3.1. Conceptualisation and operationalisation of just transitions in NbS implementation

Across all roundtables, participants emphasised that implementing NbS must not be seen merely as a question of how efficiently they support ecosystems; rather they must be considered within the broader concept of Just Transitions. This includes consideration for procedural justice (inclusive decision-making), distributive justice (fair distribution of benefits and harms), and restorative justice (addressing historical inequalities).Footnote ¹⁴

In Hanoi and Pretoria, participants highlighted how interventions to reduce antimicrobial use in agriculture can unintentionally burden smallholder farmers if not designed with economic and cultural sensitivity. Beyond economic risks, the politics of NbS also raised questions of legitimacy: Who defines what counts as a valid NbS? Who benefits? Who is excluded? Several participants critiqued externally designed “green” projects that overlook indigenous environmental systems, risking alienation of local actors and poor uptake.

“Procedural justice” emerged as a recurring theme. Calls were made for transparent governance structures, meaningful community consultation, and adaptive feedback mechanisms. Across all roundtables, “Just Transition” was seen as both aspirational and methodologically challenging. Participants cautioned that NbS cannot simply be “plugged in” to existing systems, but must instead be embedded in broader social, ecological, and economic transformations that confront root causes of inequality.

3.2. Co-benefits, opportunities, and motivators for scaling NbS

Participants across all roundtables discussed context-specific examples of NbS that show promise in addressing AMR and climate change simultaneously. In Vietnam, mangrove forest restoration was mentioned as an example of ecological and health benefits with the potential to reduce antibiotics residues. Previous studies found that mangrove forests might reduce salinity and microbial load in aquaculture environments, lower antimicrobial use, and act as carbon sinks and storm buffers.Footnote ¹⁵ Similarly, constructed wetlands were cited as promising interventions for treating hospital and agricultural wastewater. Participants discussed a case example from Vietnam that illustrated how wetlands could reduce pharmaceutical pollutants, including antibiotic residues, while restoring biodiversity and enhancing carbon sequestration in wetland soils.Footnote ¹⁶

Furthermore, agricultural interventions featured prominently, including improved manure management strategies such as composting and anaerobic digestion, which can reduce antibiotic residues in soil and water while simultaneously enhancing carbon sequestration and soil fertility.Footnote ¹⁷ Biochar production from livestock waste was also cited for its dual ability to enhance soil fertility and capture antibiotics and greenhouse gases during adsorption processes. These discussions provided insights into how regenerative practices can deliver environmental and health benefits simultaneously.

Moreover, the discussions revealed clear enablers and motivators that could accelerate the uptake of NbS for climate change and AMR mitigation. One key driver was cited as the growing awareness and political traction of the One Health approach, which promotes integrated action across human, animal, and environmental health sectors. Participants noted a rise in political interest in sustainable farming, partly driven by international climate commitments and food system reform movements. In some cases, NbS are gaining attention because they align with multiple national priorities, including food security, biodiversity conservation, rural livelihoods, and disease prevention, making them more attractive to policymakers and development partners.Footnote ¹⁸

Policy integration was seen as a key opportunity. Embedding NbS within national climate action plans, food security strategies, and AMR action plans was viewed as essential for coordinated, cross-sectoral action. Participants agreed that framing NbS as “win-win” strategies, improving productivity, reducing antibiotic use, and contributing to climate goals were effective for advocacy and engagement.

Education and farmer-led innovation were also highlighted as powerful grassroots drivers. Cited examples include farmers adapting composting into low-cost biochar production techniques or coastal aquaculture groups experimenting with mixed seaweed and fish systems to restore nutrient balance and reduce disease burden. Market-based mechanisms such as eco-labels, certification schemes for antibiotic-free products, and ESG-linked investment (environmental, social, and governance) strategies were highlighted as incentives that could support wider uptake.

3.3. Barriers to implementation and critical gaps

Despite promising examples, participants were frank about the persistent barriers limiting wider adoption of NbS interventions. Many challenges extend beyond technical limitations, reflecting structural blind spots in how environmental and health interventions are designed, financed, and governed.

A key concern was the dominance of short-termism in donor cycles and policy planning. Most NbS, especially those involving ecosystem restoration or microbial ecosystem recovery, would require long timelines to deliver measurable ecological or health benefits, but most funding and reporting mechanisms are constrained to one- to three-year periods.Footnote ¹⁹ This misalignment hinders long-term investment, monitoring, and scalability. Participants highlighted that without adequate resources and sustained support, many interventions remain confined to pilot projects with limited reach.

