The team at North Star Transition evaluated every transcript from our Wye-Usk Transition Lab interactions with one question in mind: what does health and wellbeing mean to participants? Dr Megan Gozzard reports on the study she led for us.
Early Wye-Usk Transition Lab workshops, from 2023 to 2025, surfaced a theme that often goes unnoticed: health and wellbeing. Perhaps that’s not surprising, as being healthy and well is something we tend to take for granted, until it is taken from us. For many people in the Wye-Usk landscape, health and wellbeing have never been guaranteed.
Less choice than we think
Contemporary culture treats access to health and wellbeing as a personal project. People are taught that their lack of wellbeing is their own responsibility, that they’re making poor choices or not trying hard enough. This can lead to guilt, shame and silence. Health and wellbeing rarely came up as a direct focus in Wye-Usk Transition Lab (WUTL). People may have avoided the issue, as if it had no place in a systems change workshop.
In fact, the evidence points the other way. A 2025 study in Nature Medicine followed nearly half a million people in the UK Biobank, asking how much of our risk of dying early comes from the environment we live in and how much from our genes. Once age and sex were accounted for, an individual’s genetics added only a few percentage points to the explanation of who died early, while environmental factors added around seventeen.
The factors that mattered most were not abstract. They included smoking, deprivation, physical activity, sleep, and the circumstances of daily life such as income, employment, housing and whether someone lives with a partner. Higher household income, having a job and living with a partner were linked to a lower risk of early death, while smoking, renting council housing and frequently feeling tired were linked to a higher risk. Of the 25 independent environmental factors the researchers identified, 23 (92%) are potentially modifiable. On this evidence, health looks less like a personal achievement and more like a reflection of the conditions people are exposed to.
Gender matters too. Women may live longer than men, on average; but those living in poverty may spend over a quarter of their lives in poor health. In the most deprived parts of England and Wales, among which are significant parts of the Wye-Usk region, females born in 2022–24 can expect to spend 30-31% of their lifespan in “poorer” health in the most deprived areas, against 18-19% in the least deprived areas. By contrast, the figures for males are to 23-24% and 14%, respectively.
If health is substantially shaped by the conditions we are exposed to, the question shifts from how individuals can choose to be healthier to how systems can be designed to generate the conditions for good health. At North Star Transition we ask: what does health and wellbeing look like in a regenerative system?
Listening again
To gain better insights into this question, during my summer internship with North Star Transition, I was tasked with returning to the transcripts from the Wye-Usk Transition Lab, to dig more systematically into how health and wellbeing had surfaced in the course of many different conversations. These were recorded at North Star Transition-facilitated workshops with farmers, land managers, water and conservation professionals and community members. I developed an AI script to systematically deconstruct each transcript against seven questions:
What themes recur?
What frustrates people?
What does a healthier future look like to them?
What stands in the way?
Are there any unexpected insights?
Do views differ between stakeholder groups?
And where could North Star Transition intervene?
Each summary came with supporting quotes, so every theme traced back to an anonymous participant's voice. From this more digestible format, I identified and then began a deeper analysis of emergent – or indeed, absent – themes.
Nobody talked about healthcare
The most striking finding was that no participant talked about healthcare in the clinical sense: there was no mention of the National Health Service, hospitals, disease, or waiting lists. Participants talked instead about upstream factors that make it easier for people, and the landscapes they live in, to be healthy and well.
Soil and river health came up as the foundation of food quality and human health, indicating a high awareness that a majority of UK soils are nutrient deficient: “if we want healthy people… we’ve got to start with the soil,” said one respondent. Participants also wanted access to green and blue space, which benefits individual wellbeing as well as nature.
Access to secure, local sources of nutritious food was a repeated theme, with people longing for “proper local food”, in which shorter supply chains and public-sector procurement give access and purchasing power to the individual.
Community stewardship and citizen participation was a continual thread in the discussions, with participants wanting responsibility for their local nature and its products. Stakeholders said, “we as a community want to be guardians of the river” and discussed establishing a “cross-generational buddy scheme”, in which people could be “growing food, sharing meals, sharing stories” to facilitate long-term stewardship and community.
What gets in the way
Governance arrangements, lack of local resources and poor infrastructure stand in the way of realising these dreams. There was no shortage of possible initiatives: participants voiced a shortage of coordination and little value placed on long-term solutions that benefit all.
Fragmentation and duplication are a common frustration, with “so many strategies out there already” and organisations, despite their best intentions, “doing almost the same thing next door to each other”.
Short-termism is a concrete challenge, where competitive funding cycles don’t match the timelines required to improve systems. Stakeholders also pointed to incentives that reward the wrong things: “the most profitable type of farming is often the most intensive,” said one.
