Think Health Think Nature was initiated as one of four pilot projects in Scotland being supported through Our Natural Health Service – a programme led by NatureScot and underpinned by a strong evidence base.
The Green Health Principals and Definitions document details what the partnership include in their understanding of ‘Green Health’.
Research from Scotland and around the world shows that Green Health can support health, wellbeing and quality of life. However, access to nature, greenspace and outdoor opportunities is not experienced equally. A growing body of evidence suggests that improving access to high-quality green spaces should be supported with targeted support for participation into green health activities to maximise benefits for individuals who stand the most to benefit.
The benefits of Green Health were well documented in A Dose of Nature evidence summary report by Exeter University, written in 2014.
The report highlights an extensive list of benefits to individuals;
- Can reduce the experience of pain.
- Can improve immune function
- Can protects against cardiovascular disease
- Helps to lower blood pressure
- Relief from acute stress
- Improves self- esteem
- Can speed up recovery from illness or injury
- Combats fatigue
- Benefits those suffering depression/anxiety
- Helps tackle loneliness
- Reduces ADHD symptoms in children
- Can improve concentration
- Can prevent and manage diabetes
- Reduced mortality
- Promotes physical activity
For more information you may also like to download the Our Natural Health Service leaflet.
Research continues to demonstrate that Green Health supports physical, mental and social wellbeing across all stages of life. This page brings together evidence, evaluations and learning from Highland and beyond. The literature review for this evidence base was kindly supported by University of Highlands and Islands (UHI), Highland Health Sciences Librarian Service and Mason McLeod, PhD Candidate with Centre for Rural Health Science at UHI.
Existing Research
The existing research is broad, across a wide range of themes. Here we highlight key research using quality of life indicators as a framework and highlight how green health links to prevention work and the climate crisis. Select a title for more information.
Research continues to show that Green Health can support physical health throughout life. Time in green and blue spaces can encourage physical activity, improve general health and wellbeing, and support healthy ageing (Elliot et al., 2023). Reviews have found benefits across a range of physical health outcomes (Marini et al., 2022; Wang et al., 2025; Christiana et al., 2021), while evidence in older adults suggests that access to green space may support healthier ageing, including lower risks of depression, cognitive decline and some long-term health conditions (Wang et al., 2026).
In Highland, research and evaluation have also explored the contribution of Green Health to physical wellbeing. Studies undertaken with the University of the Highlands and Islands have examined green exercise, cycling initiatives and outdoor activity for people living with Type 2 diabetes, helping to strengthen understanding of how nature-based approaches can support active lifestyles and long-term health in Highland communities (Fraser et al. 2020).
Green Health supports physical activity, recovery and lifelong health across all stages of life.
An international study across 18 countries found that access to and use of green and blue spaces was associated with better mental health (White et al., 2021), with people living with dementia who perceive having access to local green and blue spaces reporting having better quality of life and wellbeing compared to those who did not (Wu et. al., 2022). In a recent systematic review looking at the effectiveness of nature-based interventions on mental health found that nature-based interventions can improve depression, stress, anxiety and overall wellbeing (Heinen-Stach et al., 2026). Nature-based interventions have been found to be as effective as some established therapeutic approaches, suggesting that exposure to nature may offer a cost effective complementary or alternate intervention for supporting mental health (Heinen-Stach et al., 2026).
University of Stirling, Green Threads: Weaving Stories of Nature and Recovery demonstrates how connection with nature can support hope, resilience and recovery. In Highland, research and evaluation have explored the role of Green Health in supporting mental wellbeing and recovery. Work with the University of the Highlands and Islands investigated Nature Walks for Wellbeing for people experiencing severe mental illness (Hubbard et al., 2020).
Green Health supports mental wellbeing, resilience, reflection and recovery.