Evidence hierarchies also emerged as a critical issue. Participants noted that knowing “what counts” as evidence in global funding and policy spaces tends to prioritise quantitative metrics and cost-effectiveness models, often at the expense of indigenous ecological knowledge and lived community experiences. This reflects broader issues of epistemic injustice in climate and AMR fields, where certain knowledge systems are systematically undervalued or excluded from decision-making processes.Footnote ²⁰ Such epistemic bias not only limits understanding but also excludes key perspectives needed for inclusive NbS implementation. The co-benefit framing, while seen as rhetorically powerful, also brought up tensions. Some participants warned that emphasising “win-win” strategies can sometimes obscure trade-offs, such as competing land and water uses, or the exclusion of local communities from restored ecosystems.

Traditional knowledge and community-led practices in NbS planning and implementation were repeatedly highlighted as critical yet undervalued components of successful interventions, especially in Hanoi and Pretoria roundtables. Participants critiqued externally imposed models that prioritise “technical innovation” over lived knowledge, risking interventions that are ecologically sound but socially misaligned.

The disproportionate concentration of NbS research in regions such as Europe and China, which together would likely account for more than half of all peer-reviewed publications on NbS for climate change and AMR was also highlighted, demonstrating geographical disparities in existing evidence. Participants voiced concern that this uneven distribution not only limits the geographical and ecological scope of available evidence, but also reinforces existing imbalances in knowledge systems validation, limited transferability of the knowledge, local innovation, and reinforcing power asymmetries in knowledge systems.Footnote ²¹

Participants highlighted persistent data gaps, particularly the lack of integrated and cross-sectoral data linking NbS, AMR, and climate change. Despite these gaps, it was mentioned that even in the absence of comprehensive datasets, action can and must proceed. A major barrier identified across all roundtables was the absence of standardised, multi-dimensional monitoring frameworks. Current evaluation systems tend to prioritise quantifiable environmental indicators such as carbon sequestration, vegetation cover, or water retention capacity while neglecting health-related outcomes, particularly those relevant to AMR.Footnote ²² Although climate benefits of NbS are increasingly measured, AMR outcomes such as the reduction in antibiotic residues in soils or water, the decline of antimicrobial resistance genes (ARGs), or changes in infection burdens in surrounding communities remain poorly captured, despite being critical for policy and funding decisions.Footnote ²³

Furthermore, advocacy for AMR faces distinct challenges. Unlike climate change, which benefits from defined benchmarks and global agreements, AMR lacks comparable frameworks, making coordinated actions and political traction more difficult. Participants also noted that even in the climate space, where data is abundant, progress is often stalled by limited political will, underscoring that evidence alone is not enough without public mobilisation and leadership.

Institutional fragmentation emerged as a persistent barrier. Participants across all roundtables described how ministries of health, environment, agriculture, and infrastructure often operate in silos with separate budgets, mandates, and data systems resulting in missed opportunities for coordinated action. As one participant noted: “We have the pieces of the puzzle, but no one is assembling the picture.”

4.1. Reframe NbS beyond technocratic tools

Participants across all four roundtables stressed the need to reframe NbS not merely as technical fixes or ecological “interventions,” but as socially embedded, culturally meaningful, and politically situated practices. This shift requires moving away from viewing NbS as isolated and technical tools and instead recognising them as part of complex socio-ecological systems shaped by history, power, and place. This reframing is particularly relevant for AMR mitigation, where narrow technological responses, such as improved sanitation or waste treatment, often overlook the social, governance, and ecological systems that shape antibiotic use and resistance. By embedding NbS within just and inclusive systems, they can contribute more meaningfully to long-term AMR containment.

Participants cautioned against what some termed the “mechanical logic of green development,” interventions that replicate ecological functions such as carbon sequestration and water filtration while ignoring the communities and governance systems that sustain them. This critique echoes broader literature warnings that when NbS are implemented through purely technocratic or efficiency-driven frameworks, they risk ignoring local realities and exacerbating existing inequalities.Footnote ²⁴ For instance, a constructed wetland might be lauded for its ability to treat pharmaceutical waste and sequester carbon, but if it displaces customary land users or redirects scarce water resources, it may unintentionally undermine local livelihoods or fuel conflict. Participants warned that focusing solely on biophysical metrics like “tons of carbon stored” sidelines questions of who gains, who loses, and who decides. The London roundtable echoed these critiques, highlighting how over-technologising NbS, akin to past reliance on engineering-based climate solutions, risks repeating governance failures. NbS should instead be embedded in broader societal transformations that centre equity, justice, and co-governance.

