What does a ‘Natural Health Service’ mean for rural areas?

Evidence shows that regular contact with nature can improve health, reduce avoidable illness, support wider social and economic goals, and deliver public service savings. Rural areas are increasingly exploring how to make better use of the natural assets around them as part of health, economic and place-based strategies. As understanding of nature‑based approaches deepens — from green social prescribing to broader outdoor interventions — new data and evaluations are helping to clarify what works and why. What are nature-based interventions, and why do they matter now for rural communities? Jessica Sellick investigates. 

Across the UK, the idea that nature can support people’s health and wellbeing has moved from the margins of public conversations to the centre of public policy discussions. Back in 2016, The Parliamentary Office of Science and Technology (POST) published a summary highlighting growing evidence that regular contact with green space addresses the increasing economic and social costs associated with sedentary urban lifestyles, improves health, and can therefore be used as part of a treatment plan for some clinical conditions.  Since then, this work has accelerated. Terms such as green social prescribing, nature-based interventions, and community-led green infrastructure have become part of everyday language in the health and care system. The phrase ‘natural health service’ emerged in 2023 through work assessing the economic value of Wildlife Trusts programmes and their potential to reduce demand on the NHS. Since then, health bodies, local authorities, protected landscapes, charities and community organisations have all begun exploring how nature can be embedded more systematically into prevention, treatment and recovery. In May 2026, York St John University called for protected landscapes to be formally recognised as part of the UK’s infrastructure for supporting health. All of this reflects a wider shift: moving from a focus on lifespan to healthspan, ensuring people not only live longer but live well. What’s the potential of a Natural Health Service, and how could it operate more effectively in rural areas?   

What is a Natural Health Service and why does this matter now? In May 2023, Ricardo conducted an economic assessment of Wildlife Trusts programmes to investigate if there were any benefits to the NHS and to calculate any cost savings. They found interventions such as group outdoor activities and volunteering led to measurable improvements in mental health, loneliness and social isolation, physical activity, and confidence, skills and economic participation. Indeed, these improvements translated into reduced GP appointments, fewer A&E attendances, fewer inpatient admissions and lower treatment costs that could all be quantified. Indeed, for every £1.00 invested in these activities, returns of £2.00+ in reduced NHS treatment costs were identified. Within the report, a ‘Natural Health Service’ was positioned as a community-based system of nature-based health support that works alongside the mainstream NHS to improve wellbeing, prevent illness, and reduce demand on clinical services. It is built around a core idea that access to nature is part of the nation’s health infrastructure.  

“The Wildlife Trusts are clearly providing benefits to people faced with health inequity, including those with restricted mobility, older people, carers and those who are economically inactive. What is remarkable, is that in addition to improving people’s physical, emotional and mental well-being, there is a clear cost-benefit to the NHS, and therefore to wider society. If Wildlife Trusts programmes like those described in this research were made available to people in more places, they could help prevent unnecessary ill-health and reduce the number of people requiring NHS services. This Natural Health Service alongside the creation of natural spaces in communities across the country will help bring about health and sustainable places to live and work”, Professor Sir Michael Marmot, UCL Institute of Health Equity (page 7).  

In May 2024, Natural England used the phrase in relation to Nature Recovery Projects (NRP), Nature Therapy, nature based practice, and the 5 Pathways to Nature Connection to highlight the importance of connecting people with nature for the good of their health. Drawing on the findings of a consultation exercise on plans for a new National Nature Reserve, more than half of the 2,000 respondents said one of their ‘top three’ reasons for visiting a green space was benefits to their physical and mental health. In April 2026, an evaluation of four Mersey Forest Natural Health Service products delivered between 2019 and 2024, described how it is concerned with ‘improving the health and wellbeing of individuals and communities…by providing a holistic approach to health care’.  

The phrase has since been expanded to include other forms of outdoor therapy such as ecotherapy, forest bathing, and wild therapy. As well as bringing the outdoors in (provide nature experiences on hospital wards or setting up rooftop gardens), it has also found its way into NHS staff training, population health and national strategic documents (e.g. Natural England’s recovering nature for growth, health and security).  

