A Governance Perspective on Green Prescriptions in Forests: Lessons from Best-Practice Countries

Acknowledging the widely recognized benefits of nature connection, particularly within forest environments, this thesis investigates the governance structures, arrangements, processes, and actions related with the implementation of the so-called “Green Prescriptions” (GRx) in more advanced countries, with a focus on deriving lessons applicable to Italy and Bangladesh, where these approaches are not mainstreamed yet. The study aims to understand how nature-based health interventions are integrated into national health systems, using the best practices of Japan, Korea, the USA, Canada, and New Zealand as benchmarks. The research employs an exploratory qualitative approach, supported by a comprehensive literature review and content-based comparative analysis of policy documents, reports and papers. The methodology is structured around a conceptual framework that builds upon the foundational works of Atun et al. (2010), Mendel & Scott (2010), Foley et al. (2023), Kjaer (2004), Sikor et al. (2017), and the World Health Organization (2000). This framework focuses on governance elements, financing, planning, service delivery, monitoring and evaluation, and demand generation. The analytical framework was developed to systematically analyze the qualitative data from each country, incorporating key elements such as country context, governance phases (setting, implementation, and enforcement of rules), and the outputs of GRx programs. This framework allows for the identification of successful practices and challenges in different governance models, providing a basis for formulating recommendations tailored to the specific contexts of Italy and Bangladesh. Key findings reveal that Japan and Korea have developed robust legal frameworks and dedicated research institutions to support GRx, while the USA and New Zealand have successfully integrated GRx into community health programs and promoted broad public awareness. Canada's approach emphasizes digital platforms to facilitate healthcare providers in prescribing nature-based activities. The findings reveal that while Italy's situation is more akin to Japan and Korea, with a need for regional governance and research integration, Bangladesh requires foundational steps to establish GRx, including the development of urban green spaces and public awareness campaigns. The study's implications are significant for policymakers, practitioners and scientists in Italy and Bangladesh. For Italy, recommendations include developing specific GRx legislation, leveraging regional governance structures, and enhancing collaboration between healthcare and environmental sectors. For Bangladesh, the study recommends launching public awareness initiatives, creating accessible and safe urban green spaces, and establishing a central coordinating body within the health ministry to oversee GRx implementation. These steps are essential for both countries to harness the full potential of nature-based health interventions and improve public health outcomes. Some of the lessons learned from the more advanced countries and the recommendations formulated for Italy and Bangladesh are also valid and applicable to other countries, particularly those within the Mediterranean basin. Consequently, this thesis not only enhances our understanding of nature-based health prescriptions but also provides a framework that can guide the implementation and integration of similar interventions in various Mediterranean countries