme faces various issues [64], including bottlenecks in clinical pathways, inconsistent referral mechanisms, a reliance on short-term funding, and delivery at local level but difficulty embedding it across the healthcare system as a whole. A fragmented and continually shifting provider landscape can create problems for primary-care clinicians attempting to find suitable programmes for their patients, while secondary-care practitioners may not have the same access to established referral routes [65,66]. Green activity providers are often reliant on short-term competitive funding arrangements, disrupting long-term planning and continuity of care, and creating a challenge for healthcare professionals to stay on top of what’s currently available [66]. Social prescribing providers, often based in the voluntary sector, can also lack the training and expertise for managing individuals with complex physical or mental health needs [66].

A holistic and collaborative approach is needed to improve the implementation of green social prescribing. Greater awareness of the practice needs to be built among clinicians [65], with appropriate investment and support provided for practical issues such as identifying providers and referring patients. To support providers and expand provision to existing community gardens, meaningful incentives such as long-term funding and training opportunities should be secured; such steps would improve continuity of access and avoid loss of institutional knowledge. Improved training to support service users with complex needs and increasing the diversity of activities available would improve the inclusivity of the service. Barriers (operational or implementation) to participation need to be removed, by improving transport offerings, expanding to existing community gardens, and developing suitable green spaces in areas which are lacking. Green prescribing policies must successfully be monitored evaluated and implemented to determine whether have achieved their desired outcomes and whether resources were used effectively [65]. The establishment of clear evidence-based protocols would help ensure that green social prescribing interventions are delivered consistently, evaluated rigorously, and scaled effectively across different socioeconomic contexts. Another challenge is the limited awareness and understanding of the benefits of green social prescribing [65]. Addressing this gap requires systematic evaluation of intervention effectiveness using patient-reported outcome measures and standardised assessment tools, such as the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and the Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS). These measures would enable more robust assessment of outcomes and generate empirical evidence on the effectiveness of green social prescribing. Such evidence would support more efficient resource allocation, strengthen the case for integration into clinical practice, and inform future policy development.

Implementation science frameworks, outcomes and study designs are essential to understand multilevel barriers, design strategies to overcome those barriers, and analyse the ability of those strategies to advance the uptake and scale-up at the local, national and international arenas [67–69].

Rewarding people for interactions with nature.

The 10 Year Health Plan outlines the creation of a digital health reward scheme, which will reward participants for taking positive actions to improve their health. When developing this scheme, engagement with nature should be incorporated as a positive action participants can take to improve their mental and physical health. The BetterPoints scheme [71], used by several local councils across the UK, encourages green and healthy behaviours by rewarding app users for physical activity and active travel. BetterPoints users are rewarded for time spent doing physical activity, recorded through phone apps and wearables, with points that are exchangeable for vouchers. While focusing mainly on exercise and carbon reduction from active travel, the scheme can be personalised to include specific programmes, e.g., the Love Your Park programme in Ealing [58]. This programme rewarded residents for taking part in park-based community events. Digital incentives could similarly encourage exploration and use of local green spaces, linking to community-led events and reaping the health benefits.

Incorporating nature into the NHS app.

The NHS app is expected to undergo significant development within the 10 Year Health Plan, converting it to a “full front door to the entire NHS” and giving patients greater control over their health [2]. Key improvement outlined includes tools to advice and signpost patients for non-urgent care; self-referrals; and links to support services, e.g., social enterprises and community groups. The app creates opportunity to bring together several suggestions outlined in this paper. To build public awareness, the benefits of nature exposure could be incorporated into advice given by the app for non-urgent mental health self-care, along with personalised information on local nature-rich environments and events. The app could highlight opportunities for green social prescribing and streamline self-referral to social prescribing link workers or local nature-based initiatives. It can also serve as a platform for rewilding initiatives and support services offered by community-led groups, charities, and wildlife trusts.

In addition, systematic data collection techniques such as the use of smart nature surveillance systems can improve monitoring and tracking over time. Nature surveillance could capitalise on existing infrastructures. For example, in recognition of the need for the NHS to respond dynamically to climate risks, the Greater London Authority and Mayor’s Office for London are implementing a new air quality alert system, targeted specifically at clinicians in General Practices and Emergency Departments [59]. Building on this emerging healthcare system adaptation, nature surveillance and warning systems could be further integrated into NHS operations and incorporated into digital tools to support both patients and clinicians. At the same time, there is a need for further large-scale studies employing robust research methodologies. Effective policy integration requires high-quality longitudinal evidence capable of establishing causal relationships between specific nature-based interventions and health outcomes. Such evidence would provide a strong foundation for the large-scale adoption of nature-based solutions within clinical practice and policy.