自然健康服务的理论框架与实施体系

The Framework and Implementation System of Nature-based Health Services (NBHS)

摘要

【目的】厘清自然健康服务（nature-based health services, NBHS）的定义，探讨开展NBHS的绿色空间类型、实施路径及体系构成，为实现NBHS本土化运用提供理论基础。【方法】使用资料检索与文献梳理相结合的研究方法，对英国、日本、韩国、德国、芬兰与加拿大的NBHS案例进行研究，总结了NBHS的理论框架与实施路径。【结果】NBHS是面向具有特定需求的人群而设计和实施、通过利用自然环境及要素开展的健康促进服务项目，包括服务对象与需求识别、转介与方式匹配、组织网络与项目交付、随访与效果评估、监管与问责、支付与可支付化6个环节。NBHS的有效实施需要根据NBHS干预的专业复杂度来匹配不同类别的绿色空间。【结论】NBHS作为一种低成本、可持续的公共健康促进手段，在中国的普及运用还处于初级阶段，未来可开展符合中国国情的NBHS制度研究，为本土化探索奠定基础。

Abstract

[Objective] This study aims to clarify the conceptual boundary, institutional attributes, spatial basis, and implementation pathway of nature-based health services (NBHS), and to provide a theoretical and practical reference for establishing a systematic NBHS framework in China. Against the background of increasing chronic disease burden, mental health pressure, population ageing, and rising medical costs, NBHS are regarded in this study as a low-cost, accessible, and sustainable supplement to conventional clinical medicine and social welfare services. The study further seeks to explain how natural environments and organized nature-based activities can be transformed from individual, fragmented health-promoting experiences into structured, deliverable, assessable, and accountable public health services. [Methods] This study adopts conceptual analysis, literature review, and international comparative case analysis. First, NBHS is distinguished from several related concepts, including nature-based solutions, ecosystem services, and nature-based interventions, in order to identify its service-oriented characteristics and institutional boundaries. Second, six representative countries, namely the United Kingdom, Japan, South Korea, Germany, Finland, and Canada, are selected for comparative analysis. These cases are examined in terms of policy support, access and referral mechanisms, organizational delivery, intervention forms, target populations, professional qualifications, payment arrangements, and monitoring systems. Third, based on the relationship between service recipients, green space resources, professional intervention, and institutional responsibility, the study constructs a graded framework for NBHS implementation. This framework includes the classification of green spaces, the identification of service recipients and needs, referral and service matching, organizational networks, project delivery, follow-up assessment, regulation, accountability, and payment mechanisms. [Results] The findings show that NBHS should not be understood merely as spontaneous contact with nature or as a general category of nature-based activities. It is a structured health promotion and social intervention service designed for populations with identifiable health, rehabilitation, welfare, or social support needs. Its core attributes include clear service recipients, defined delivery processes, responsible institutions, professional or organizational support, follow-up assessment, and regulatory accountability. The international comparison indicates that mature NBHS systems usually rely on stable institutional arrangements. In the United Kingdom, green social prescribing connects medical and community resources through link workers and integrated care systems. Japan and South Korea emphasize forest therapy and forest welfare, with strong support from forestry and public agencies. Germany incorporates nature-based rehabilitation into the medical and insurance system through certified therapeutic sites. Finland develops green care through professional associations, municipal services, and community networks. Canada promotes nature prescription through medical professionals, park agencies, and non-profit organizations. These models reveal that access and referral mechanisms are decisive for service precision, equity, and sustainability. Where medical, community, or social welfare institutions are involved, NBHS is more likely to achieve accurate population targeting, standardized service delivery, and policy or financial support. The study also finds that green space is not only the physical carrier of NBHS, but also a key determinant of service supply capacity. In the NBHS framework, green spaces should be classified according to service intensity, organizational requirements, professional intervention, and risk control. At the urban scale, green spaces can be divided into open universal spaces, organized delivery spaces, and base therapeutic spaces. At the community scale, they can be divided into neighborhood embedded spaces, community co-governed spaces, and institution-managed spaces. Their supply level can be assessed through accessibility, coverage capacity, and carrying capacity. Accessibility concerns the complete behavioral chain of reaching, entering, using, leaving, and repeatedly participating in NBHS activities. Coverage capacity reflects whether suitable green space types and resources exist within the daily living circle or referral radius. Carrying capacity concerns space size, service quota, waiting time, staffing, activity frequency, and risk management. The study further proposes a three-tier classification of service recipients: people with relatively mild health promotion needs who can participate through self-referral; people with chronic disease, psychological distress, or social support needs who require community-level referral; and people with severe health or functional limitations who require medical assessment and assisted participation. [Conclusion] China is currently moving from dispersed nature-based health practices toward the institutionalization of NBHS. Existing practices such as forest wellness, horticultural therapy, therapeutic gardening, and wellness bases have accumulated useful experience, but they remain weak in service referral, process management, effectiveness evaluation, payment mechanisms, and spatial equity. A China-oriented NBHS system should therefore integrate population needs, green space classification, referral pathways, service delivery, follow-up assessment, regulation, accountability, and mixed payment arrangements. Rather than relying only on forest wellness bases, scenic areas, or medical institutions, China should build a multi-level green space network that includes urban parks, community gardens, pocket parks, therapeutic landscapes, institutional gardens, and specialized wellness bases. Such a framework can improve the accessibility, equity, and sustainability of nature-based health services, support the integration of NBHS into public health governance and social welfare systems, and provide a practical pathway for transforming natural resources into everyday health-promoting services.

