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.
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