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We all like simple solutions.  There is reason to celebrate when the answers to difficult or complex problems are straightforward, simple to implement and have long term cost effectiveness.  The break-up of traditional silo thinking that separated the health and environmental agendas is supremely exciting and there could be huge gains.  

But this is a journey rather than a quick win.  It is crucial that we gain better understanding of the ways in which nature prescribing can be beneficial, how benefits can best be achieved and what the barriers might be.  This is not about looking a gift horse in the mouth – it is about making sure we know how to ride it.

There is already an undeniable body of evidence that connecting with green spaces and nature – particularly through shared activities – can improve our health and wellbeing and help tackle a range of chronic conditions. Data from Natural England shows that the NHS could save more than £2 billion in treatment costs if everyone in England had equal access to good quality green space.  Now a £4.7M pilot scheme will examine how to scale-up nature prescribing services to reduce health inequalities and improve mental health through test projects delivered by fifteen Health and Social Care Partnerships starting in April.  The Government wants 1,000 link workers in place by the end of 2021 to connect health services with local activities.  It is hoped that by 2023 – 2024 at least 900,000 people will improve their physical and mental health through referrals.

The environmental voluntary sector is ideally placed to deliver these activities. Thames21 connects people with nature by putting healthy rivers back at the heart of community life. Engaging, educating and empowering communities is integral to our work to transform rivers. Providing people with meaningful, purposeful shared activities in blue-green space is what we do, and for many years Thames21 has seen the mental and physical health benefits first-hand.  Thames21 is currently working in partnership with the London Borough of Enfield on a programme that will involve the community in creating new woodlands and wetlands. It specifically plans to deliver public health benefits through nature-prescribing and volunteer programmes – while reducing flood risk and creating a better river environment

I am personally convinced that green space with water is most beneficial of all for mind and body. Imagine visiting your local urban park. It is almost certainly a great natural space with grass, plants and trees and where you can see a wider sky.  Next, add water to this picture. Imagine a stream flowing through that park and immediately you have added life, movement, light and reflections.  You have added the sounds of nature and health as the water is a magnet for wildlife which chatters in the trees, splashes, swims, hovers.  There is the balm to the spirit that we all feel when we look into a clear pool or watch the water gliding past.  Our well-being has been turbo-charged, just by adding water.

The benefits of nature prescribing do not result from green spaces alone, but from what you do in them. Providing a sense of practical purpose, bringing people together through shared goals around such widely appealing features as rivers, can potentially provide some of the most effective pathways to mental and physical health.  Opportunities for shared and constructive activities emerge from the challenges that our rivers face:  a concerted drive to restore our rivers to health, to improve their biodiversity and beauty, helping to tackle issues ranging from plastic pollution to habitat loss.

All this potential needs to be comprehensively tested and evidenced to ensure that as we scale up nature prescribing, funding and opportunities are targeted to produce the greatest health benefits.

We will not solve the health crisis simply by writing out green prescriptions.  How do we prevent huge numbers of prescriptions being stuffed in a drawer and forgotten?  When you are feeling ill or up against it, to be told briskly that you should do something active outdoors in green spaces may not be appreciated, particularly in the early days of a new scheme. First, nature-prescribing must be made as easy and as attractive as possible for people to take up.  We need the right structure and support in place to make it easier for those who are feeling vulnerable to take those first steps to involvement and towards the benefits we know are there.

Next: to be cost effective and ensure long term health benefits, nature prescribing must be sustainable.  It should signpost and provide pathways to greater long term involvement, back to long-term physical and mental health. It needs to connect people to activities which have a track record of sustained involvement; that draw people in so that they want to continue and develop things further. 

The evidence for nature or social prescribing is there, but essential detail is lacking. We need more evidence on the most effective type and manner of nature prescribing and how the benefits to human health can be maximised.  And once collected we need this to be analysed and shared. There must be a commitment from Government now – not just to nature prescribing but to consistently evaluating its effectiveness. The Government needs to commit to this in the long term.  Long- term investment is vital if we are to evidence the benefits to chronic conditions.

Success does not just depend on the Government, health care providers and the beneficiaries alone. Can the environmental sector a) adapt to accommodate large-scale nature prescribing and b) should it?  The environmental sector is governed by charitable objectives which are fundamentally environmental.  I personally believe that the interdependence of people and the environment makes nature prescribing a natural development, but the question will need to be asked and considered.

Activity programmes of organisations such as Thames21 could be tailored to meet health, and wellbeing outcomes.  Environmental volunteering sessions could be developed that are focussed on engagement or which target those who would benefit most, and activities tailored to deliver the best health and wellbeing outcomes. There is the potential to create a journey through a series of volunteering steps and foster a growing commitment from beneficiaries that could lead them into long term, positive change for the rest of their lives.  But for such things to happen there must be real appreciation of the potential benefits of nature prescribing.

Over the coming months, as vaccines start to take us out of the Coronavirus Pandemic, demand for environmental volunteering will rocket. The link with health and well-being has been underlined ever more strongly this year.  Increasingly it is understood that human health and the environment are intimately connected and that we cannot tackle one crisis without the other.

Debbie is the Chief Executive of Thames21. Views expressed in this article are those of the author, not necessarily those of Bright Blue. [Image: Stefan Marks]