What people want
It became evident that health and wellbeing is not a standalone sector. It emerges from the intersection between food, housing, transport, energy, work, finances and community, and sits downstream of other systems.
Participants wanted an integrated, whole-system approach that makes it easier for people to live healthily and well. For many, that meant long-term, collaborative governance that delivers at scale. It meant profitable, resilient farming and local food economies, healthy and accessible landscapes, and rural communities that people can afford to stay in, across generations. And it meant finance and policy strategies that reward regeneration rather than block it. Underneath it all was a wish to “provide hope for the next generation”.
Cautionary themes also came through. Words like “regenerative”, “transformation” and “rewilding” don’t land consistently with all audiences and can alienate people. One participant called rewilding “a toxic word”. Similarly, discussing health and wellbeing can unintentionally stimulate blame and shame, especially when emphasis seems to be placed on the individual.
Health as a measure of success
Detailed analysis of Lab transcripts shows health being framed as purpose and shared value, as an outcome of systems interventions, as a multi-scale systems challenge, as an ethical and political organising principle, and as a governance and measurement challenge.
We have plenty of health indicators through which to evaluate people’s experience of wellness, from NHS waiting times to obesity rates, mental health prevalence and air pollution. Official wellbeing measurement exists too. In England, the Office for National Statistics has run a Measuring National Wellbeing programme since 2011, and the Treasury’s Green Book guidance from 2021 now lets analysts put a value on wellbeing when appraising policy.
Wales has gone further. Its Well-being of Future Generations Act (2015) commits government to reporting against national indicators, including the gap in healthy life expectancy (years lived in good health) between the least and most deprived areas. Yet health is multi-factorial, hard to capture in a single metric, and rarely the yardstick for a land-use, farming or finance decision.
This matters economically. Across the UK, a record 2.83 million working-age people were out of the workforce through long-term sickness in early 2024, at a cost of £212 billion per year through lost output and additional welfare payments and NHS costs. Many actions that cut emissions, such as active, non-vehicular mobility, better housing and healthier diets, are foundational to improved health. A healthy, well population should not just be a by-product of a thriving economy; achieving the broadest possible wellbeing should be a clear objective.
What’s next
A refined version of this analytical process will be applied to other North Star Transition’s projects, including Fens Transition Lab and future labs in other landscapes. Over time, accumulated evidence will show what different communities identify and value as communal wellness, where regions differ and why, and where shared projects to promote better health might make sense.
The most useful result so far is practical: a way to measure – and to talk about – health and wellbeing. Metrics that include rural-sensitive deprivation indicators would give tangible evidence of the economic value of better health where a landscape is flourishing, and of the cost where it is not. A shared vocabulary that does not blame the individual would help stakeholders direct more resources towards better health for more people.
Available evidence suggests there is power in potential “small win” interventions, especially when these are designed to offer co-benefits, such as new cycle routes, successful in many UK and European cities, which facilitate reduced emissions and less traffic whilst making active transport easier.
Taken together with our analysis of the Lab transcripts, the evidence gives North Star Transition a new lens for evaluating regenerative systems: one that treats human and landscape health as connected foundations for future wellbeing.
References
Argentieri MA et al. Integrating the environmental and genetic architectures of aging and mortality. Nature Medicine 2025; 31: 1016–1025. https://www.nature.com/articles/s41591-024-03483-9
Government Actuary’s Department. Why are women living over a quarter of their lives in poor health? 5 May 2026. https://actuaries.blog.gov.uk/2026/05/05/why-are-women-living-over-a-quarter-of-their-lives-in-poor-health/
Office for National Statistics (ONS), released 15 April 2026, ONS website, statistical bulletin, Healthy life expectancy by national area deprivation, England, and Wales: between 2013 to 2015 and 2022 to 2024
Office for National Statistics. Measures of National Well-being Dashboard. https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/measuresofnationalwellbeingdashboard/2018-04-25
HM Treasury. Wellbeing Guidance for Appraisal: Supplementary Green Book Guidance. 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1005388/Wellbeing_guidance_for_appraisal_-_supplementary_Green_Book_guidance.pdf
Welsh Government. National indicators and national milestones for Wales (Well-being of Future Generations (Wales) Act 2015). https://www.gov.wales/node/44920
Office for National Statistics (ONS), released 1 May 2026, ONS website, article, Sickness absence in the UK labour market: 2025
Independent report, updated 31 March 2026, GOV.UK website, Keep Britain Working: Final report. https://www.gov.uk/government/publications/keep-britain-working-review-final-report/keep-britain-working-final-report.
Milner J et al. Health benefits of policies to reduce carbon emissions. BMJ. https://pmc.ncbi.nlm.nih.gov/articles/PMC7190375