Nature-based health initiatives: A governance assessment tool based on indicators

Abstract

Nature-based health initiatives (NbHIs) are emerging as innovative approaches to promoting human well-being and environmental sustainability. However, a standardised method to evaluate the multi-actor, multi-level, and multi-sector governance required for their implementation is lacking. This study addresses this gap by presenting an evaluation tool empirically tested through a multi-case study involving three NbHIs at different stages of development in North-Eastern Italy. Data were collected through 20 in-depth structured interviews with experts and 27 online questionnaires completed by the initiative participants. A total of 152 governance indicators were derived and hierarchically aggregated into a composite index, designed to capture the multidimensional and context-sensitive nature of NbHI governance, based on a purpose-built conceptual framework. The findings highlight that overall governance performance does not align uniformly across all dimensions and components of the framework. This variability is shaped by governance-related and contextual factors, such as the composition of the actor network and the maturity stage of each initiative. The proposed methodology provides a practical and adaptable tool for monitoring and evaluating the governance of NbHIs, helping to identify strengths and weaknesses and offering guidance for targeted improvements. It enhances understanding of how these initiatives can generate meaningful environmental and health outcomes through stronger cross-sectoral collaboration, providing evidence to support their integration into both health and environmental policy agendas. Finally, the study illustrates the application of the tool by offering case-specific recommendations and actionable insights for practitioners involved in the design and implementation of NbHIs.