{
  "abstract": "Background Exposure to open space provides well-established health and wellbeing benefits; however, inequalities in access persist. The National Health Service (NHS) in Scotland has 825 hectares of open space (around half of its total estate) accessible to patients, caregivers, staff, and the public. These spaces present a unique but underexplored opportunity to realise additional health and wellbeing value. To date, no studies have quantified the health and wellbeing value of NHS or comparable health-based estate.Methods This cross-sectional study applied two survey-based non-market valuation methods in line with Natural Capital Accounting principles. First, the Office for National Statistics (ONS) approach estimated health benefits from outdoor exposure using Quality-Adjusted Life Years (QALYs). Second, a stated-preference contingent valuation method (CVM) elicited willingness to pay (WTP) for access to NHS open spaces to capture wider wellbeing benefits. Data were collected through an online survey of a representative sample of 2,449 adults in Scotland in late 2024.Results An estimated 91 million hours of annual exposure occur within NHS Scotland open spaces. Most visits last less than 30 minutes, are associated with accessing NHS services, and involve low-impact activities, indicating that benefits are primarily linked to mental wellbeing. People with disabilities, mental health conditions, or limited access to other open spaces were more likely to use the NHS estate for recreation. Based on the QALY approach, the annual health benefits from this exposure are valued at £82.0 million [£67.8–£96.1 million], mostly from primary care sites. The CVM finds annual WTP estimates of £145 [£123–£180] per adult for hospital sites and £125 [£111–£207] for primary care sites.Conclusion These findings demonstrate substantial social and economic value generated by NHS open spaces. Results are being shared with NHS Scotland boards and Public Health Scotland to inform estate planning and support the NHS Scotland Climate Emergency and Sustainability Strategy.",
  "authors": [
    {
      "affiliations": [
        "Health Economics Research Unit, University of Aberdeen, Aberdeen, UK"
      ],
      "name": "Luis Loria-Rebolledo"
    },
    {
      "affiliations": [
        "Public Health Scotland, Edinburgh, UK"
      ],
      "name": "Neil Chalmers"
    },
    {
      "affiliations": [
        "Health Economics Research Unit, University of Aberdeen, Aberdeen, UK",
        "RTI Health Solutions, Manchester, UK"
      ],
      "name": "Verity Watson"
    },
    {
      "affiliations": [
        "Health Economics Research Unit, University of Aberdeen, Aberdeen, UK"
      ],
      "name": "Dwayne Boyers"
    },
    {
      "affiliations": [
        "Health Economics Research Unit, University of Aberdeen, Aberdeen, UK"
      ],
      "name": "Melanie Antunes"
    }
  ],
  "title": "OP02 Estimating the value of the health and wellbeing benefits of the NHS Scotland outdoor estate: a cross-sectional study",
  "uid": "adcaad85-6a90-595d-9ee4-f38ed46e32e7"
}