The Interplay Between the Built Environment, Health, and Well-Being—A Scoping Review

Abstract

Objective: This scoping review aims to investigate the complex interplay between the built environment, health, and well-being and to provide a comprehensive overview of the knowledge needed for crucial health and well-being enhancement in cities. Method: A scoping review method has been chosen using four databases. The first sample was reduced from 2819 papers to 71 papers by implementing exclusion criteria, snowballing, and direct searches to find a relevant final sample. Results: Built environmental elements such as the neighborhood, urban architecture, activities, public spaces, greenery, lights, safety, aesthetics, and amenities were identified to be impactful on health and well-being outcomes. The two-way association of each environmental factor and its criteria with specific types of health and well-being issues such as cancer, cardiovascular diseases, stress, etc. was determined to identify solutions and ways for improvement. Conclusions: This scoping review provides a comprehensive overview of the intricate interplay between the built environment, health, and well-being. By synthesizing existing knowledge of the built environmental factors, it explores the basis for evidence-based strategies to enhance health and well-being. By illuminating theoretical knowledge of the built environment on health and well-being, our findings will provide a deeper foundation of sources and practical insights for related fields.

1. Introduction

The built environment embodies the physical environment that shapes people’s daily experiences. The built environment could indicate social determinants of health (SDHs) as an environment in which people are born, grow, work, live, and age and could hold significant control over their health and well-being. From the urban layout and neighborhood plan to green spaces, the quality of the urban elements could have a profound impact on individuals’ and society’s health and well-being [1,2,3,4].

Several reports including the World Happiness Report, Global Burden of Diseases, and Rapid Review of Health Inequalities have emphasized the role of multifaceted relations between built environment, health, and well-being. These reports highlighted the impact of the built environment on flourishing human life from physical health to mental well-being and mortality rate. The World Happiness Report, which is a partnership between UN sustainable development solution networks, Oxford Wellbeing Research Centre, and Gallup, emphasizes that the impact of access to green and blue spaces, scenic beauty, daylight, local environment quality, and community amenities could affect individual subjective well-being and happiness [5,6]. The global burden of diseases published by the Institute for Health Metrics and Evaluation (IHME) indicates that environmental quality could affect different non-communicable diseases around the world such as cardiovascular disease, cancer, diabetes, and depression, which are going to increase based on the data in the years ahead [7]. The rapid review of health inequalities in health and well-being in Norway published by the Institute of Health Equity indicates that the social and physical quality of neighborhoods is impactful on health equity. It also emphasizes that some factors of the local environment can enhance the health status and reduce the health gap and inequalities while other factors may directly or indirectly cause harm and increase the health gap. The built environment condition could utilize opportunities for social activities and social infrastructures, accessibility of greenery, infrastructure for physical activity, walking and cycling, and access to facilities that influence health and well-being across the life span [8].

While all the reports emphasize the impact of the built environment on health and well-being, it is worth mentioning during that, the launch of sustainable development goals, Ban Ki-Moon stated that cities are the place where the battle for sustainability development will either win or lose [9]. Considering that by 2050 more than 70 percent of the population will live in cities, shaping future cities will have a major impact on sustainable development [10]. The interplay between SDG 11 for sustainable cities and communities and SDG 3 for good health and well-being is vital for shaping future urbanization and city development to achieve holistic sustainable development. With the expansion of cities, developing environments that support healthy and equal life situations for all citizens becomes significant. Urban environments can reduce health inequalities, improve well-being, and decrease disease rates with well-planned infrastructure and access to healthy environmental factors. The synergy between SDG 3 and SDG 11 supports both outcome enhancement of the two SDGs and provides achievement of all SDGs through two-sided association.