Within the NHS itself, its adoption now extends beyond individual wellbeing to areas including health equity and biodiversity recovery: “health justice and ecological reciprocity. By training NHS staff, we ensure that people who would otherwise have little or no access to natural spaces can benefit – while also helping those spaces thrive”. Indeed, Wildlife and Countryside Link indicates how the 10 Year Health Plan for England can better achieve its objective by increasing access to nature – and the role of the NHS in doing this through “repurposing its dormant estate for the good of the wider community, such as by creating woodlands or gardens…An NHS estate with more green and blue space has the potential to make significant contributions to reducing air pollution, as well as other NHS priority areas such as Net Zero”.  

A Natural Health Service matters now because the NHS faces ongoing pressures (e.g. access, demand for care, financial distress, workforce recruitment and retention), and wants to make three radical shifts: from hospital to community, from analogue to digital, and from sickness to prevention. As well as delivering better health outcomes, the Government wants to unlock broader economic benefits.  Within this national conversation, nature is increasingly recognised as a practical, low‑cost part of the solution — improving wellbeing, reducing avoidable illness and easing demand on clinical services. As a result, the idea has moved from concept to implementation.  

What does the evidence tell us? Back in 2016, POST highlighted research into the direct public benefits of urban green spaces in relation to physical activity, mental health, and specific treatments. They highlighted three types of studies that have examined the links between green space and health:  

1. Cross-sectional observation studies: researchers use regional or national data to explore correlations between public health and the amount and proximity to nearby green space.  

2. Cohort studies: researchers select groups from the wider population, which are followed over time to identify changes to physical and mental health as a result of access to green space.  

3. Experimental studies: researchers look at the direct effects of green space on indicators of health and wellbeing (e.g. sights, sounds and being outdoors).  

POST’s review of UK and international research found a mixed picture. People living closer to green areas tend to have lower levels of mortality, obesity and related illnesses, although this appears to be linked to higher levels of exercise rather than the presence of green space itself. There was no clear evidence that proximity to, or frequent visits to, green space directly improves mental wellbeing. Some experimental studies show that people feel happier when walking through a nature reserve or exercising with scenes of nature, compared with urban environments; and both patients and hospital staff report feeling happier and more relaxed after spending time in a garden or outdoor space. While the Faculty of Public Health (FPH) has proposed that interaction with nature may be effective in treating some mental illnesses, existing studies could not determine whether similar improvements would occur if the same physical or social activities took place indoors.   

Although the health benefits of green, outdoor and nature‑based interventions were recognised, even when evidence was not yet definitive, it is in the past 3-5 years that the evidence base has begun to be systematically brought together. This includes:  

• Quantifying economic benefits and cost savings: In 2023, the Wildlife Trusts commissioned an independent economic analysis to investigate if there were any benefits to the NHS resulting from its programmes. Across five different programmes, analysts found fewer inpatient admissions, fewer A&E attendances, fewer outpatient appointments, and reduced treatment costs for mental health conditions. They also modelled what would happen if these programmes were delivered at scale: expanding the Wild at Heart programme to 1.2 million people with poor mental health could save the NHS £635.6 million. As well as hard economic evidence, they also highlight how people in the most deprived areas are 10 times less likely to live near natural spaces, and only 35% of low-income households live within a 10-minute walk of green space. Researchers highlighted the benefits for people living in deprived areas and those with a history of anxiety and depression, and the importance of improving access to green and blue spaces.     

• Quantifying the mental health benefits of green and blue space: a National Institute for Health and Care Research (NIHR) funded 10‑year study linked household greenness, proximity to green and blue spaces, and GP records for over 2 million adults in Wales, finding that every additional 360 metres distance from the nearest green or blue space was associated with higher odds of anxiety and depression. People living within 200–300 metres of greener environments had a lower risk of developing these conditions, with the protective effects strongest in more deprived areas. 

• Correlating green-space access to life expectancy: The Health Foundation analysed how neighbourhood‑level access to green space relates to life expectancy in England, combining Friends of the Earth’s green space dataset (2020), Office for National Statistics (ONS) life‑expectancy data (2016–2020) and English Indices of Deprivation (2019). The analysis shows a clear gradient: men’s life expectancy rises from 78.2 to 81.2 years, and women’s from 82.8 to 84.7 years, between areas with the lowest and highest access to green space.  

