---

The UK National Health Service (NHS) has officially introduced a new medical paradigm called ‘Green Social Prescribing’. This is a non-medical approach that utilizes contact with nature as an alternative or complementary intervention to conventional treatments such as medication or surgery. It is also a systematic and evidence-based policy designed to promote mental health and well-being, and to reduce health inequalities. Green Social Prescribing has evolved from a niche intervention into a structured public health strategy that yields measurable outcomes.

 

 

Dr. Liz O’Brien is a Principal Social Scientist at Forestry Commission England, working within the ‘Society and Environment Research Group’. Her research centers on the human-nature relationship, specifically focusing on the cultural ecosystem benefits provided by trees and forests, as well as their effects on physical, mental, and social health and well-being. She explores how nature experience and contact with forests enhance an individual’s quality of life, and analyzes how such experiences influence community social cohesion and the formation of cultural values. Dr. O’Brien conducts research that not only evaluates the social and cultural values of trees but also measures the emotional responses and behavioral changes that occur when people interact with the healing environment. Furthermore, she actively participates in various national projects within and outside the UK, international collaborative research, and expert groups, playing a crucial role in connecting the social functions of forests to policy and evidence-based practice.

---

From Medical Treatment to Nature-Based Prescribing

The introduction of ‘Green Social Prescribing (GSP)’ symbolizes a fundamental shift in perspective regarding public health policy. Moving away from the traditional medical model that concentrated solely on the biological causes of diseases, it now officially recognizes and intervenes in the social, economic, and environmental factors that determine health. This concept is derived from the broader framework of ‘Social Prescribing’. ‘Social Prescribing’ refers to a method where trusted professionals identify an individual’s non-medical health issues and social needs, and connect them with non-clinical support or services within the community.

Green Social Prescribing is a sub-concept that specifically targets nature-based activities for these connections. This encompasses diverse activities such as local walking groups, community gardening, nature conservation volunteering, outdoor swimming, and forest art activities. This approach goes beyond merely expanding treatment options. It is a strategic attempt to extend the scope of the health system into local communities and natural environments, integrating them as active partners in health promotion.

In the UK, this principle is being applied flexibly to suit the specific characteristics of each region’s health system. England has adopted a primary care-led referral model, while Scotland utilizes a delivery system centered around community link workers. Wales implements a community-based integrated model rather than a medical-centric approach, and Northern Ireland operates social prescribing through a network of 30 health organizations. This demonstrates that Green Social Prescribing is not a rigid directive from the central government, but an adaptable policy framework tailored to local contexts.

Green Prescriptions Rooted in the National Health System

In the UK, Green Social Prescribing is no longer an experimental approach; it is now an integrated system within the official health service framework of the National Health Service (NHS). Through the ‘NHS Long Term Plan’ announced in 2019, social prescribing was adopted as a formal component of the English health system. Subsequently, in 2022, it became mandatory for all primary care networks to include social prescribing as an essential service. From 2019 to the end of 2023, a total of 9.4 million social prescribing-related consultations took place, of which 5.5 million were assigned codes indicating actual referrals.

The key factor that enabled the institutionalization of Green Social Prescribing is the emergence of a new professional role known as the ‘Link Worker’. The operational system in England works as follows: when a General Practitioner (GP) or a primary care institution refers a patient to a Link Worker, the Link Worker conducts an in-depth consultation to identify the patient’s social needs and connects them with the most suitable nature-based activity organizations. To support this, 3,200 Link Workers are currently active in England, and the ‘National Academy for Social Prescribing’ was established in 2019 to oversee the standardization and research of social prescribing.

Link Workers are the decisive mechanism that has made Green Social Prescribing scalable within a vast and complex health system like the NHS. They serve as connectors between the public healthcare system and community-based volunteer and non-clinical service providers. While it is difficult for doctors to directly keep track of various local activities, Link Workers provide access to relevant networks and specialized knowledge; they are a new type of healthcare workforce focused on ‘tailored connections’ rather than diagnosis or medical prescriptions. The UK government’s large-scale creation of this profession was a strategic choice to firmly establish Green Social Prescribing as a regular service rather than a mere recommendation.

Evidence-Based Outcomes of Green Social Prescribing

The UK’s Green Social Prescribing has moved beyond simple experimental trials and is now proving its actual policy outcomes and economic feasibility through numerical data. The government invested £5.77 million over two years to conduct a Green Social Prescribing pilot project. Through this initiative, 8,339 participants experiencing mental health challenges received structured support for nature-based activities.

Notably, this project substantially contributed to alleviating health inequalities. 57% of the participants belonged to the most socioeconomically vulnerable groups, and 21% were from ethnic minorities. This demonstrates that Green Social Prescribing functioned as an effective access route for populations that were previously difficult to reach through conventional medical services.

The subjective well-being index of program participants also showed statistically significant improvement. Measured against the four personal well-being indicators (ONS4: Happiness, Life Satisfaction, Worthwhile, Anxiety) developed by the Office for National Statistics (ONS), all domains recorded better scores than before participation. This margin of improvement is particularly noteworthy considering that the initial average values were significantly lower than the national average. Post-participation, most indicators reached the UK average level, and the ‘Anxiety’ score dropped even lower than the average. This suggests that Green Social Prescribing functions effectively as a mental health recovery strategy capable of laying the groundwork for psychological restoration in a short period.