Despite the rich research that has been performed on the critical interconnection between the built environment, health, and well-being [11,12,13,14] a significant gap exists in knowledge about specific elements of the built environment that have the most influence on citizens’ health and well-being. While the existing literature [15,16,17,18] pointed to the broad impact of the built environment on health, well-being, and disease prevalence, a deeper comprehensive understanding is needed to figure out the complex relation of specific diseases and health inequalities with environmental factors. Also, there is a need to recognize the specific characteristics that the built environmental elements need to have to enhance the health and well-being of society. As science is approaching the complex connection in this interdisciplinary field, there is also a need for acknowledging reliable methods and measurement approaches to understand the complex interconnection between fields.

To address the gap, a scoping literature review has been conducted to foster the understanding of the intricate interplay between built environment, health, and well-being. Throughout this review three questions to be answered are defined:

• Which aspects of health and well-being are affected by the built environment?
• Which specific characteristics of the built environment can affect citizens’ health and well-being?
• Which methods are suitable to identify the complex interplay between the built environment, health, and well-being?

With a comprehensive and in-depth analysis of the literature, this paper tried to identify critical environmental characteristics and their conditions that could enhance the health and well-being of citizens. Specific diseases from a wide range of physical diseases to mental and social health disparities impacted by the built environment were identified and various measurement approaches to advance the reliability of research in this critical domain were analyzed. By integrating existing knowledge and exploring areas for improvement, this paper aimed to gather evidence-based intervention or prevention information to foster health and well-being by the built environment to achieve more equitable urban areas for citizens in future developments.

2. Theoretical Framework

The research about the impact of the built environment on health and well-being has evolved over the past decades. The field was highlighted by Ulrich researching the impact of hospital design and nature view windows on patients and hospital staff and then enhanced by other scientists by looking at all aspects of the environmental effects on citizens’ health [19,20,21,22]. As cities grow, researchers focus on different aspects of the built environment such as colors, artificial light, natural patterns, social places, and so many other elements as the means to impact people’s environmental experience [23,24]. The interdisciplinary research combines different theories that in this section will be defined as a foundation to grasp the main challenge.

2.1. Health and Well-Being

2.1.1. Health

The traditional definition of health as the absence of disease was changed by the World Health Organization (WHO) in 1946 to take into consideration different aspects of individuals’ physical, mental, and social health and well-being [25]. In a conference held in Ottawa 40 years later, the concept of health advanced to health promotion by setting. Health is defined by the Ottawa Charter as well-being created and lived by people in the setting of their daily lives. This setting allows them to create or solve problems related to health and identify boundaries by which they define roles, learn, work, play, and love. Health is shaped by actions that provide health for all while enhancing public health by enabling people to control and improve their health. These actions include building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services [26]. The shift not only targets all aspects of individuals’ health but also approaches their quality of life and the state of well-being. There are three different types of health mentioned in this study: mental, physical, and social health.

Mental health is defined by the WHO as a state of well-being in which individuals can realize their abilities, cope with normal life stress, work fruitfully, and contribute to their community [27]. Besides the absence of mental illness, it is defined as having positive feelings and positive functioning [28]. Jahoda divided mental health into three categories: self-realization, fully exploiting potential, a sense of mastery of the environment and autonomy [29].

Physical health is the normal functioning of the body and its system and the absence of diseases and injury. It is also defined as having a balance between internal and external relations. Physical health is the dynamic state of the body and the way it functions with the environment, participating in social activities and social work, being capable of performing basic social functions, the absence of painful conditions, and the ability to adjust to condition changes according to external factors [30].

Social health is composed of societal and individual characteristics [31]. From the viewpoint of society, society is healthy when individuals have equal opportunity and access to facilities and services, in other words, there is a high performance of citizens. From the individual viewpoint, individuals who have a high quality of life, interact with other people, and react to social conventions have good social health [32]. Social health is also defined as the degree to which individuals function in society [33].

2.1.2. Well-Being

Over time the definition of well-being has evolved [34]. Two concepts of well-being are objective and subjective well-being. Objective well-being refers to the quality of life and social attributes that target the capabilities of an individual´s functioning and the environment’s opportunities that are given [35,36]. Subjective well-being is described as individuals’ evaluation of their life and subjective feelings about their experiences and activities that include happiness, life satisfaction, and positive feelings [37,38]. The focus of this field of study is on happiness and quality of life as part of well-being.