• New, national datasets on nature engagement: The People and Nature Survey was first carried out by Natural England in 2020 and then repeated in 2022. In the first survey, based on a sample of 2,000 adults, 26% reported no visits at all to green or natural spaces, with this only partially recovering in the 2022 dataset, which drew on 16,000 participants. Respondents also reported that green and natural spaces were important to their mental health (89%), that being in nature made them happy (87%) and that having a private garden or allotment improved their wellbeing (86%). These two datasets have underpinned later national analyses by Natural England, the Department for Environment, Food & Rural Affairs (Defra) and the ONS (e.g. UK Natural Capital Accounts). 

• NHS strategies and estates as under-used health creating assets: In 2025, Wildlife and Countryside Link published a briefing highlighting the need for the NHS to utilise nature as a health asset, noting that the 10 Year Health Plan for England does not include any references to green social prescribing, nature, walking or access to nature. It draws on national data from a green social prescribing project showing happiness increased by 22%, life satisfaction by 21% and anxiety reduced by 14% among participants. The briefing also includes case studies covering air pollution, obesity and active travel.  

In 2024, Natural England synthesised existing UK and international reviews on nature exposure and health. This ‘review of reviews’ was undertaken to strengthen understanding of the wider determinants of health (health sector) and the human impacts of biodiversity loss (environment sector). Rather than focusing on material resources (i.e., how nature provides us with food, fuel and medicine), it focuses on the impact of exposure to natural environments and active engagement with them. Echoing the earlier POST review, the synthesis reveals that exposure to green space, particularly in urban areas, is associated with improved psychological wellbeing, physical activity and linked health outcomes – and it cites studies in children and young people to highlight a growing evidence base showing that blue space exposure is also beneficial for psychological wellbeing and physical activity. The review also clarified where evidence is strong, where it is emerging, and where gaps remain. They identified three areas for further research: (i) the impact of nature-based interventions for specific groups and specific activities, (ii) the risks that a changing climate poses to human health and wellbeing through exposure to changing nature, and (iii) understanding the health and wellbeing outcomes of nature improvement work.  

“In recent years, the UK’s major health and environmental strategies have increasingly recognised something communities have long understood – access to nature is essential for good health…the evidence is growing that regular contact with green and blue spaces supports both physical and mental wellbeing…Despite this widespread recognition of the health benefits of outdoor interventions, the evidence base is limited by inconsistent measurement of health outcomes. Different programmes measure outcomes in different ways, making it difficult to determine which approaches are most effective, for whom and under what circumstances. The presence and complexity of multiple metrics for health also make effective evaluation challenging for many community groups and those not embedded in health evaluation practices. This slows progress and limits the ability of policymakers, funders and practitioners to invest confidently in interventions that could significantly improve community health and reduce health inequalities”, Dave Bell, Natural England (March 2026).  

In March 2026, Natural England published ‘Healthy Outdoors: a guide for measuring health outcomes when evaluating outdoor interventions’. This is intended to be a practical tool for a range of organisations to identify appropriate measures and principles that can help ensure evaluations are consistent, robust, and focused on health outcomes. The guide was designed by Natural England in collaboration with the Department of Health and Social Care, Defra, Sport England, Active Travel England and a wider stakeholder advisory group. It contains a range of measures drawn from the People and Nature Survey, Active Lives surveys, Public Health Outcomes Framework and demographic categories that correspond with ONS datasets (e.g. Census, English indices of deprivation). The list of measures (page 16) covers:  

• How is the intervention delivered: the cost of resources used, what is delivered, and where it is delivered.  

• Who is taking part in the intervention: how many people are registered, attending, and completing each activity. There are also indicators covering the demographics of participants and their experiences of the intervention.  

• How does the intervention link the outdoors to health: time spent outdoors, intent to continue, intent to get outdoors more, feel connected to nature, and change in travel mode.  

