Payments for ecosystem services and their impacts on health and wellbeing: a systematic review

Abstract Background Human health is reliant on the services that nature provides such as food, clean water, and clean air, known as ecosystem services. Payment for Ecosystem Services (PES) (often funded by European consumers through carbon offsetting) seek to improve environmental conservation and reduce poverty by paying local individuals or communities to ensure ecosystem services. We conducted a systematic review of PES impacts on health and subjective wellbeing (SWB). Methods We searched 5 databases and grey literature, with reviewers independently assessing inclusion against a pre-published protocol (PROSPERO: CRD42024591264). Articles were included if they studied effects on health and/or subjective wellbeing using either qualitative or quantitative methods. Risk of bias was assessed using ROB-2, ROBINS-I and CASP. Following data tabulation, we conducted random-effects meta-analysis, effect direction plots and framework analysis. Pathways linking PES to outcomes were mapped with a logic model. Results Of 5,689 articles screened, 39 were included. Quantitative studies showed mixed impacts on SWB and health. While some studies in Vietnam, Mexico, and China reported improvements on SWB, other studies in Burkina Faso, Costa Rica, Peru, and Ecuador found no meaningful change or deteriorations. Improvements in waterborne diseases were observed in Nepal, while an increase in the incidence of diarrhoea was observed in Bolivia. Qualitative studies also provided mixed evidence on healthcare access and use; in some contexts, PES schemes helped finance primary healthcare facilities, especially in rural areas with limited infrastructure. Other studies reported anxiety, stress, and frustration, often linked to the amount of money received and the timing of payments. Conclusions The effects of PES programmes on health and wellbeing are highly variable, depending on context and programme design. European investments in PES can be refined to be more health-promoting. Key messages • PES schemes show mixed impacts on wellbeing and health. Positive effects on childhood diarrhoea in some countries, while others report no change or negative wellbeing effect. • Consider programme design, including timely payments and context, is crucial.