Happiness can be divided into hedonic happiness (short-term happiness) and eudaimonic happiness (long-term happiness). Short-term happiness or hedonic happiness has been identified as an emotion related to pleasure and positive emotions [39]. It is related to everyday emotional experiences of joyful, pleasant, positive emotions and satisfaction [40,41]. Experienced happiness, hedonic well-being, or emotional well-being point to the emotional quality of individuals’ everyday experiences. The frequency and intensity of the experiences (joy, pleasure, affection, satisfaction) that make a person’s life pleasant are considerable [42]. Eudaimonic happiness is about the fulfillment of the individual’s true nature, including self-actualization and commitment to socially shared goals. The term eudaimonic happiness comes from “eu” (good) and “daimon” (indwelling spirit, genius) [41]. Eudaimonic happiness is about pursuing meaningful goals and expressing one’s potential [37,38,39]. Quality of life is determined by the satisfaction of individuals in their lives, the ability to accomplish everyday tasks, desires, and values [43,44].

2.2. Built Environment

The built environment consists of all environmental elements made by humans that provide a setting for people’s lives, work, and activities. The built environment refers to different scales from buildings to neighborhoods and cities and covers aspects like quality, arrangement, function, appearance, and attractiveness of environments. It includes urban design, land use, and patterns of human behaviors in a physical environment that encompasses public spaces, amenities, location and density, transportation, residential, commercial, offices, and industrial environments [45,46].

2.3. The Interplay Between the Built Environment, Health, and Well-Being

Research has identified that the built environment plays a crucial role in health and well-being outcomes [17,21,22,47]. Various environmental factors influence health and well-being status daily as citizens spend a considerable amount of their day in the built environment and interact with it. Understanding the two-way connection of the built environment affects human behavior and daily experiences and reduces social inequalities [45,48,49]. The interplay between the built environment, health, and well-being is multifaceted and complex and needs a holistic approach to identify the collective and influential effects. Understanding this complex connection is essential to implementing intervention and prevention approaches for health promotion in society.

2.4. Requirement for Methodological Approaches

To have a comprehensive overview of the complex interplay between the built environment, health, and well-being, various methodological approaches need to be utilized based on the needs of the research. Methodological triangulation, which is using more than one method to comprehensively study a phenomenon, is usually used to enhance the analysis and interpretation of findings and to obtain a complete picture of the problem [50]. Survey-based methods and statistical modeling are commonly used for investigating people’s experiences and feelings through self-reported data [51]. Various types of statistical modeling based on the type of data are used to find patterns, correlations, and relationships between factors and values that can be valuable to find correlations and impacts in the complex relation between factors. Besides the methods mentioned, the physiological measurement of human emotions acts as an effective engineering method targeting complexity. Physiological measurement provides opportunities to delve into specific research with advanced technological tools. Different sensors for physiological measurement can be used based on the design of the experiments such as electrocardiography, electroencephalography, electromyography, pulse oximetry, blood pressure measurements, body temperature measurements, and galvanic skin response measurements [52].

2.5. Knowledge Gap

Regardless of numerous studies about the built environment’s connection to health and well-being, significant gaps need to be addressed. While most of the research has identified the impact of the built environment on different aspects of health or well-being, it has only found a connection of isolated factors of the built environment with either one or two aspects of health or well-being. There is an absence of comprehensive research that targets the complex interplay between most of the aspects of the built environment with various aspects of health and well-being. This fragmented information limits the accumulative knowledge and understanding of the synergies’ effect that are necessary for future research and implementation in urban design policies. Additionally, most research delivers general information about the built environment. There is a lack of specification about the characteristics that the mentioned environmental factors need to have to directly impact health and well-being. Addressing these knowledge gaps and the methods suitable for finding the information needed in these complex interplay concepts will help foster the acquisition of knowledge. This paper aims to provide comprehensive knowledge of the existing science and integrate the concepts to provide broad overall knowledge about the built environment that impacts citizens’ health and well-being.