• What are the intended outcomes of the intervention: there are measures for mental health and wellbeing (i.e., wellbeing, mood, life satisfaction, loneliness, absenteeism), physical health (total physical activity, weight status/BMI, sleep quality), and clinical outcomes which may require engagement with a healthcare provider (e.g. cognitive performance, blood pressure, depression, anxiety, stress, mental ill health).  

The guide suggests that by using consistent, valid and reliable metrics, including those provided in the guide itself, findings from different studies can be compared and synthesised over time, enabling systematic reviews and meta-analyses that combine evidence from multiple studies to produce stronger and more reliable conclusions. 

The evidence on nature and health is growing but still fragmented, with studies using different methods, timescales and measures. Despite this, consistent patterns are emerging: access to green and blue spaces is linked with better mental health, longer lives and reduced demand on health services. New national datasets are strengthening the picture, but inconsistent measurement still limits comparison. Natural England’s new standardised metrics aim to fix this challenge, although many studies continue to struggle to involve communities in generating the data on which the evidence base depends.  

What does the Natural Health Service look like in rural areas? The World Health Organization (WHO) recommends that green spaces of at least 0.5 hectares should be accessible within 300 metres of where people live (a 5-minute walk). This definition has informed Natural England’s Green Infrastructure Framework’s standards which define what good green infrastructure looks like – covering urban nature recovery, urban greening factor and urban tree canopy standard – and which initially focuses on everyone having access to good quality green and blue spaces within 15 minutes’ walk from home, an ambition that also sits within the Environmental Improvement Plan (EIP).  

Back in 2016, the WHO compiled an evidence base setting out available research evidence on urban green space interventions and their impacts, case studies of lessons learning and Impact Assessment experiences on green space planning. In 2023, the WHO commissioned the University of Exeter to assess the value of the health and wellbeing benefits and risks of urban green and blue spaces. Also in 2023, the European Environment Agency (EEA) published a briefing setting out the health benefits of urban green space, highlighting how the degree of greening varies across neighbourhoods, with less and lower quality green space typically found in communities of lower socio-economic status. The EEA notes that the provision and quality of green space is set by Member States and local bodies – with Berlin using a guideline of 500 metres to  a green space of at least 0.5 hectares (5-10 minute walk), and 1km to 1.5km to larger areas of green space, of at least 10ha; while in Italy, urban planning regulations require that 9m²of parks and public areas are available for recreationper person.  The EEA is calling for targeted action to reduce inequalities in access to high-quality green space to maximise the health and wellbeing benefits of nature in cities.  

Interest in green space and nature in urban areas has also increased amid policy focuses on creating biodiverse and accessible green infrastructure by bringing nature back into cities, the role of nature-based solutions in climate adaptation and resilience, to support the social inclusion of disadvantaged groups, and address health inequalities. Some examples include:  

• NHS Forest: a programme run by the Centre for Sustainable Healthcare, which began as a tree planting project on healthcare sites in 2009 and has expanded to establish a wide range of green spaces on and around NHS sites. 

• Northern Roots: delivers a social prescribing programme through connection to nature, growing, creativity and community. Activities are delivered from an urban farm and 160 acres of woodland, moorland and meadow. In September 2025, Northern Roots launched the world’s first Randomised Control Trial into the impact of green social prescribing on mental health. This initiative is part of GreenME, a Horizon Europe research project spanning six countries where Oldham is the project’s urban case study.  

• Nature Towns and Cities: a coalition of organisations aiming to work with 100 towns and cities across the UK to support them to transform their urban landscapes for people and nature (including providing grant funding and accreditation).  

• Parks for London: this includes health and wellbeing guidance for local authorities, health and social care practitioners and other stakeholders on how to improve and expand green space and maximise health benefits. Parks for London also facilitates strategic development, working with partners and stakeholders to develop green space strategies.   

• Streets Ahead: the Royal Society for Public Health (RSPH) has published a range of documents over the last decade calling for high streets to become drivers of health and wellbeing. The evidence suggests only 5% of land in cities is freely accessible green space and that 49% of people do not have access to green spaces for exercise or rest in their high streets. The RSPH is running a healthy places campaign and defines 10 core building blocks for a healthy high street.  

