The systematic mapping of nature-based solutions across the climate-health nexus arrives at a moment when policymakers increasingly demand integrated evidence rather than siloed assessments. By applying the well-established vulnerability framework—decomposed into exposure, sensitivity and adaptive capacity—the authors provide a structured vocabulary for describing precisely where and how interventions such as urban green infrastructure, agroforestry, wetland conservation and forest restoration intervene in the causal chain running from climatic hazard to human health outcome. This analytical choice matters because vulnerability frameworks have long been used in climate impact assessment, yet their explicit application to health outcomes mediated by ecosystems remains comparatively rare. The result is a conceptual bridge that allows findings from disparate literatures—urban planning, epidemiology, ecology and development studies—to be compared on common terms.

The distinction between the three vulnerability components deserves closer attention, because each implies a different theory of change for intervention. Reducing exposure means physically shielding populations from hazards: floodplains restored with wetlands absorb storm surges before they reach settlements, street trees and vegetated corridors lower ambient temperatures in heat-prone districts, and riparian buffers filter pollutants before they enter drinking water supplies. Reducing sensitivity, by contrast, addresses how severely a given dose of hazard translates into harm, for example by improving air quality so that the same pollution episode produces fewer respiratory events, or by strengthening food systems through diversified agroecosystems so that a drought year does not translate directly into nutritional deficits. Enhancing adaptive capacity is the most socially mediated of the three, encompassing the resources, knowledge and institutional support that communities can mobilise when hazards strike. The review’s finding that nature-based solutions operate across all three domains simultaneously helps explain why their health benefits often appear diffuse and difficult to attribute in conventional evaluation designs, since a single intervention may act through several pathways at once.

The evidence on mitigation benefits documented in the review aligns with a growing body of quantitative assessments. Urban trees and green spaces moderate the urban heat island effect through shading and evapotranspiration, with measured temperature reductions in dense city districts frequently reaching several degrees Celsius during peak heat events. Given that heat is among the deadliest climate-related hazards and that mortality from heat events is concentrated among elderly people, outdoor workers and those with pre-existing cardiovascular and respiratory conditions, the health stakes of urban greening are substantial. Similarly, the documented improvements in air and water quality connect to well-established epidemiological associations between particulate matter exposure and cardiovascular disease, and between contaminated water and enteric illness. The review’s emphasis on food security links to the role of diversified agricultural landscapes and agroforestry systems in stabilising yields under variable rainfall, which in turn protects nutrition in regions where dietary diversity is already precarious.

Equally significant is the review’s treatment of mental health, an dimension often relegated to the periphery of climate-health assessments despite mounting evidence that green environments support psychological restoration, reduce stress markers and are associated with lower rates of depression and anxiety. Climate change itself contributes to mental health burdens through disaster exposure, displacement, livelihood loss and chronic anxiety about environmental futures—a phenomenon increasingly described in the literature as eco-anxiety or climate distress. Nature-based solutions that maintain or restore familiar, functioning landscapes may therefore serve a dual role: they reduce the physical hazards that trigger acute psychological trauma, and they preserve the everyday contact with nature that supports ongoing mental well-being. The review’s inclusion of these pathways within the vulnerability framework signals a welcome broadening of what counts as a climate-health outcome.

The treatment of trade-offs is arguably the review’s most policy-relevant contribution. The Uganda afforestation case cited in the study illustrates a failure mode that has recurred across many large-scale tree-planting initiatives: carbon sequestration objectives pursued in isolation from local land-use realities can displace cultivation, intensify pressure on remaining soils, and increase water demand from fast-growing plantations in ways that deplete local aquifers. Such outcomes are not incidental design flaws but predictable consequences of narrow framing. When the full socio-ecological system is not accounted for, an intervention designed to deliver climate benefits in one dimension can generate health harms in another—reduced food production threatens nutrition, water scarcity threatens hygiene and disease resistance, and loss of access to common lands can erode livelihoods and social cohesion. The review’s insistence that these dynamics be treated as integral to NbS assessment, rather than as peripheral caveats, challenges the sector to move beyond benefit catalogues toward genuine multi-criteria evaluation.