3. Materials and Methods

3.1. Research Design

As the objective of this paper was to identify the built environmental factors that affect citizens’ health and to identify aspects of health affected by them in cities, a scoping review was identified as a suitable method to map the domains, identify relevant criteria, and generate a frame. This review aimed to collect evidence about the environmental factors’ effects on people´s health and well-being. Specifically, it aimed to assess the characteristics and spatial structure of the built environment. A scoping review method was deemed suitable for conducting this review considering the interdisciplinary coverage of this type of research review [53]. A scoping review includes an overview of the existing literature to find the gaps in a research field and identifies a suitable method when the research questions point to a wide topic that needs a holistic approach to find suitable answers [54]. The flexibility of scoping reviews allows exploratory research to clarify the content [55].

3.2. Main Approach of the Scoping Review

This scoping review benefits from the PRISMA framework structure. The PRISMA-ScR guidelines, an extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method for scoping reviews, are followed in this scoping review [56,57]. This scoping review follows five stages consisting of identifying the research question, identifying relevant studies, study selection, charting the data, and the final stage, collating, summarizing, and reporting the results [58]. Different stages of the scoping are described in the following sections.

Protocol and registration.

We did not register the protocol for this review.

3.3. Stage 2—Identifying Relevant Studies

The first step of the literature review relates to identifying relevant studies and can be considered a mechanical process. Through the search engines defined in Figure 1, without subjectivity, the studies related to the research questions were identified. The keywords that were defined to identify studies relevant to this paper’s research questions were (healthy city OR “urban health”) AND (built environment OR urban OR city) AND (health OR well-being OR well-being) AND citizens. The guideline set for this scoping review was not limited based on year of publication. The rationale for this structure was to identify all the factors of the built environment that are impactful on health and well-being. Four databases have been chosen related to engineering, medicine, and interdisciplinary research to have a holistic approach to answering the interdisciplinary questions of this research. In the first step, which was the identification of relevant literature in Scopus, Web of Science, PubMed, and ScienceDirect by a mechanical process, 2819 papers were identified in the domain of topics (Figure 1). The PRISMA-ScR guidelines were followed in this study as shown in Figure 1 and

Table 1. Steps followed based on the PRISMA-ScR checklist items 5 to 13 for this scoping review.

PRISMA-ScR Items for the Method Section	PRISMA Checklist for This Scoping Review
Protocol and registration	The protocol used for this scoping review is the protocol of Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We did not register the protocol for this review.
Eligibility criteria	The papers need to include keywords in the title, keyword, or abstract and to be published in peer-reviewed journals. Only original articles written in English were included and grey literature, single case studies, conference papers, and books were excluded. Articles on noise, air, soil, and water pollution as well as off-topic articles were excluded.
Information sources	The databases of Scopus, Web of Science, PubMed, and ScienceDirect were used to cover aspects of interdisciplinary research related to health, well-being, and engineering in this scoping review.
Search	Keywords designed to answer research questions were used in the four databases: (healthy city OR “urban health”) AND (built environment OR urban OR city) AND (health OR well-being OR well-being) AND citizens. The first database was 2819 articles. The search strategies were designed and refined through team discussions, inclusion/exclusion criteria were designed, and duplicate removal was implemented.
Selection of sources of evidence	After applying inclusion and exclusion criteria and performing deep analysis to identify off-topic papers the database ended with 53 articles. Direct search and snowballing were used, leading to 73 papers for the final sample. Data were organized in an Excel matrix and information for each paper was reviewed and added to the relevant section to identify commonalities of findings.
Data charting process	Three reviewers developed a data chart to identify and categorize variables and continuously refine categories throughout the process of result analysis. Grounded theory is used to define variables and categories used in the Excel matrix as headers.
Data items	Data were classified into three categories. The data were abstracted based on article characteristics, built environmental elements, and health and well-being affected by the built environment.
Synthesis of results	The first category covered publication information details like title, country, authors, institutions, journal, keywords, abstract, conclusion, implication, year, and methods. The second category focused on health and well-being affected by the built environment such as mental, physical, and social health and quality of life with subcategories in Section 4. The third category focused on built environmental characteristics like greenery, light, public spaces, facilities, safety, urban architecture, neighborhood, etc.

