Bringing nature-based health prevention into cities: the role and perception of Green Care in Germany

Germany lags behind other European countries in implementing preventive health measures, particularly in nature on prescription (green prescribing) to support mental health, while countries such as the United Kingdom, have made substantial progress in implementing nature-based interventions. One promising approach is Green Care—ranging from everyday experiences in green and blue spaces to structured nature-based health promotion and therapy—which supports individual health, community wellbeing, and ecosystem restoration. From a public health perspective, Green Care can contribute to health promotion and prevention by addressing stress, anxiety and depressive symptoms, loneliness, social isolation, and physical inactivity. However, in Germany, the concept of Green Care remains largely unknown. It is only marginally embedded in public discourse, professional practice, and technical language, with limited research on its implementation. Although Germany offers many nature-based services in green and blue spaces, these initiatives are often fragmented, barely visible, and rarely labelled as “Green Care.” Understanding the landscape and stakeholder perceptions is essential for closing knowledge gaps, increasing visibility, and informing a national strategy. This study examines Green Care in Germany using the Ruhr area as a case study. It aims to reveal stakeholder perceptions, identify reasons for low awareness of Green Care, and highlight opportunities and barriers. The empirical basis comprises qualitative interviews ( n = 12) and a co-creation workshop involving Green Care actors. Findings reveal limited awareness despite existing initiatives like therapeutic gardening. Main barriers include unequal access, limited cross-sector cooperation, funding gaps, staff shortages, and dominance of pharmaceutical health approaches. Identified potentials include existing networks, initial financing structures and the multifunctional use of green and blue spaces. This study addresses a research gap by identifying factors that hinder and promote the integration of Green Care in Germany, offering guidance for policymakers, practitioners, and researchers to scale initiatives and embed nature-based approaches into sustainable urban development.