关键词

自然健康服务 / 绿色空间供给 / 实施路径 / 公共健康治理

Key words

nature-based health services / green space supply / implementation pathway / public health governance

参考文献

[1] Patel V, Saxena S, Lund C, et al. The Lancet Commission on Global Mental Health and Sustainable Development[J]. The Lancet, 2018, 392(10157): 1553-1598.

[2] 张金光, 余兆武, 赵兵 . 城市绿地促进人群健康的作用途径: 理论框架与实践启示[J]. 景观设计学(中英文), 2020, 8(4): 104-113.

[3] Zhang J G, Yu Z W, Zhao B . Impact Mechanism of Urban Green Spaces in Promoting Public Health: Theoretical Framework and Inspiration for Practical Experiences[J]. Landscape Architecture Frontiers, 2020, 8(4): 104-113.

[4] 姜斌, 张恬, 苏利文 . 健康城市: 论城市绿色景观对大众健康的影响机制及重要研究问题[J]. 景观设计学, 2015, 3(1): 24-35.

[5] Jiang B, Zhang T, Sullivan W C . Healthy Cities: Mechanisms and Research Questions Regarding the Impacts of Urban Green Landscapes on Public Health and Well-Being[J]. Landscape Architecture Frontiers, 2015, 3(1): 24-35.

[6] Twohig-Bennett C, Jones A . The Health Benefits of the Great Outdoors: A Systematic Review and Meta-Analysis of Greenspace Exposure and Health Outcomes[J]. Environmental Research, 2018, 166: 628-637.

[7] 李同予, 李徐钧逸, 薛滨夏, 等 . 公共健康促进功能的绿色基础设施研究进展与展望[J]. 风景园林, 2025, 32(7): 12-20.

[8] Li T Y, Lixu J Y, Xue B X, et al. Research Progress and Prospect of Green Infrastructure with Public Health Promotion Function[J]. Landscape Architecture, 2025, 32(7): 12-20.

[9] Shanahan D F, Bush R, Gaston K J, et al. Health Benefits from Nature Experiences Depend on Dose[J]. Scientific Reports, 2016, 6: 28551.

[10] Astell-Burt T, Pritchard T, Francois M, et al. Nature Prescriptions Should Address Motivations and Barriers to Be Effective, Equitable, and Sustainable[J]. The Lancet Planetary Health, 2023, 7(7): e542-e543.

[11] Wolch J R, Byrne J, Newell J P . Urban Green Space, Public Health, and Environmental Justice: The Challenge of Making Cities ‘Just Green Enough’[J]. Landscape and Urban Planning, 2014, 125: 234-244.

[12] Rigolon A. A Complex Landscape of Inequity in Access to Urban Parks: A Literature Review[J]. Landscape and Urban Planning, 2016, 153: 160-169.

[13] World Health Organization Regional Office for Europe . Urban Green Spaces and Health[R]. Copenhagen: WHO Regional Office for Europe, 2016.