.

3.4. Stage 3—Study Selection, Inclusion and Exclusion Criteria

The second step of the method includes inclusion and exclusion criteria to align and narrow the sample to meet the study´s scope. The exclusion of articles in this step was performed by reading the titles and keywords. The articles that did not contain related keywords defined for this search and were considered irrelevant in answering the research questions and out of scope and were excluded from this process. Grey literature was also excluded from the list of papers which resulted in a significant reduction in the number of papers to 517 papers. In the third sample, duplications were identified, and the number of samples was reduced to 469 papers including review papers. The fourth step involved reading abstracts and keywords and excluding non-English papers, which resulted in 106 papers that included 70 original research papers and 36 review papers. The review papers are separated to be used as a source for Section 1, Section 2 and Section 5. In this step, we specifically tried to find relevant papers focusing on built environmental structures and excluded papers related to air, soil, water, and noise pollution. The papers related to these topics were excluded due to their focus on chemical and technical topics related to pollution and were considered to be out of the scope of this scoping review. We intended to focus on urban area elements that were shaped, designed, or influenced by human intervention (built environment). The green areas that were taken into consideration were greenery that was intentionally shaped and designed for human activities such as parks and neighborhood greenery which are integral components of cities and align with urban design. The blue spaces included in this scoping review regarded spatial design of the urban environment related to water such as views of water and accessibility. The papers must answer the research questions and be relevant to the scope of this scoping review. In step five, the articles were completely reread before deciding to include them. Twelve papers have been removed from the data and the number of papers was fifty-three. The reasons to exclude the papers after complete reading were multiple publications from the same dataset, conference papers and reports, and not being focused completely on the built environment and health or mentioning the character of the built environment.

3.5. Stage 4—Charting the Data

To ensure the inclusion of the relevant articles and to have a comprehensive scope, two methods have been chosen: backward and forward snowballing and direct search. The direct search was performed by searching with similar predefined keywords in databases of three high-impact journals related to medicine: JAMA, The Lancet, and Nature. Snowballing forward and backward was implemented to ensure a high-quality database with a special focus on the built environment, health, and well-being covered in this scoping review. After implication, the direct search and snowballing of the final sample of this scoping review resulted in 71 papers. The 71 papers were categorized in the Excel matrix (Version 16.89.1).

For the categorization of the data and to find answers to the research questions, grounded theory has been used. The categorization of data and analysis were performed by the authors and no frameworks for categorization have been used. The theories that emerge from data are the key aim of grounded theory. Based on that, researchers immersing themselves in data and comparing various pieces of information could identify new patterns, associations, and theory concepts which allow them to produce theories that are grounded in data and applicable and relevant to the real world [59]. As mentioned, the categorization used in this scoping review was based on reading the whole article and finding impactful criteria of the built environment and aspects of health and well-being mentioned in each paper and adding all criteria to the Excel matrix as the headings. Through reading each paper, new criteria were found and added to the Excel matrix, establishing deeper analysis and finding commonalities between the findings of the papers.

3.6. Study Risk of Bias Assessment

After defining the research questions, keywords were defined and reviewed by reviewers several times to ensure the relevance of the database. After defining the first sample of the database, meetings were held regularly to define the categorization. The research team read through the text of all papers in the final database and performed an in-depth analysis to reduce the potential biased risk of unrelated data being involved in the review. During the review of all papers, the research team commented on papers that were identified to be out of scope multiple times to identify the most relevant papers for this scoping review. Variables have been revised regularly to ensure analyzing and categorizing data were conducive to answering the research questions in the Excel matrix. The revision of variables such as their code and subcodes was performed along with the reviewing of papers.

