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A new study led by Swansea University argues that the health benefits of nature-based healthcare may depend not only on access to green space, but also on the biodiversity and ecological quality of the environments involved.
The findings, published in Environmental Research Letters, challenge the common assumption that all green spaces can be treated as equivalent in nature-based health research and introduce the first framework linking biodiversity, ecological condition and environmental sustainability with the wellbeing outcomes of nature prescribing — an approach increasingly used across the NHS.
The research comes as nature-based health programmes expand across the NHS, amid growing concerns about the impact of biodiversity loss on human wellbeing.
While programmes such as nature-based social prescribing encourage people to spend time in parks, woodlands and other natural spaces, most existing research treats “nature” as a single, uniform resource, overlooking ecological differences that may influence how effectively environments support wellbeing.
For example, a biodiverse woodland or wetland may support wellbeing differently from a closely mown playing field or heavily managed park.
To address this gap, researchers from Swansea University and the University of Bayreuth developed a One Health Sustainability Framework that brings together public health, ecology and sustainability science. The framework highlights how biodiversity, habitat condition and ecosystem integrity may shape the effectiveness — and long-term resilience — of nature-based health programmes.
Lead author Dr Konstans Wells, from Swansea University's Centre for Nature-Based Solutions, said: "Nature prescribing is a promising and rapidly expanding area of healthcare, but we still know surprisingly little about how the ecological characteristics of different environments influence wellbeing. Much of the current evidence focuses on exposure to nature in general, while paying less attention to biodiversity, ecosystem condition and ecological quality. Our framework highlights the need to move beyond simply asking whether nature is beneficial and towards understanding what kinds of nature, and how much, are needed to support health in a sustainable way."
The study emphasises that natural environments vary widely in their ecological characteristics. Biodiverse, structurally complex ecosystems — such as woodlands, wetlands or species-rich grasslands — differ fundamentally from simplified or heavily managed green spaces. These differences may influence the extent and durability of health benefits, as well as the resilience of the ecosystems themselves.
As nature-based health programmes grow, the authors note that increasing demand for natural spaces could place additional pressure on ecosystems unless ecological capacity and conservation needs are considered alongside human wellbeing.
Co-author Dr Menna Brown, whose research focuses on nature-based social prescribing and implementation within NHS and community healthcare settings, said: "Nature-based social prescribing is becoming an increasingly important part of preventive healthcare, with growing evidence that connecting people with nature can support health and wellbeing. As these programmes grow, the next challenge is understanding how different types of natural environments contribute to those outcomes and how we can maximise benefits for both people and nature.
"A One Health approach allows us to move beyond asking simply whether nature-based interventions work and towards understanding what kinds of environments are most effective, for whom, and under what circumstances. This is essential if we are to develop nature prescribing in a way that is both evidence-informed and environmentally sustainable."
The framework builds on Swansea University’s growing expertise in nature-based health research. Dr Brown, together with GP and honorary Swansea University researcher Dr Catherine Jenkins, recently led the development of an evaluation toolkit for Nature-Based Social Prescribing. The authors suggest that future evaluation approaches could benefit from incorporating ecological indicators — such as biodiversity and habitat condition — alongside traditional health measures.
By examining ecological quality and environmental pressures alongside wellbeing outcomes, future studies could help address a key evidence gap: whether different types of natural environments influence not just the scale of health benefits, but their persistence over time.
According to the authors, the framework provides a foundation for future research into how health promotion and environmental stewardship can be advanced together.
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