Relationship between environmental and sustainability-related literacy and health behaviors: a systematic review

The climate crisis poses significant risks to environmental and human health, emphasizing the need for integrated approaches such as planetary health and related co-benefits. In this context, environmentally sustainable and health-promoting behaviors are often closely aligned, suggesting that environmental and sustainability-related literacy may positively influence health behaviors. However, this association has not been systematically synthesized. Therefore, this review aimed to examine the relationship between environmental and sustainability-related literacy and health behaviors.

Following PRISMA guidelines and a preregistered protocol (PROSPERO CRD420251104050), literature searches were conducted in seven databases on 9 April 2025. Studies examining the association between environmental and sustainability-related literacy and health behaviors were included. Screening, data extraction, and quality appraisal (using the Joanna Briggs Institute checklist) were conducted independently by two reviewers. Due to heterogeneity in concepts and measures, a narrative synthesis was performed.

Of 7,864 non-duplicate records, five cross-sectional studies (2020-2024) were included. One study identified an explanatory pathway linking environmental literacy to health behaviors via environmental attitudes and sustainable lifestyles. Three studies reported positive associations between environmental and sustainability-related literacy and health behaviors, including diet and smoking. One study did not report results for the specific association examined in this review. Overall study quality was mixed.

Findings suggest a potential positive relationship between environmental and sustainability-related literacy and health behaviors, supporting the idea of co-benefits between sustainability and health. However, the small number of studies, their cross-sectional design, and conceptual and methodological heterogeneity restrict firm conclusions. Further research using robust designs, clearer conceptual frameworks, and standardized measures is needed to better understand causal relationships. Strengthening environmental and sustainability-related literacy could support strategies to promote both public health and environmental sustainability, alongside necessary structural and policy-level actions.

PROSPERO, CRD420251104050.