Similar trade-off dynamics emerge in other contexts documented in the broader literature. Constructed wetlands and urban blue-green infrastructure can, if poorly maintained, become breeding grounds for mosquito vectors, potentially increasing rather than reducing vector-borne disease exposure—a concern particularly relevant as warming climates expand the geographic range of pathogens such as dengue and West Nile virus. Green gentrification represents another well-documented tension: neighbourhood greening projects that successfully deliver cooling, air quality and recreational benefits can also raise property values and displace the very low-income residents who bear the greatest climate-health burdens. The review’s framing of these outcomes as trade-offs within the same vulnerability framework that captures benefits provides a coherent analytical basis for anticipating and managing them, rather than discovering them retrospectively.

The methodological approach of the review—a stepwise process that first maps climate-health linkages and then interrogates the NbS literature for evidence bearing on each linkage—has both strengths and limitations worth noting. Its strength lies in traceability: each claimed connection between an intervention and a health outcome can be traced back through the climate-health pathway it traverses, making the evidence base auditable and gaps visible. Its limitation, acknowledged implicitly by the authors’ call for future research, is that the underlying studies vary enormously in design, geographic coverage and rigour. Much of the available evidence on NbS and health is observational, context-specific and short-term, which constrains the confidence with which findings can be generalised across settings. The review’s scope—spanning urban green infrastructure, rural agroforestry, coastal and inland wetlands—captures this heterogeneity but also means that conclusions must remain appropriately qualified.

The call for strengthened monitoring deserves particular emphasis in light of implementation trends. As governments and investors channel growing sums into nature-based approaches under frameworks such as the European Green Deal and various national net-zero commitments, the absence of systematic long-term monitoring creates a risk that interventions are scaled on the basis of optimistic assumptions rather than verified outcomes. Monitoring that tracks not only carbon and biodiversity indicators but also health-relevant variables—heat exposure, air quality, water availability, nutrition, vector incidence and mental health measures—would allow adaptive management to correct course when trade-offs emerge. The vulnerability framework offers a ready-made structure for such monitoring, since each component suggests measurable indicators: hazard exposure can be tracked through environmental monitoring, sensitivity through health surveillance, and adaptive capacity through social and institutional metrics.

The review’s conclusion that local context determines whether NbS deliver net benefits or net harms carries implications for governance. Interventions imposed from outside, without meaningful participation of the communities whose land, water and livelihoods are affected, are systematically more likely to reproduce the failure modes documented in the Uganda case. Conversely, co-designed initiatives that incorporate local ecological knowledge and secure land tenure tend to show more durable outcomes across both climate and well-being dimensions. This points toward a governance agenda in which equity is not an afterthought but a design criterion: the distribution of benefits and burdens across communities becomes as central to evaluation as the aggregate magnitude of benefits.

Finally, the study’s positioning of NbS as a bridging concept across climate, biodiversity and health agendas speaks to a broader institutional challenge. International policy processes—climate negotiations under the UNFCCC, biodiversity frameworks under the Convention on Biological Diversity, and health governance through the WHO—have historically operated in parallel, with limited mechanisms for joint planning or shared accountability. Evidence syntheses of the kind presented here provide the intellectual foundation for such integration, demonstrating that the same interventions can serve multiple objectives simultaneously, but also that pursuing any single objective in isolation can undermine the others. As climate impacts on health intensify and the costs of purely technological adaptation mount, the case for approaches that work with ecosystems while honestly accounting for their limits and trade-offs grows correspondingly stronger. The research agenda the authors outline—long-term impact assessment, systematic monitoring and context-sensitive implementation—offers a credible pathway for translating that promise into practice.

Subject of Research: …

Article Title: Nature-based solutions for climate and health: mapping synergies and trade-offs

Article References: Mahmoud, N., Kamar, M., Perez Arredondo, A. M., Mtweve, P., & Biber-Freudenberger, L. (2026). Nature-based solutions for climate and health: mapping synergies and trade-offs. One Ecosystem, 11, Article e164014. https://doi.org/10.3897/oneeco.11.e164014

Image Credits: AI Generated

DOI: 10.3897/oneeco.11.e164014

Keywords: Nature-based, solutions, climate, health, mapping, synergies, trade-offs, scientific research