[14] Xian Z, Nakaya T, Liu K, et al. The Effects of Neighbourhood Green Spaces on Mental Health of Disadvantaged Groups: A Systematic Review[J]. Humanities and Social Sciences Communications, 2024, 11(1): 488.

[15] 孙震, 吴承照 . 森林疗愈的影响因素及产业化进展研究综述[J]. 风景园林, 2025, 32(8): 93-101.

[16] Sun Z, Wu C Z . A Review of Research on the Influencing Factors and Industrialization Progress of Forest Healing[J]. Landscape Architecture, 2025, 32(8): 93-101.

[17] 国家林业和草原局办公室 . 国家林业和草原局办公室关于印发《贯彻落实〈国家林业和草原局关于促进林草产业高质量发展的指导意见〉任务分工方案》的通知[EB/OL]. (2019-03-19)[2026-01-12]. https://www.forestry.gov.cn/c/www/gkzfwj/272404.jhtml.

[18] Office of the National Forestry and Grassland Administration. Notice of the Office of the National Forestry and Grassland Administration on Issuing the Task Allocation Plan for Implementing the Guiding Opinions of the National Forestry and Grassland Administration on Promoting the High-Quality Development of the Forestry and Grassland Industry[EB/OL]. (2019-03-19)[2026-01-12]. https://www.forestry.gov.cn/c/www/gkzfwj/272404.jhtml.

[19] Steigen A M, Eriksson B G, Kogstad R E, et al. The Meaning of Social Support in Nature-Based Services for Young Adults with Mental Health Problems[J]. International Journal of Environmental Research and Public Health, 2022, 19(3): 1638.

[20] England NHS . Green Social Prescribing[EB/OL]. (2025-12-22)[2026-01-12]. https://www.england.nhs.uk/personalisedcare/social-prescribing/green-social-prescribing/.

[21] Carrington D. ‘Better Than Medication’: Prescribing Nature Works, Project Shows[EB/OL]. (2024-09-04)[2026-05-23]. https://www.theguardian.com/environment/article/2024/sep/04/better-than-medication-prescribing-nature-works-project-shows.

[22] Wood C J, Polley M, Barton J L, et al. Therapeutic Community Gardening as a Green Social Prescription for Mental Ill-Health: Impact, Barriers, and Facilitators from the Perspective of Multiple Stakeholders[J]. International Journal of Environmental Research and Public Health, 2022, 19(20): 13612.

[23] Sempik J, Aldridge J . Care Farms and Care Gardens: Horticulture as Therapy in the UK[M]//Hassink J, van Dijk M. Farming for Health. Dordrecht: Springer, 2006: 147-161.

[24] Forest Therapy Society . Forests: Certified Forests[EB/OL]. (2025-12-23)[2026-01-12]. https://www.fo-society.jp/en/forests.html.

[25] Shin W S . Forest Policy and Forest Healing in the Republic of Korea[EB/OL]. (2015-10-10)[2026-01-12]. https://www.infom.org/news/2015/10/10.html.

[26] Park S, Kim S, Kim G, et al. Evidence-Based Status of Forest Healing Program in South Korea[J]. International Journal of Environmental Research and Public Health, 2021, 18(19): 10368.

[27] 刘立军 . 森林康养理论与实践[M]. 北京: 中国林业出版社, 2023.

[28] Liu L J . Theory and Practice of Forest Health Care[M]. Beijing: China Forestry Publishing House, 2023.

[29] Natural Resources Institute Finland (Luke) . Green Care Activities Contribute to Place-Based Sustainability[EB/OL]. (2023-08-09)[2025-12-23]. https://www.luke.fi/en/news/green-care-activities-contribute-to-placebased-sustainability.

[30] Ylilauri M. Green Care Organization and Certification in Finland[EB/OL]. [2026-01-12]. https://www.gcfinland.fi/tiedostopankki/431/Abstract-Martta-Ylilauri-Kristiansand.pdf.

[31] Finnish Ministry of the Environment. Everyman’s right in Finland: Public Access to the Countryside: Rights and Responsibilities[R]. Helsinki: Finnish Ministry of the Environment, 2007.

