There is increasing interest in the potential use of outdoor water environments, or blue space, in the promotion of human health and wellbeing. However, therapeutic nature-based practices are currently outpacing policy and the evidence base for health or wellbeing benefits of therapeutic interventions within blue space has not been systematically assessed. This systematic review aims to address the gap in understanding the impacts of blue space within existing interventions for targeted individuals. A systematic review was carried out, searching Google Scholar, SCOPUS, PubMed, etc. through to August 2017. Only blue space interventions were included that were specifically designed and structured with a therapeutic purpose for individuals with a defined need and did not include nature-based promotion projects or casual recreation in the outdoors. Thirty-three studies met the inclusion criteria and were assessed. Overall, the studies suggest that blue care can have direct benefit for health, especially mental health and psycho-social wellbeing. The majority of papers found a positive or weak association between blue care and health and wellbeing indicators. There was also some evidence for greater social connectedness during and after interventions, but results were inconsistent and mixed across studies with very few findings for physical health. This is the first systematic review of the literature on blue care. In summary, it has been shown that mental health, especially psycho-social wellbeing, can be improved with investment in blue spaces. Key areas for future research include improving understanding of the mechanisms through which blue care can improve public health promotion.

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13Geomalacus maculosus is a slug species protected under EU law with a distribution limited to

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Despite the recognised benefits to human health from green and blue spaces, socioeconomic inequalities in access to and use of such spaces have been observed. Using a multidisciplinary, multistakeholder systems approach and structural equation modelling, this paper examines the structural and behavioural dynamics of green and blue spaces, people and health and wellbeing outcomes. Systems thinking offers a deeper understanding of the dynamics of collective choices at all levels within the determinants and the circular causality of these processes. The resulting map shows that behavioural and structural dynamics of green and blue spaces reinforce social cohesion, mental and physical benefits and their circular causality. Acknowledging the importance of multiple uses of green and blue spaces, this paper concludes that delivering universal services at a scale and intensity proportionate to the degree of need is vital to ensure services and health and wellbeing benefits are available to all, not only the most advantaged.