Green threads: weaving stories of nature and recovery
Dr Wendy Masterton from Stirling University has led a Society for the Study of Addiction-funded project to develop a powerful documentary exploring the role of nature in recovery. The film titled, Green Threads: Weaving stories of nature and recovery captures the transformative impact that nature-based approaches can have on individuals in recovery services. The film doesn’t just showcase stunning visuals – it brings to life real stories and powerful examples of how connecting with nature can support healing, growth, and wellbeing. It’s a moving reminder of the strength found in open spaces and the resilience of those on their recovery journey.
This documentary builds on Wendy’s previous research and the development of nature-based programme guidance manuals.
🎞️ Trailer – a quick glimpse into what the film offers
📽️ Full Documentary – for the complete experience
Castro et al. (2026) found that people living in greener and more biodiverse spaces reported lower levels of loneliness, suggesting that access to nature-rich environments may help support social wellbeing and foster a greater sense of connection. These findings match previous work by Villeneuve et. al. (2024) which found that people living in greener neighbourhoods were less likely to experience neighbourhood related loneliness and social isolation suggesting that green spaces play an important role in supporting social connectedness and community engagement.
In Highland, evaluation of Green Health Prescriptions and community-based activities has highlighted the importance of social connection as a pathway to improved wellbeing. Learning from Green Health Packs and Events also demonstrated the value of shared outdoor experiences in reducing isolation and strengthening community connections.
Green Health strengthens social connections and community wellbeing.
A systematic review by Fry et al. (2026) found that changes to outdoor environments, such as improving parks, creating gardens, planting trees and developing greenways, can support health and wellbeing, reinforcing the importance of investing in nature-rich places that enable people and communities to thrive.
In Highland, research has helped improve understanding of how people access and use local greenspaces. Research with pregnant women and young families in Badenoch and Strathspey explored barriers and opportunities affecting greenspace use, while work by the James Hutton Institute has contributed to wider understanding of the relationship between place, greenspace and health.
Green Health helps create environments that support healthier lives.
Research suggests that Green Health can play a role in reducing health inequalities. Evidence from Wales found that visiting nature was associated with higher levels of wellbeing and smaller gaps in wellbeing between socioeconomic groups (Garrett et al., 2023). UK-wide research has also found that deprived communities often have less access to green space, despite greater green space being associated with lower rates of preventable death, reinforcing the importance of equitable access to natural environments as a public health priority (Ngan et al., 2025).
Fair access to nature is an important part of creating healthier and more equitable communities.
Green Health can be a cost-effective approach for improving health, wellbeing and prevention (Nejade et. al., 2022). An economic assessment of a Wildlife Trusts nature-based programme found that for every £1 invested an estimated £2.16 was generated in social and health-related benefits with a potential of £635.6 million in NHS savings if expanded nationally (The Wildlife Trusts, 2023).
In a 2023 evaluation of green social prescribing programme in North Wales found that every £1 invested generated up to £5.36 in social value through improved health, wellbeing and social connection (Makanjuola et al., 2023). Nature-based social prescribing programmes involving horticulture and craft activities generated up to £3.30 to £4.70 of social value for every £1 invested and when projected over a year is estimated to have a potential return of £5.40 to £7.70 for every £1 invested (Whiteley et.al., 2025). Demonstrating that investment in nature-based programming can achieve both positive health and wellbeing outcomes while potentially having significant cost–effective implications for population health and healthcare services (Shanahan et. al., 2019).
In Highland, evaluation has been an important part of the Green Health Partnership’s work. Learning from Green Health Prescriptions, Green Health Packs and Events, and wider partnership activity has helped inform service development, strengthen referral pathways and build the case for continued investment in preventative, nature-based approaches to health and wellbeing.
Green Health supports prevention and there is growing evidence of strong return on investment for people, communities and health systems.
