Integrating Green Care Initiatives into National Healthcare provisions: a literature review focused on governance dimensions

The umbrella term Green Care (GC) includes a spectrum of interventions supporting health promotion, disease prevention, and rehabilitation. GC can potentially improve public healthcare provision, responding to modern increases in demand for healthcare in the general population and the specific needs of vulnerable groups. Actions aimed at expanding care provision are often undertaken by the government justified on public economic grounds to reduce the impact of market and information failures that undermine people's ability to maximize their welfare. Despite this, public health organizations and institutions have not yet recognized GC's potential in supporting innovative health practices. Green Care Initiatives (GCIs) are organized interventions involving professionals of different legal entities (e.g., private, public) and various fields (e.g., forestry, healthcare, agriculture) representing diverse environmental, economic, social, and health-related stakes. Therefore, the issue is strictly connected to the partnership composition, decision-making processes, and rules implemented by GC actors and, thus, embedded in a governance framework. Given this, our aim is to comprehend which conditions could enable GCIs to be recognized within the public health system by adopting an analytical understanding of governance. Therefore, we conducted a systematic literature review of international studies on integrating GCIs into healthcare systems by exploring the conditions observed for this to happen and through which specific governance arrangements. By following the PRISMA guidelines, search strings of keywords were combined concerning the themes of "Green Care," "Healthcare," and "Governance" in Scopus and Web of Science databases. Then, pre-defined criteria were applied to refine the selection of relevant documents. Finally, findings were categorized under the main dimensions to facilitate qualitative analysis. Results from our research indicate that the discourses around governance are more developed in Social Farming, while contrastingly, Forest-based initiatives remain little explored. Our governance analytical framework could facilitate institutional awareness and evidence-based decision-making to support the integration of GCIs into healthcare practices. Furthermore, it could help determine relevant aspects for the success of GCIs by paving the way for developing an evaluation framework based on different health and environmental governance dimensions.