Into The Blue: Blue Health and Surfing in the 21st Century

Nick Hounsfield
7 min readMar 16, 2021
A perfect wave from underwater at The Wave

When I was a boy, my happiest times were when I was by water: fishing, sailing, swimming, but especially surfing with my dad. We both loved being in the water, and would have spent every day on, in, or just beside it if we could. Being in the ocean and gazing at the far horizon always brought an inner calm and put me in a totally different mindset.

Ten years ago I started to dream of a place that would help connect people with nature, water and waves. Surfing to me is more than just a sport, a culture, a way of life… it’s my medicine, my reset button, the thing I do to rediscover the best version of myself. I wanted to share this feeling, and the many health benefits of surfing, with people of all ages, backgrounds and abilities. Fast forward a decade and this original vision is still at the heart of The Wave — the inland surfing destination I have created in Bristol, UK.

Over the years I’ve become aware of thousands of other people using water and surfing to help restore people’s mental and physical health and boost their wellbeing. While most of us started this kind of work because of an instinctive belief, there is now a global movement of thinkers, scientists and planners dedicated to exploring what has become known as ‘blue health’. Thanks to them, the body of hard, scientific evidence for the beneficial effects of blue spaces is rapidly increasing.

Research in ‘green health’ started back in the 1980s. This is a branch of medicine that includes sustainability, philosophy, and the relationship between human health and the environment. There is now a growing consensus that being in contact with nature contributes to good physical and mental health; once seen as an eccentric concept, in the UK, green health is now a part of the NHS strategy.

Over time researchers began to look at the specific impact of water environments on human health and an area of study called ‘blue health’ emerged. In 2014 an influential book was published by scientist and activist Wallace J. Nicholls, called Blue Mind: The Surprising Science That Shows How Being Near, In, On, or Under Water Can Make You Happier, Healthier, More Connected, and Better at What You Do. In the mid-2010s, a team from the Barcelona Institute for Global Health analysed the 35 best investigations of blue space and health and wellbeing, and showed that, although research methods were inconsistent, blue space had been shown to instill positive feelings and a sense of wellbeing.

At the start of 2021 there are dozens of other independent researchers investigating blue spaces and blue health. Exposure to blue space has been clearly linked to improvements in physical and mental health and wellbeing, and there are numerous organisations offering forms of blue care to help improve human health.

Today more and more people are using water-based activities as therapy, or blue care, to help those with various health issues or other challenges. Surfing is particularly common and is currently being used to help people with physical disabilities, those with Post-Traumatic Stress Disorder (PTSD) and young people with mental health problems, among others. Surf-therapy has particularly been used with great success as a way to help military veterans suffering from PTSD in both the USA and UK.

The UK — especially the southwest of England — has been among the world leaders in exploring the potential of blue health, and in 2010 it saw the launch of the world’s first surf-therapy course, funded by the National Health Service. The course was entitled The Wave Project and began at Watergate Bay in Cornwall in September 2010, with a group of 20 young people who all had mental health disorders, some suffering from self-harm, depression, schizophrenia or severe anxiety. It was a big success and the final report concluded that it ‘demonstrated a valuable and cost-effective way to deliver mental health care, to mentor and encourage social integration of young people’.

In 2017, The Wave Project joined a group of six other surf-therapy organisations from different countries to form the International Surf Therapy Organisation (ISTO). ISTO now has more than 30 members worldwide, each using surfing for social good.

So why do blue spaces make us feel good?

At the heart of this is a concept called ‘biophilia’ — proposed in 1984 by a biologist called E. O. Wilson. This suggests that there is a bond with nature and animals that evolution has left in humans’ genetic make-up. It’s thought that because elements in nature were so vital to us as we evolved, we have retained a built-in impulse to interact with nature and we feel good when we do. Water was especially important to us, as it was a source of food and drink. Advances in neuroscience seem to support this idea, with recent research showing that natural environments directly affect our nervous system, triggering nerve impulses that make us feel more positive and less stressed.

Researchers have also proposed that humans have two kinds of attention: ‘directed’, which is strongly focused (the kind of concentration we might use driving a car); and ‘involuntary’ or ‘non-directed’, which is the kind we might give to distant noises or passing clouds, for example. It appears that nature gently stimulates our involuntary attention, while giving our directed attention a rest, allowing our minds to relax and restore themselves.

Sound is also thought to be a big part of why being near water and in nature is relaxing. The sounds made by water in natural settings, such as gentle river currents and the soft sound of waves washing ashore, fall into the category of ‘pink noise’. This is the name given to a range of sound made up equally of all the sound frequencies that humans can hear, but with more volume at the lower frequencies — ‘white noise with the bass turned up’ as it’s sometimes called! The sounds of water alone can be enough to reduce stress in people.

The calmness that people seem to feel when they are close to water seems particularly noticeable in surfers. Compared to the general population, they show significantly lower levels of depression and anxiety, and they’re much less likely to get emotionally upset by stress. Researchers suggest that this is down to the nature of surfing, specifically its combination of physical exercise and absorption in riding waves. More research is needed in this area before we can explain simply and certainly why surfing makes us calmer, but we do know that exercise lowers stress levels and is more effective when done in the presence of water.

For me and many other surfers, catching a wave creates a moment of being ‘at one’ with the powerful combination of natural forces that bring it into shore. Psychologists have coined the concept of ‘flow’ for this and they believe that this hyper-focused mind state makes us more productive. It is thought that having experiences in which we are completely absorbed to the exclusion of all else — such as surfing — can benefit our overall sense of wellbeing. Surfers also often talk about therapeutic feelings of awe and smallness in the face of natural forces that some researchers refer to as the ‘small self’. These feelings of awe when interacting with nature and their effects on our wellbeing have been investigated a lot in recent years. An influential 2015 study found that feelings of awe induced by nature could boost the immune system.

The interest in blue spaces and blue health is so strong that people are innovating and experimenting more quickly than experts and scientists can formulate hard evidence and policy. Blue health, blue care and surf-therapy are in the early stages of development as serious treatments, but the field is all the more exciting for that; discoveries that will be made in the next few years may well improve the lives of countless people in years to come. For millions around the world, blue health is a journey, and one that is only just beginning. And this really excites me.

In early 2020 I had a very personal experience of how water and waves can heal. In February my life changed dramatically. With no warning at all I suddenly suffered multiple strokes, which took away my ability to communicate. When it happened I couldn’t talk, read or write at all. Since then I have been on the long road to recovery and with lots of rehab and perseverance I have managed to regain my voice. It is still hard work and often exhausting — there are times when I still feel I’ve spent the day speaking a foreign language — but I’m getting there.

As part of the recovery process I have tried to spend as much time as I can by and in the water. As soon as I felt physically able to, I got back on my surfboard and the act of riding waves has truly become my medicine. Being in the flow state on the waves really seems to have helped reset my slightly broken brain. If I’m having a bad day and the words won’t come out or I’m struggling to process things, then a surfing session helps. I come out of the water clearer and able to communicate again. The stroke has changed my life in many ways. It has challenged me to consider what is really important and it has also shown me, first hand, the very real impact blue spaces can have on our health. It is even greater than I ever realised and I’m more passionate than ever about sharing this with people.

At The Wave, everything we do is anchored in our belief in the benefits of getting into the blue. This is why we have compiled a report looking at the theories and research behind what many of us instinctively feel — that being in or near water improves our mental health.

Find out more and download the full report



Nick Hounsfield

Founder of The Wave. Social Entrepreneur. Stroke Survivor. Passion for surfing, healthcare and Blue Health. Chairman of Surfing England.