Built environment and health: A systematic review of the state of research in Germany

Background: Empirical research on the relation between built environment and health is increasing at a tremendous pace. However, in Germany, this field of study is still in its infancy and a systematic overview of the existing evidence and the main research lines is lacking.

Objectives: This study presents the first review of research evidence on the relation between built environment and health-related risk factors and health behavior in Germany. We conducted a systematic literature research on the role of built environment for leading risk factors and health behavior in Germany.

Results: The search identified 1652 publications in total of which 16 studies were included in the final analysis. Existing studies focused on infrastructural aspects; one strand of research investigates and the role of access and attractiveness for weight-related aspects such as physical activity and body composition. Another main strand investigated the role of urbanity for smoking, drinking and dental care. Effects of emissions were less often investigated. Moreover, studies often focused on selective geographical areas and child samples which results in limited generalizability of the findings.

Methodically, the large variation across measurements posed a challenge to integrate research findings and produces inconsistent effects. Most research was data-driven and does not refer to any causal model or theory. Research designs hardly accounted for the complex relationship between built environment and health.

Implications: The heterogeneity of studies on built environment and health should be reduced to improve the comparability and integration of findings. Future research should apply unified measures, advanced research designs and investigate theory-based environment-health relationships.