Participants called for a re-grounding of NbS within local systems of stewardship and care, sharing examples of traditional practices such as rotational grazing, sacred groves, or mixed aquaculture systems that exemplified nature-based principles long before the term gained currency. These practices are not only ecologically sound but also embedded in cultural worldviews, collective labour arrangements, and spiritual relationships with land and water.

This broader framing challenges the dominance of technoscientific expertise and opens up space for plural knowledge systems, including indigenous ecological knowledge and local experimentation. As other authors argue, resilience-oriented strategies that emerge from lived experience are often undervalued in global policy discourses, despite being crucial for adaptive capacity and social legitimacy.Footnote ²⁵

Importantly, participants questioned the prevailing emphasis on “scaling up.” Rather than scaling up through replication, they proposed thinking about “scaling out,” supporting networks of context-specific practices, peer learning, and distributed governance that strengthen the collective ecosystem of NbS actors without erasing local differences.

In ecosystems heavily affected by factors such as aquaculture or livestock farming, this distributed model can support locally grounded solutions that reduce antibiotic reliance while maintaining ecological balance. Participants highlighted that designing NbS as socially grounded processes also means involving communities as co-designers and stewards, not just beneficiaries. This requires investing in participatory planning, inclusive feedback loops, and governance structures that reflect procedural justice, a core tenet of Just Transitions. Without this, NbS risks replicating the same top-down exclusionary models that have historically undermined sustainability efforts. For NbS to support lasting transitions, they must reflect and reshape the social and political systems in which they operate.

4.2. Build a research agenda that prioritises under-represented contexts

Participants consistently emphasised the urgent need to shift research priorities towards regions where the intersection of ecological vulnerability, AMR burden, and climate impacts is most acute, notably sub-Saharan Africa, Southeast Asia, and parts of Latin America. These regions hold the greatest potential for transformative NbS, yet they remain significantly under-represented in funding pipelines, academic outputs, and global partnerships. This concern was particularly strong for AMR. As one participant noted in Pretoria, “We still don’t know enough about how resistance is spreading through our soil and water systems because most studies are being done elsewhere.” Several participants pointed out that research on NbS for AMR and climate change is heavily concentrated in regions like Europe and China, with limited attention to tropical ecosystems, small-scale farming, or informal waste systems that characterise many low- and middle-income settings.Footnote ²⁶

Rather than applying NbS models developed or tested in high-income contexts, participants stressed the importance of co-creating context-specific solutions with local researchers, farmers, fishermen, and indigenous knowledge holders. Research must respond to community-defined priorities and ecological realities, not merely imported from elsewhere.

This call resonates with broader global calls for epistemic justice in environmental health research, which entails not only diversifying who conducts research, but also rethinking how research questions are formed; whose knowledge is legitimised; and how findings are interpreted, shared, and acted upon.Footnote ²⁷ Without this critical lens, NbS research risks replicating extractive models in which communities are treated as passive data sources rather than co-producers of knowledge.

Participants in Hanoi and Pretoria gave several examples of practices that remain invisible in mainstream research, including herbal livestock treatments or community-managed aquaculture, both of which may contribute to reduced antibiotic use while supporting ecological resilience.

In practical terms, participants recommended several strategies to rebalance the research landscape:

• • Invest in long-term research capacity within low- and middle-income countries (LMICs), including through funding regional research hubs and building graduate training programmes embedded in local institutions;

• • Support South–South collaborations and regionally led networks that prioritise locally defined research agenda;

• • Develop context-appropriate success indicators that capture social, cultural, and ecological dimensions beyond standardised global metrics;

• • Encourage transdisciplinary approaches that bridge ecology, public health, traditional medicine, economics, indigenous studies, and environmental justice.

London discussions reinforced the need for flexibility in defining success, recognising that effective NbS may look different depending on the place. Participants stressed that outcomes cannot always be measured in the same way across diverse settings. In the case of AMR, this means that counting antibiotic residues or resistant bacteria is important, but so is listening to how farmers, health workers, and households perceive and manage resistance. Understanding these social dynamics can offer powerful insights for reducing unnecessary antibiotic use and building trust in nature-based practices.