Emerging evidence suggests that Green Health can play an important role in responding to the climate crisis. Nature-based activities can strengthen people’s connection with nature, which is associated with greater engagement in pro-environmental behaviours and environmental stewardship (Guazzini et al., 2025).Research suggests that nature connection may also support psychological resilience in the face of climate-related concerns, including eco-anxiety, by fostering a sense of connection, purpose and engagement in meaningful environmental action (Willis et al., 2024)
Nature-based approaches can also strengthen community resilience by building social connection, collective action and stronger relationships between people and the natural environment, all of which are increasingly recognised as important for adapting to climate change (Locatelli et al., 2025). International evidence further identifies nature-based solutions as delivering benefits for human health, climate adaptation and biodiversity simultaneously, offering a ‘triple win’ for people, place and planet (WHO & IUCN, 2024).
In 2023 Highland Adapts, Highland Environment Forum and Highland Green Health Partnership wrote a guide for Community Partnerships in Highland to highlight the interconnections between nature, climate and health.
In 2024 the Highland Charter for Climate, Nature and Health was launched. The Charter has now reached 100 signatories – 42 organisations and 58 individuals. This growing network demonstrates the strength of collaborative action across the Highlands and the commitment to creating a healthier, more sustainable and resilient region.
Highland Research & Learning
Alongside national and international research, the Highland Green Health Partnership has supported and contributed to a growing body of local research, evaluation and learning. This work helps us understand how Green Health is experienced in Highland communities, informs service development and strengthens the evidence base for nature-based approaches to health and wellbeing. Our learning comes from a range of sources, including university partnerships, student research projects, programme evaluations and community-based initiatives.
Current and Recent Projects
Partnerships with universities are important in helping to evaluate programmes, generate new knowledge and strengthen the evidence base for Green Health. Researchers from the University of the Highlands and Islands, alongside colleagues from other universities, have made significant contributions to understanding how nature-based approaches can support physical health, mental wellbeing, active lifestyles and community wellbeing. This growing body of work highlights both the strong research interest in Green Health across the Highlands and Islands and the value of linking research with practice.
Partnership projects in Ullapool and Kinlochleven aim to test community led pathways to green health activity. The Kinlochleven Trust and Ullapool & Lochbroom Development Trust are working with the University of Highlands and Islands to evaluate this innovative pathway which focusses on the assets of the local community. Evaluation methods include training green health coordinators to be community researchers and carry out qualitative interviews with participants, green health providers and community members supported by ongoing reflections from the green health coordinators and surveys for individual activities.
This work has been developed through new funding awarded to NHS Highland CAMHS to deliver community-based interventions alongside essential, third-sector partners, working in the Inverness and Lochaber localities. The aim is to support young people’s mental health while addressing the growing health and healthcare inequalities that shape both their present and future wellbeing. Evaluation is being led by Aberdeen University, alongside partners, and will focus on qualitative data through reflective diaries and observations and semi-structured interviews with young people.
Evaluation leads- University of South Wales, University of Dundee and University of Highlands & Islands
Evaluation Leads University of Highlands and Islands-Professor Anthea Innes (UHI), Dr. Anna Terje (UHI), Mason McLeod (UHI), Laurelin Cummins-Fraser (Trees for Life) and Franny Schlicke (Trees for Life)
This project was developed as a collaboration between Trees for Life and researchers at the Centre for Rural Health Sciences (UHI). Through consultation with people living with dementia and care partners, observations, and participant reflection, the study aimed to inform Dundreggan Rewilding Centre decision making about whether a dementia-inclusive residential experience could become a viable and sustainable future offering. More broadly, the project sought to contribute to ongoing efforts to reduce exclusion from outdoor and nature-based opportunities for people living with dementia and their care partners in the community
This project aimed to explore how golf-related activities can improve health, wellbeing, social inclusion and quality of life for older adults and people living with dementia in a rural community. The project used stakeholder consultations to gather views from older adults, people living with dementia, care partners, voluntary sector groups, health and social care stakeholders, local tourism and recreation partners, UHI golf programme students and the Royal Dornoch Golf Club to identify both barriers and opportunities for inclusive gold participation.