• GREENHEALTH: a 4-year project led by the James Hutton Institute which explored the relationship between green spaces in urban areas and human health. The main findings show that urban green spaces support public health and wellbeing, especially mental health, but the effects are uneven and vary by gender, income and type of green space used. The research also shows benefits from using green space rather than simply living near it.  

• Hampden Fields in Aylesbury (Buckinghamshire): a collaboration between The Land Trust and Taylor Wimpey for the delivery and long-term management of Sustainable Alternative Natural Greenspace (SANG) spanning 62 hectares, integrated within the wider 3,000 home development. This will bring The Land Trust’s SANG portfolio to 17 sites and 503 hectares nationwide; and provides a blueprint to support other new communities to deliver environmental, health and wellbeing benefits for residents and visitors.   

In 2025, Natural England published a report examining how people in England use their local green and natural spaces, finding that while 73% of people in England live within a 15-minute walk of a green space, more than a quarter (27%) do not. In line with other studies, they found lack of access is not evenly shared, citing how only around a quarter of adults (26%) living in the most socially deprived areas have a green space close to home, compared with well over one-third (38%) in the least deprived areas.  Indeed, more than a third (36%) of adults whose health conditions limit daily life live more than 15 minutes away from a green space; and people who live more than 15 minutes away were found to have around 60% lower odds of visiting green spaces frequently. Similarly, people who perceive their local green spaces as unsafe, poorly maintained or inaccessible are just as unlikely to use them, even when they are nearby. Researchers suggest that quality matters as much as quantity.  

Significantly, the report highlights rural-urban differences in green space access:  

• Residents in rural areas report significantly better access to green and natural spaces compared to those in urban settings: half of rural residents (50%) indicated that they could reach their nearest green or natural space within a 5-minute walk, compared to only about a third (31%) of urban residents.   

• Natural England noted that the definition of green space reveals different findings between urban and rural populations: according to some scenarios in Defra’s modelling, rural households have lower access to green spaces compared to urban households. For example, in the “all green spaces” scenario, 85% of urban households were estimated to have an eligible green space within 1km, compared to just 50% of rural households. However, in the “all green space with rights of way” scenario, which includes all accessible green spaces of 2 hectares or more and rural rights of way within 1 km of a household, rural households have slightly better access than urban households: 93% of rural households were estimated to have an eligible green space compared with 91% of urban households. The Country Land and Business Association (CLA) was instrumental in working with Natural England to include accessibility in public rights of way in the modelling.  

• There was not a strong relationship between living in a rural area and having a positive assessment of green space quality in the local area.  

• Urban residents were more likely to use green spaces frequently compared to rural dwellers.  

Building on differences in how green space is defined, in some of the data private land is excluded, some of the sample sizes are quite low (e.g. access to green space is based on responses from 16,378 urban residents and 2,971 rural residents), and analysis focuses on quantity not quality. All of this means across studies that we don’t get a comprehensive picture of how near rural residents are to a green, natural, open or outdoor spaces, whether they can access it them and if they use them.  

More substantive strands of rural work have been exploring how protected landscapes and community forests can play a stronger role in improving physical and mental health. Some examples include:  

• A natural health service for North Yorkshire: a green social prescribing programme delivered by the North York Moors Trust, North York Moors National Park, Yorkshire Dales National Park, Howardian Hills National Landscape and Nidderdale National Landscape. The programme includes a 10-week programme of guided outdoor sessions and personalised nature plans to help participants stay connected with local community activities beyond the programme. It also provides training for professionals across health, housing, criminal justice, employment and community services about using nature as an asset in prevention, treatment and recovery. In June 2026, York St John University published an evaluation of the programme, finding that amongst participants mental wellbeing increased by 24%, social wellbeing by 17.5%, physical wellbeing by 13.5% and loneliness reduced by 15.2%. Participants also reported feeling calmer and less anxious, more socially connected, more confident and motivated, more inclined to be active outdoors, and had a stronger appreciation for protected landscapes and their value. Dr Tom Ratcliffe who led the research describes how: “Our evaluation shows unequivocally that the Natural Health Service for North Yorkshire works. In just ten weeks, participants experienced measurable improvements in mental and physical wellbeing, stronger social connection, and reduced loneliness; all through supported interaction with nature. The task now is to embed and scale this approach so that green social prescribing becomes a routine part of prevention and early intervention across North Yorkshire’s Protected Landscapes and our wider health and care systems”. Researchers argue that the programme marks a step change in how protected landscapes are understood, and that they should be formally recognised as a core part of the UK’s national health and wellbeing infrastructure.   

