The use of non‐medical referral, community referral or social prescribing interventions has been proposed as a cost‐effective alternative to help those with long‐term conditions manage their illness and improve health and well‐being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of ‘if‐then’ statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web‐based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.

Social prescribing is an approach that aims to improve health and well-being. It connects individuals to non-clinical services and supports that address social needs, such as those related to loneliness, housing instability and mental health. At the person level, social prescribing can give individuals the knowledge, skills, motivation and confidence to manage their own health and well-being. At the society level, it can facilitate greater collaboration across health, social, and community sectors to promote integrated care and move beyond the traditional biomedical model of health. While the term social prescribing was first popularised in the UK, this practice has become more prevalent and widely publicised internationally over the last decade. This paper aims to illuminate the ways social prescribing has been conceptualised and implemented across 17 countries in Europe, Asia, Australia and North America. We draw from the ‘Beyond the Building Blocks’ framework to describe the essential inputs for adopting social prescribing into policy and practice, related to service delivery; social determinants and household production of health; workforce; leadership and governance; financing, community organisations and societal partnerships; health technology; and information, learning and accountability. Cross-cutting lessons can inform country and regional efforts to tailor social prescribing models to best support local needs.

Many studies suggest that exposure to natural environments (‘greenspace’) enhances human health and wellbeing. Benefits potentially arise via several mechanisms including stress reduction, opportunity and motivation for physical activity, and reduced air pollution exposure. However, the evidence is mixed and sometimes inconclusive. One explanation may be that “greenspace” is typically treated as a homogenous environment type. However, recent research has revealed that different types and qualities of natural environments may influence health and wellbeing to different extents. This ecological study explores this issue further using data on land cover type, bird species richness, water quality and protected or designated status to create small-area environmental indicators across Great Britain. Associations between these indicators and age/sex standardised prevalence of both good and bad health from the 2011 Census were assessed using linear regression models. Models were adjusted for indicators of socio-economic deprivation and rurality, and also investigated effect modification by these contextual characteristics. Positive associations were observed between good health prevalence and the density of the greenspace types, “broadleaf woodland”, “arable and horticulture”, “improved grassland”, “saltwater” and “coastal”, after adjusting for potential confounders. Inverse associations with bad health prevalence were observed for the same greenspace types, with the exception of “saltwater”. Land cover diversity and density of protected/designated areas were also associated with good and bad health in the predicted manner. Bird species richness (an indicator of local biodiversity) was only associated with good health prevalence. Surface water quality, an indicator of general local environmental condition, was associated with good and bad health prevalence contrary to the manner expected, with poorer water quality associated with better population health. Effect modification by income deprivation and urban/rural status was observed for several of the indicators. The findings indicate that the type, quality and context of ‘greenspace’ should be considered in the assessment of relationships between greenspace and human health and wellbeing. Opportunities exist to further integrate approaches from ecosystem services and public health perspectives to maximise opportunities to inform policies for health and environmental improvement and protection.

This is the author’s version of a work that was accepted for publication in Landscape and Urban Planning. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published at doi:10.1016/j.landurbplan.2015.05.008.Exposure to green space is associated with a variety of positive health states. Research to date has focused primarily on ‘generic’ green space in urban areas, where green space is relatively scarce and where it is dominated by playing fields and parks. The current research adds to our understanding with an examination of relationships between different types of green space and mental health in rural areas in England (approximate rural population = 4 million). The aggregate land cover classes of Land Cover Map 2007 were linked to rural residential areas (Lower-level Super Output Areas) and then linked to rural participants (n = 2020) in the 18-year longitudinal British Household Panel Survey. Random effects regression of mental health (as measured by GHQ12 scores) against land cover enabled effects to be simultaneously estimated from both mean between-individual differences and from within-individual differences over time. The nine natural land cover classes (Broadleaved woodland; Coniferous woodland; Arable; Improved grassland; Semi-natural grassland; Mountain, heath and bog; Saltwater; Freshwater; Coastal) were not significantly associated with differences in mental health between individuals. However, significant relationships were observed between some types of land cover and within-individual change in mental health amongst individuals who relocated during the 18 annual waves of the panel. These findings indicate the presence of important health related ecosystem services from different land cover types that have not previously been investigated and which help more effective spatial planning and land use management.Economic and Social Research CouncilNational Institute for Health Research Health Protection Research Unit (NIHR HPRU