Leveraging blue spaces for public health: Co-creating a whole-system action plan.

Objectives: •To co-create evidence-based, whole-system recommendations for leveraging blue spaces to enhance public health.•To highlight the salutogenic and equigenic benefits of blue spaces.•To guide decision-makers and practitioners in preserving, revitalising and using urban blue spaces for synergistic benefits to people and the planet. Study design: Systems based co-creation. Methods: 1)Establish an evidence base through extensive mixed-methods academic research over six years on the health benefits of urban blue spaces.2)Partner with a water-focused national research and innovation program to incorporate policy expertise and reduce siloed working.3)Co-create an action plan with stakeholders using system-based participatory research, following the DISCOVER framework. Results: The full system map consists of 137 variables and 220 causal linkages. The system map is structured around four core mechanisms that illustrate how urban blue spaces influence health: promoting physical activity, fostering social interaction, supporting a healthy environment, and reducing population stress. Conclusions: Four strategic objectives identified, achievable through 12 policy actions. Blue spaces offer significant health benefits that have historically been overlooked in regeneration projects. The co-created recommendations provide a comprehensive guide for decision-makers and practitioners to maximise the health benefits of blue spaces. Implementing these recommendations can lead to synergistic benefits for both people and the planet.