Further Research and Development
- Bespoked’ Cycle to Health Evaluation Report: Promoting health, well-being & active travel through an Inverness social enterprise — University of the Highlands and Islands
- What motivates participants to adhere to green exercise? — University of the Highlands and Islands
- Does the mode of exercise influence the benefits obtained by green exercise? — University of the Highlands and Islands
- Velocity Cycle to Health — University of the Highlands and Islands
- Fraser et al. (2020) Psychological Effects of Outdoor Activity in Type 2 Diabetes: A Review — University of the Highlands and Islands
- Hubbard et al. (2020) Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: Use of theory and practical know-how — University of the Highlands and Islands
Green Health Packs and Events Evaluation Report
The Green Health Events and Packs project formed part of the Think Health Think Nature work programme of the Highland Green Health Partnership and were delivered throughout 2020. This report, carried out by Hilliam Research and Analysis, evaluates the success of the initiative and makes recommendations for any roll out of similar funding initiatives in the future. Read the Green Health Packs and Events Independent Evaluation Report.
Green Health Partnerships in Scotland – An Evaluation of the First Three Years
As the core element of implementing the ONHS programme, four pilot Green Health Partnerships (GHPs) were set up in 2018 to demonstrate how better cross-sectoral coordination can mainstream approaches to improving health through engagement with the natural environment. They were in Dundee, Lanarkshire, North Ayrshire and Highland. The Green Health Partnerships in Scotland- An Evaluation of the First Three Years report presents an overview of how the GHPs worked to achieve five key aims in the first three years of operation.
The James Hutton Institute has carried out a number of studies on the contribution of green and open space in public health and wellbeing. The aim of the project was to explore the relationship between green space and human health using a range of methods and disciplinary approaches at different scales. To read the reports click here.
An evaluation of Green Health Prescriptions across Dundee, Highland, and North Ayrshire
One of the original elements of Green Health Partnerships was the drive to setup and run Green Health Prescription Green Health Prescription (GHPr) pathways, where service users receive a prescription from a healthcare professional, community service, or self-refer. The GHPr allows healthcare professionals to connect patients with free or low-cost outdoor activities delivered and supported by the third sector, including charities and volunteer groups. At the time of this evaluation, Dundee, North Ayrshire, and Highland are in various stages of embedding the GHPr into the referral pathways that they offer. It is, therefore, an ideal time to see what the people coordinating and participating in GHPr think of it. Read the Evaluation from the Public Health Interventions Responsive Studies team – An Evaluation of Green Health Prescriptions across Dundee, Highland and North Ayrshire.
Understanding the barriers to utilising the greenspace in pregnant women and young families in the Aviemore Area.
This study was undertaken by a 3rd Year Medical student from Aberdeen University working on a six week placement with the Think Health Think Nature, in 2019. It has helped to inform Green Health developments in the Badenoch & Strathspey area.
*Report Link Coming
Learning from the COVID-19 Pandemic
A survey of Key Workers and those who have been shielding due to COVID19 on access to greenspace and exercise during lockdown.
The study was undertaken by a 3rd year Medical Student from Aberdeen University on a six week placement with Think Health Think Nature, in 2020. It has helped to inform the partnership’s response to COVID. Access to Greenspace and Exercise During Lockdown.
Exploring how engagement with organized outdoor based activities impact community dwelling people living with dementia perceptions of their wellbeing in the Scottish Highlands
Mason McLeod is a PhD of Health Candidate with the Centre for Rural Health Sciences from the University of the Highlands and Islands. Using participatory action research approaches, she works with people living with dementia and their care partners as co-researchers to learn how engagement with organized outdoor activities/ programs impact their perceptions of their wellbeing in the Scottish Highlands.
Mason is currently conducting field work with two different organizations providing structured outdoor based activities for people living with dementia. Using in-depth qualitative research methods, these settings will form comparative case studies examining how participation in outdoor activities can influence and support wellbeing, experiences of living with dementia within rural communities and how best to integrate outdoor environments into health and social care services for people living with dementia.
