Kate Bailey CMLI MRTPI reflects on the health and wellbeing benefits of physical activity, social prescribing and natural assets

    Peter Neal © Olympic Park
    Olympic Park. © Peter Neal

    Kate Bailey CMLI MRTPI, Chair of the Landscape Institute Policy Committee, attended a natural health conference earlier this year. Here, she reflects on the topics, themes, and thoughts for the future.

    The Natural Health Service (NaHS) Conference at Liverpool John Moores University in May provided a wealth of evidence to demonstrate the huge value to communities of green infrastructure in terms of health and wellbeing.

    Set up by the Mersey Forest and partners and funded by the National Lottery, NaHS uses the natural environment to provide physical activities for individuals and communities in Merseyside and North Cheshire. The conference brought together academics and professionals from NHS England, Local Nature Partnerships, local authorities, universities, several environmental trusts and other organisations aiming to engage people in outdoor activities.

    The benefits of being active

    The highlight of the first session was the inspirational talk by Professor Greg Whyte, who has been responsible for encouraging and training sedentary celebrities, including Eddie Izzard, David Walliams and Jo Brand, to undertake extraordinary physical challenges in aid of Sports Relief. He explained that any activity, no matter how small, will have positive benefits for health. Incremental steps towards becoming more active out of doors can lead to behaviour change.

    Lack of physical activity accounts for 16% of all deaths in the UK. The UK is high on the list of inactive populations, as defined by Sport England and WHO guidelines for health. Inactivity is recorded in 18.2% of the population of Holland; in 40.5% of the population of the USA, and in 63.3% of the UK population. And we think Americans are unhealthy!

    The elderly, the poor and the obese are least active, such that the London Borough of Newham comes bottom of the UK list, despite being the closest borough to the Olympic Park. Inactivity carries the same risk for coronary vascular disease as smoking, and twice the risk of obesity. A third of children now leave primary school either obese or overweight; obesity will lead to shortened lives for these children.

    On the positive side, increased outdoor activity can be demonstrated to have a beneficial effect on mental health, mood, sleep, social integration and family life. Moderate levels of activity can reverse type 2 diabetes, which at present affects four million people and costs the NHS £20 billion each year. Professor Whyte talked about ‘Green Gyms’ and ‘Blue Gyms’ – open water swimming is shown to strengthen our immune systems – and suggested that we should focus on encouraging children to join ‘Forest Schools’ and similar teams or clubs, as well as coaxing older people to join in different types of gentle outdoor activities.

    Social prescribing

    Bev Taylor of NHS England is working to embed ‘social prescribing’ across the NHS, connecting patients via their GP with link-worker ‘navigators’ and community groups, to manage health conditions via social activities the person is interested in. These may be gardening groups, health walks, exercise groups, nature conservation groups and others that improve individual wellbeing and promote independent living.

    Eco-therapy, green prescriptions and regular contact with the natural environment have all been shown to enhance physical health, mental wellbeing and social relationships within communities. Encouraging results from a pilot project in Rotherham, where Voluntary Action Rotherham is funded through an NHS Clinical Commissioning Group standard contract, demonstrated that in-patient stays fell by 51% and A&E attendance by 35% in 2015. (Source: Sheffield Hallam University.)

    Natural assets

    Paul Nolan, Director of the Mersey Forest, spoke about their work to transform unloved sites and derelict land close to urban areas, and their engagement with communities to maximise the use of woodlands for health. NaHS is demonstrating to health professionals that using natural assets that provide commissionable services for people most at risk can benefit society far more effectively than spending NHS budgets on conventional prescriptions and healthcare interventions.

    Healthy places provide low-cost interventions that in turn reduce public spending. Pilot projects have been used to test and develop projects and programmes across Merseyside, including Nature4Health, funded by the Big Lottery. The ‘Natural Choices’ pilot in Liverpool resulted in an 18% increase in reported wellbeing over a nine-month period. The NaHS Consortium has carried out a social return on investment study, which predicts that for every £1 invested in the service, a social return of £6.75 will be generated.

    General messages from other participants suggest that the natural environment needs to be safe and accessible to encourage people to get involved. The NaHS is a collaborative learning process, requiring leadership and partnership at a local level. GPs, schools and conservation groups need to be willing to adapt and learn new skills, in order to make things happen near to where people live and work. Changing behaviours is difficult; projects need clear objectives, clarity about added value and thorough evaluation of outcomes.

    Landscape professionals have an important role to play in disseminating the messages about green infrastructure, physical activity and the benefits to health and wellbeing. The LI’s Policy and Communications Committee will be developing this theme further in the next year.

    The LI will explore further the theme of public health and landscape in Bristol next month at Built-in Health: designing for health in the public realm.

    For more information on LI public health policy, visit our policy area.


    1. The real issue is about people making unsustainable life choices which is explained by ‘Life History Theory’ as being the product of poorly resourced habitual environments. The whole environment needs to change to support positive habitual behaviour change, and it is the professions and professionals that need educating most in this respect – not ‘people’. Currently, the message sounds like ‘we have always known what is best, so let us get on with it’. A more jaundiced view might be that the professions are foraging in a new area of work using new terms in an old narrative.

      The article tells us that “Lack of physical activity accounts for 16% of all deaths in the UK”. Suicide is the biggest killer of men under the age of 55.

      It is unlikely that landscape architects cause much harm through their activities, however they are scratching at the surface and having barely any real impact. But they could cause much good by growing as a profession to lead this environmental catastrophe we face – our failure to create and nurture human habitats for thrival. Its not about the ‘green’ – its about all the colours. Its not about the trees – its about the ‘commons’. The old fogies may not be able to change their ways, but the young professionals must rise up and face these challenges with fresh ideas and understandings. Start with Lawrence Halprin and apply contemporary evolutionary psychology. Here is a talk I gave two weeks ago in Guernsey on the subject – its for a lay audience, but starts the ball rolling: https://www.youtube.com/watch?v=cK190guCia4&t=10s

      • I’m very new to this website. I intend to do a landscape architecture conversion course next year and I found this article and your response very interesting. Am I right in thinking that a Landscape Architect could play a very important role here in designing walkways and cycle paths throughout cities that could provide people with a pleasant and safe alternative to getting to work which would enable them to be active and get out their cars? For instance near where I live in Birmingham we have a cycle path/ walkway that runs along the River Rea which is brilliant during daylight but quite intimidating when it is dark. It would be great if it could be made to feel safer at night. Would that be a Landscape Architects job or would that be a different profession?


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