Health net-outcome objectives and approaches for spatial planning and development: a scoping review

The objective of this scoping review was to map the body of knowledge on net gain and no-net-loss (net-outcome) objectives and approaches applicable to health in spatial planning and development policies and practice.

There is an established body of academic and gray literature addressing environmental net-outcome objectives, such as biodiversity net gain, in spatial planning policies and practice. While a health net-gain objective has been proposed as a driver for health protection and the realization of health, such an objective and approach are yet to be scoped and defined.

This review considered scientific and gray literature sources that described health net-outcome objectives and approaches that can be implemented in spatial planning and development policies and practice. Source contexts were not limited to specific countries, geographical areas, or settings. All types of evidence were considered.

This review followed the JBI methodology for scoping reviews. Searches of 19 information sources were conducted in August 2023 and updated in July 2024. Key databases included Scopus, MEDLINE, and Embase. Sources of gray literature were included, and citation searching was conducted. No language or date restrictions were applied. Following a high level of agreement during piloting, titles and abstracts were screened by 1 reviewer, and 50% of full texts were screened by 2 reviewers. One reviewer extracted data describing the characteristics of evidence sources and the net-outcome objectives and approaches described within them. Data analysis included categorization, frequency counts, and a SWOT (strengths, weaknesses, opportunities, threats) analysis.

Of 8290 unique records identified through database and gray literature searching, 474 evidence sources were assessed for eligibility, resulting in the inclusion of 112 sources, alongside 7 others identified from citation searching, for a total of 119 sources. Included evidence sources dated from 1974 to 2024, with an increasing frequency of publication from 2008. Social objectives were found from the 1990s, and conservation policies engendered well-being objectives from 2018. Frequently encountered perspectives related to regenerative and sustainable design and development, biodiversity, and conservation. Almost all sources originated from developed Western economies. Broad objectives relevant to health (90/119) outnumbered distinct health objectives (29/119). Most sources addressed development projects, among other scales. Sources frequently described the reconceived use of development to protect and improve health and well-being, overcome sustainability challenges, and strengthen socioecological systems. Implementation often featured participatory approaches, mitigation hierarchies, and assessment, although some sources advocated positive opportunities for health creation rather than the use of contested quantitative accounting frameworks. Challenges and opportunities were predominantly associated with objective specification and assessment. Potential value conflicts were identified relating, in part, to differing anthropocentric and biocentric approaches and objections to quantification and commodification.

This review found many socio-environmental net-outcome objectives relevant to health and emergent health objectives that were immature and less frequently reported. These present differing scopes, focuses, and implementation options that are relevant to policymakers' specification of future objectives. Specification entails value judgments, and equity considerations are important. Knowledge gaps to address include transferability between countries, policy domains, and disciplines; multilevel evaluation; and integration within spatial planning systems and current impact assessment theory and practice.

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