Research Limitations and Emerging Areas
A summary of current research limitations:
- Heterogeneity of study populations and settings
- High risk of bias, low certainty of evidence, and methodological weakness
- Small sample sizes and self selection bias
- Lack of universal definition and understanding of green health and nature based interventions
- Short term interventions, lacking studies investigating the long term effects
A summary of practical challenges
- Lack of secure and sustainable funding
- Inequalities in access to nature and green spaces
- Limited guidance and standardization in delivery
- Effectiveness can vary considerable depending on individual characteristics and circumstances
- Wide variation in outcomes measured and programme design
Do your own search!
PubMed is a free resource supporting the search and retrieval of biomedical and life sciences literature with the aim of improving health–both globally and personally. The following link takes you to a pre-populated PubMed search containing words commonly used in the green health peer reviewed literature. All articles in the search are open access and free to view.
Invitation to carry out research projects
We are always interested in hearing from students, researchers, practitioners and community organisations who would like to explore Green Health through research, evaluation or quality improvement projects. Whether you are undertaking a student placement, dissertation, service evaluation, collaborative research project or practice-based enquiry, we welcome opportunities to learn together and strengthen the evidence base for Green Health in Highland. If you have an idea or would like to discuss a potential project, please get in touch- greenhealthhighland@gmail.com
- Castro et al., (2026) Exposure to Green, Blue and Biodiverse Spaces and Loneliness
- Elliott et al., (2023) Nature Contact and General Health
- Fraser et al., (2020) Psychological Effects of Outdoor Activity in Type 2 Diabetes: A Review
- Fry et al., (2026) The effect of place-based nature interventions on human health: A systematic review
- Garrett et al., (2023) Visiting Nature is Associated with Lower Socioeconomic Inequalities in Wellbeing in Wales
- Guazzini et al. (2025) Systematic Review on Nature Connectedness and Pro-Environmental Behaviour
- Harrison et al., (2023) Benefits of Nature-Based Interventions in Socio-Economically Deprived Communities
- Heinen-Stach et al., (2026) The effectiveness of nature-based interventions on mental health: A systematic review
- Hubbard et al., (2020) Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: Use of theory and practical know-how — University of the Highlands and Islands
- Locatelli et al., (2025) People-Nature Relations and Climate Adaptation
- Makanjuola et al., (2023) Prevention of Poor Physical and Mental Health through the Green Social Prescribing Opening Doors to the Outdoors Programme: A Social Return on Investment Analysis
- Marini et al., (2022) The Effect of Physical Activity Interventions Carried Out in Outdoor Natural Blue and Green Spaces on Health Outcomes: A Systematic Review
- Nejade et al., (2022) What is the impact of nature on human health? A scoping review of the literature.
- Ngan et al., (2025) Inequality in green space distribution and its association with preventable deaths across urban neighbourhoods in the UK, stratified by Index of Multiple Deprivation
- Shanahan et al., (2019) Nature-Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes
- The Wildlife Trusts (2023) A natural health service: Improving lives and saving money
- Villeneuve et al., (2024) Does urban greenness reduce loneliness and social isolation among Canadians? A cross-sectional study of middle-aged and older adults of the Canadian Longitudinal Study on Aging (CLSA).
- Wang et al., (2025). Green space and older adults’ health: a scoping review. ://doi.org/10.1093/geroni/igaf119
- Wang et al., (2026) Association between green space exposure and elderly health: a systematic review and meta-analysis
- White et al., (2021) Associations between Green/Blue Spaces and Mental Health Across 18 Countries
- Whiteley et al., (2025) Health Economics-Informed Social Return on Investment (SROI) Analysis of a Nature-Based Social Prescribing Craft and Horticulture Programme for Mental Health and Well-Being.
- WHO & IUCN (2024) Nature-Based Solutions for Health
- Willis et al., (2024) Refocusing on nature: the role of nature reintegration in environmental, mental, and societal wellbeing.
- Wu et al., (2021) Perceived and objective availability of green and blue spaces and quality of life in people with dementia: results from the IDEAL programme.