4.3. Advance monitoring frameworks that capture co-benefits and trade-offs

Participants across all roundtables emphasised the need for integrated indicators that align with the One Health paradigm, capturing environmental, human, and animal health outcomes simultaneously. Suggested measures included reductions in microbial loads and greenhouse gases emissions, improvements in soil health, and social science-informed indicators such community satisfaction, behavioural change, and governance effectiveness. Literature also highlights the potential for adapting existing environmental impact assessment models to include AMR-specific parameters and integrated One Health metrics.Footnote ²⁸ However, many participants noted that AMR-related outcomes are still rarely included in NbS monitoring frameworks. Indicators such as reductions in antibiotic residues, ARGs, or changes in infection patterns in nearby communities are often missing, despite being critical to understanding co-benefits. This was identified as a significant gap that limits the ability to advocate for NbS as tools for AMR mitigation.

Effective NbS, participants argued, must be socially and culturally embedded, drawing on indigenous knowledge systems and participatory governance structures rather than externally imposed technical models. This perspective was echoed in calls for monitoring and evaluation frameworks that reflect diverse knowledge and complex realities. Participants stressed that understanding the co-benefits and trade-offs of NbS requires blending quantitative metrics with qualitative, context-specific social insights, such as perceptions of fairness, trust, and power dynamics, to inform equity, governance, and social transformation.

In contrast, the London roundtable revealed a tendency to prioritise quantifiable outputs and surveillance systems, illustrating regional differences in evidence preferences and policy framing.

A key recommendation was to develop localised and context-sensitive monitoring frameworks. While standardised global indicators can support coordination, they may overlook local ecological conditions, priorities, and culturally embedded notions of success. To address this, participants advocated for participatory, community-led systems such as citizen science, community health worker reporting, and local ecological monitoring as essential tools to ensure relevance, accountability, and legitimacy of NbS monitoring. One participant in Pretoria noted, “Monitoring should not be something done to communities, but with them, especially when it comes to issues like antibiotic use or farming practices that people manage daily.”

4.4. Invest in collaborative governance and economic innovation

While technical feasibility and ecological performance are often emphasised in NbS discussions, the roundtables revealed that governance and financing models are equally critical to long-term success. It was emphasised that NbS must be intentionally embedded within intersectoral governance platforms such as One Health coordination bodies, national task forces, or local multi-sectoral planning councils. These structures can facilitate alignment of priorities, joint resource mobilisation, shared monitoring, and collaborative intervention design. Beyond efficiency, such platforms are also seen as essential for fostering co-ownership and adaptive learning across sectors.Footnote ²⁹ The discussions stressed that multi-sectoral governance must institutionalise procedural justice by ensuring that local communities, farmers, and indigenous groups participate in decision-making processes as co-creators of NbS strategies.

Integrated governance is particularly relevant to AMR. Participants noted that decisions related to antibiotic use, waste management, and environmental regulation are often made in isolation by different ministries or agencies. Without shared planning, promising interventions, such as improved wastewater reuse or sustainable aquaculture, can fall through the cracks.

Economically, participants called for the adoption of full-cost accounting frameworks that capture environmental and public health co-benefits, such as reduced infection rates, lower antibiotic use, improved food security, and enhanced resilience. Although these models are closely aligned with planetary health and Just Transition goals, they remain underused in most donor and policy evaluations systems.Footnote ³⁰

To support NbS at scale, participants advocated for more innovative and inclusive financing mechanisms, including:

• • public-community partnerships, where local governments and grassroots organisations jointly fund and manage NbS initiatives;

• • performance-based payments, with funding tied to demonstrated health and climate outcomes over time; and

• • blended financial models, combining donor grants, private investment, and national budget to reduce risks and promote equitable implementation.

The relevance of these models for AMR and climate change mitigation was underscored in discussions around long-term infrastructure. Participants noted that NbS with health and environmental co-benefits often require sustained investment; short-term grants are insufficient, particularly when results may take time to emerge.

Across all roundtables, there was consensus that governance and financial mechanisms must be intentionally designed to promote equity and inclusion. Ensuring access for smallholder farmers, indigenous communities, women, and other marginalised groups, who often face barriers to formal financing yet stand to benefit significantly from NbS, is essential. Mechanisms for equitable benefit-sharing, tenure security, and democratic oversight were identified as key conditions for socially just and sustainable NbS scale-up. As one participant noted, “Farmers can’t be expected to reduce antibiotic use unless we support the systems that allow them to do so.”