•  The Mersey Forest Natural Health Service: is currently being delivered in Cheshire and includes horticultural therapy, nature-based mindfulness practice, conservation projects and Forest School. An evaluation by Liverpool John Moores University found around half of the participants (49%) lived in the top five most deprived wards, wellbeing improved for 75.4%, engagement in physical activity increased from 85.5% to 88.1% and the number of individuals categorised as ‘minimally active’ reduced from 15.2% to 11.9%, and the proportion of visits to green spaces increased for ‘every day’ and ‘most days’.   

• Nature for Health: delivered by Clwydian Range and Dee Valley National Landscape, and working in communities from the coastal towns of Rhyl and Prestatyn in the north, to Llangollen and Corwen in the south of the Clwydian Range and Dee Valley National Landscape offering conservation, creative and physical engagement activities.  

The evidence from protected landscapes and community forests demonstrates how a Natural Health Service can deliver measurable improvements in physical, mental, emotional and social wellbeing – but only when the right conditions are in place. This information provides a blueprint for scaling their models and applying them across more rural areas, which requires:  

• Long-term co-investment across sectors: health, housing, transport, employment and environmental bodies must jointly fund and commission programmes. This embeds nature-based interventions across multiple policy areas. Evidence suggests short-term funding, year-on-year grants, prevent the development and sustained delivery of nature-based interventions.  

• Community organisations need to be seen as a formal partner of the NHS, and integrated into NHS operations, not at its margins: evaluations have found unclear referral pathways from health into community organisations and low awareness among professionals of what nature-based interventions are.  

• Formally recognising nature-based interventions within prevention, early intervention and recovery – not discretionary add-ons.  

• Treating rural open and green spaces as part of health and wellbeing infrastructure: not simply as environmental amenities.  

While green social prescribing has been a core component in dialogues about a Natural Health Service, rural areas can be much more ambitious in that they offer a wide range of assets to support health, wellbeing and economic outcomes:  

• Evidence consistently shows that childhood engagement with nature is one of the strongest predictors of adult use of green space. How can we build our understanding of existing outdoor learning partnerships with school youth volunteering programmes and family-based nature activities happening in the countryside, identify gaps in delivery, and design and deliver more initiatives that ‘normalise’ nature as part of everyday life?  

• Rural communities have a track record in developing, managing and supporting local assets. How can we build on this to enable more groups to maintain and manage local green spaces, provide micro/small grants for local stewardship, and support community-led design, delivery and evaluation of nature based interventions?  

• How can we utilise all kinds of rural spaces beyond protected landscapes to bring together assets into a coherent rural health infrastructure (e.g. farms and estates, village halls and community hubs, local businesses)?  

Where next? Although terms such as Natural Health Service, green social prescribing and nature-based interventions are not always directly referenced in health policy documents, the evidence for their impact is substantial and growing. What often began as a series of pilot projects has broader approaches to improve health outcomes, strengthen communities and support rural economies.  

The next phase could involve exploring how different rural places can adapt and scale approaches that work for their local context and residents. This could include (but is not limited to):   

• developing local natural health partnerships in rural areas (bringing together NHS, local authorities, community organisations, charities and businesses – not necessarily a new body, but by coordinating partnerships that already exist and work well);  

• shaping a flexible rural offer that meets the health and wider needs of rural communities (covering physical and mental health and programmes for all age groups);  

• creating long-term funding models (combining public funding, philanthropy, private sector contributions and community investment); and  

• shared data and outcomes frameworks (to demonstrate the impact and what is working well and less well).  

Very finally, and turning the telescope around, the need for a Natural Health Service in rural communities is increasingly important. Life expectancy is higher in rural areas than urban areas outside London, but preventable deaths are higher for those further from major towns and cities. This suggests that nature-based approaches should be considered as part of a wider rural prevention agenda: helping people to stay healthy, age well and access support closer to where they live.