[32] Foundation B C P . The BC Parks Foundation Launches PaRx: Canada's First National Nature Prescription Program[EB/OL]. (2020-11-30)[2026-01-12]. https://www.parkprescriptions.ca/blogposts/the-bc-parks-foundation-launches-parx-canadas-first-national-nature-prescription-program.

[33] Li Y M, Xie Y L, Sun S Q, et al. Evaluation of Park Accessibility Based on Improved Gaussian Two-Step Floating Catchment Area Method: A Case Study of Xi’an City[J]. Buildings, 2022, 12(7): 871.

[34] Babalis D. A New Typology of Pocket Parks: Inspiring Small Spaces for Changing Cities[J]. Proceedings of the Institution of Civil Engineers - Urban Design and Planning, 2020, 173(3): 108-117.

[35] Haubenhofer D K, Elings M, Hassink J, et al. The Development of Green Care in Western European Countries[J]. EXPLORE, 2010, 6(2): 106-111.

[36] Nieberler-Walker K, Desha C, Bosman C, et al. Therapeutic Hospital Gardens: Literature Review and Working Definition[J]. HERD: Health Environments Research & Design Journal, 2023, 16(4): 260-295.

[37] Neutens T, Schwanen T, Witlox F, et al. Equity of Urban Service Delivery: A Comparison of Different Accessibility Measures[J]. Environment and Planning A: Economy and Space, 2010, 42(7): 1613-1635.

[38] Kwan M P . Space-Time and Integral Measures of Individual Accessibility: A Comparative Analysis Using a Point-Based Framework[J]. Geographical Analysis, 1998, 30(3): 191-216.

[39] Talen E. The Social Equity of Urban Service Distribution: An Exploration of Park Access in Pueblo, Colorado, and Macon, Georgia[J]. Urban Geography, 1997, 18(6): 521-541.

[40] Nicholls S. Measuring the Accessibility and Equity of Public Parks: A Case Study Using GIS[J]. Managing Leisure, 2001, 6(4): 201-219.

[41] Elwyn G, Frosch D, Thomson R, et al. Shared Decision Making: A Model for Clinical Practice[J]. Journal of General Internal Medicine, 2012, 27(10): 1361-1367.

[42] Bickerdike L, Booth A, Wilson P M, et al. Social Prescribing: Less Rhetoric and More Reality. A Systematic Review of the Evidence[J]. BMJ Open, 2017, 7(4): e013384.

[43] Tierney S, Wong G, Roberts N, et al. Supporting Social Prescribing in Primary Care by Linking People to Local Assets: A Realist Review[J]. BMC Medicine, 2020, 18(1): 49.

[44] Ylilauri M, Voutilainen O . Review of Nordic Nature-Based Service Models: Study on the Opportunities and Challenges of the Nature-Based Services in Finland, Sweden and Norway[R]. Vaasa: University of Vaasa, 2021.

[45] Moore G F, Audrey S, Barker M, et al. Process Evaluation of Complex Interventions: Medical Research Council Guidance[J]. BMJ, 2015, 350: h1258.

[46] Benson T, Sladen J, Liles A, et al. Personal Wellbeing Score (PWS)−A Short Version of ONS4: Development and Validation in Social Prescribing[J]. BMJ Open Quality, 2019, 8(2): e000394.

[47] Donabedian A . The Quality of Care: How Can It Be Assessed?[J]. Jama, 1988, 260(12): 1743.

[48] Berwick D, Fox D M . “Evaluating the Quality of Medical Care”: Donabedian’s Classic Article 50 Years Later: “Evaluating the Quality of Medical Care”[J]. The Milbank Quarterly, 2016, 94(2): 237-241.

[49] Sandhu S, Alderwick H, Gottlieb L M . Financing Approaches to Social Prescribing Programs in England and the United States[J]. The Milbank Quarterly, 2022, 100(2): 393-423.

基金资助

国家自然科学基金面上项目“基于大学生积极心理促进的校园恢复性环境循证建构研究”(52378014)

国家心理健康和精神卫生防治中心“我国当代心理健康问题多学科融合防治策略”课题研究一般支持课题“基于自然干预的城市社区嵌入式老年心理健康服务体系研究”(GXDXK2025B-19)