The Social Return on Investment (SROI), an economic evaluation metric, further supports the environmental sustainability and viability of this policy. According to analysis, for every £1 invested by the government, an estimated £2.42 of social value was generated in return. This implies that Green Social Prescribing is not a cost item that burdens healthcare finances, but rather a structural investment leading to future medical cost reductions and improvements in the quality of life.

Program Case Study: “Feel Good in the Forest”

The data-proven effects of Green Social Prescribing are vividly demonstrated through specific programs like ‘Feel Good in the Forest’. Operated through a partnership between Forestry England and Sport England, this program is regarded as a representative model of Green Social Prescribing.

The program is fundamentally designed around a participant-centered approach. Beyond simply opening up the forest, it provides tailored nature-based health programs that meet the needs of specific target groups. For example, these include ‘Woodland Warblers’ where participants sing together in the forest, ‘Walk and Talk 999’ which is an interactive walking group for male participants such as emergency responders, group activities for the homeless, and ‘seated exercises’ for those with mobility issues. These activities were designed to lower the psychological and physical barriers for each demographic, thereby significantly increasing program accessibility.

The actual experiences of the participants substantiate the structural effects of Green Social Prescribing. Emphasizing psychological stability, one participant noted that the forest environment “clears the head,” while another mentioned that “meeting people lowered anxiety levels”. In particular, male participants experienced sharing feelings they normally couldn’t express through joint activities with peers, and those with chronic illnesses like diabetes gained the motivation to consistently maintain physical activity.

Such multi-faceted effects stem from the combination of three elements: the natural environment, meaningful activities, and social connection. The program does not merely provide nature as a space; it designs a structured sensory experience that respects the individual’s life and enables recovery.

The success of the program is the result of the organic integration of the forest as a welcoming and neutral space, activity composition that respects participant choices, and the dedicated coordinators executing them. The forest serves as a non-judgmental restorative environment that hospitals or counseling rooms cannot provide; here, participants experience recovery while being respected as individuals rather than ‘patients’. This clearly illustrates that Green Social Prescribing is not simply about ‘using’ nature, but a complex therapeutic system designed to foster human relationships, autonomy, and emotional stability within nature.

Real-World Barriers Hindering Sustainability

Despite achieving remarkable policy outcomes, Green Social Prescribing still faces several structural constraints preventing it from taking root as a sustainable system.

The first issue pointed out is the gap in awareness and information regarding Green Social Prescribing. While both medical professionals and the general public show a positive attitude towards it, awareness of the specific approach of ‘Green Social Prescribing’ remains low compared to the broader concept of ‘Social Prescribing’. Medical staff believe that many patients will prefer traditional pharmaceutical treatments, and they feel it is difficult to provide guidance on local nature-based activities without a Link Worker assisting the prescribing clinician. This acts as a barrier limiting the policy’s potential for expansion.

However, a more fundamental structural constraint lies in the supply base. Currently, most community organizations providing Green Social Prescribing services rely on financial structures based on short-term, competitive projects, making it impossible to ensure service continuity and establish long-term plans. Providers lack the specialized personnel and resources to stably support participants with complex mental health issues, and they have a strong tendency to prefer prevention-focused participants. This reveals a clear structural mismatch between the stable demand generated by the official referral system (NHS-Link Worker) and the instability of the local supply base meant to support it.

If this imbalance is not resolved, the foundation of the entire system could be shaken. Through institutionalization, the NHS has deployed regular staff and built a structural ‘referral pathway,’ but the local service providers underpinning this remain in a vulnerable state. If this disconnected structure—where demand is structured but supply is temporary—continues, its sustainability as a trusted public system ultimately cannot be guaranteed.

Policy Implications and Future Directions

The UK’s experience with Green Social Prescribing has yielded crucial lessons for maturing and expanding the system. The most critical task is to move Green Social Prescribing beyond the level of individual ‘projects’ and drive changes in public health policy and budget so that it is recognized as a core part of the system. This requires strong advocacy at the national level. A successful future depends on robust partnerships. A pan-societal cooperative framework encompassing the health sector, government, community organizations, and the volunteer sector must be strengthened. Such collaboration serves as the foundation for sharing resources and knowledge, bridging gaps between sectors, and creating synergy. In particular, it is urgent to shift away from the unstable funding structure of short-term competitive bidding and transition to a long-term financial support model that allows service providers to operate stably and grow. Concurrently, efforts to strengthen field capacity and improve awareness must continue. The benefits and potential of Green Social Prescribing must be consistently communicated to General Practitioners, Link Workers, and potential service users alike. Furthermore, the legitimacy of the policy must be reinforced by accumulating evidence regarding long-term health impacts and cost-effectiveness. Given that providers of green activities currently tend to focus more on prevention and early intervention rather than complex mental health issues, establishing education and clinical support systems to enhance their expertise is also a critical task.

Ultimately, the lesson from the UK’s experience is that successful Green Social Prescribing relies on building an interconnected ‘ecosystem’ rather than a linear ‘referral pathway’. Investment must not only focus on the patient referral process but also on the capacity, stability, and integration of all stakeholders, including activity providers, community partners, research institutions, and policymakers. For nature to become a reliable form of prescription-based intervention, the entire health and environmental ecosystem surrounding it must be systematically supported and sustainably maintained.

---

Source: Planet03 (2025)