3.7. Methodological Limitations

One of the limitations was excluding grey literature, white papers, and conference proceedings in the sample to limit the literature review’s final sample to peer-reviewed articles. Another limitation of the study was the focus on urban land use and development and excluding research only about rural areas. The reason to exclude rural areas was the call in most of the reports for cities’ enhancement and the fact that in 2050 more than 70 percent of the population will live in cities.

4. Results

4.1. Descriptive Result

4.1.1. Number of Publications

In general, the research in this scoping review about the impact of the built environment on health and well-being started in 2002 and increased over time. No set limitation for exclusion based on the publication year indicates the new interest in research about this interdisciplinary field. A notable increase in publications was identified from 2012 from the examined papers. The increasing trend in the publication rate is noticeable in Figure 2 with a positive slope.

4.1.2. Location of the Studies

The distribution of the studies´ location by continent presented in

Table 2. The location of the studies by continent. The distribution of the papers is based on the continents involved in each research.

Continents	Number of Papers
Europe	31
Asia	26
North America	16
South America	4
Oceania	1

shows that most of the studies have been conducted in Europe. It is significant to mention that papers not written in English were excluded from the study which could influence the number of findings by continent, especially in continents where English is not one of the main languages. Additionally, some of the research was conducted in multiple continents so each study was counted for every continent involved in that paper. Different time trends have been identified in continents that show different research interest changes around the world. Studies from North America assessed the effect of the built environment on citizens’ health and well-being with 16 papers. From earlier research to the present, there is a focus on urban safety and street conditions [60,61]. There is a shift in research in North America from targeting urban greenness [62,63,64] to a broader exploration of the various aspects of the built environment’s impact on public health. The observed trend seems to shift to social dynamics and community health [65,66] and then to a holistic approach to covering different environmental factors affecting urban planning and design. An evolving interest can be seen in research from North America to understand in a comprehensive and interdisciplinary approach the various aspects of the built environment affecting public health and well-being [67,68,69].

The overall topic trend in Europe in research about cities, health, and well-being can be divided into three: green infrastructure and urban greenery, public spaces, and urban social environment. Earlier research was more focused on greenery [70,71]. From 2010 to 2020 a shift in research topics occurred toward public spaces, social dynamics, and urban social issues focusing on urbanicity, urban planning, and different environmental factors affecting citizens’ health and well-being [72,73,74,75,76,77]. After 2020 the research focused on the integration of urban greenness with environmental sustainability combined with urban planning. The research seems to have a more comprehensive approach to considering multiple aspects of interconnections impacting the health and well-being of citizens [78,79,80,81,82].

Research related to the impact of the urban area on health and well-being in Asia started with a general discussion about urban planning [83,84,85]. It shifted to focus more on green space impact until 2020 [84,85,86,87,88,89,90,91,92,93]. In the present research, the focus is of a combination of natural areas with outdoor spaces, social interaction, and activities [15,94,95,96,97,98,99,100,101,102,103,104]. The research in South America was more focused on public spaces, greenery, safety, and neighborhoods. A growing interest was observed in assessing the impact of public spaces and urban greenery on enhancing citizens’ well-being and social interaction [105].

4.2. Health and Well-Being

4.2.1. Physical Health

Studies highlighted that various built environmental factors affect several aspects of physical health. Twenty-seven studies investigated the relationship of the built environment with physical health [60,61,62,64,65,69,71,73,74,79,82,83,87,90,95,105,106,107,108,109,110,111,112,113,114,115,116]. Results of the studies identified that public spaces, greenery, safety, amenities and facilities, neighborhood, surrounding environment, artificial light and sunlight, urban architecture and accessibility, dwelling size, relaxation area, aesthetics and attraction, and blue spaces affect physical health.

Living in neighborhoods distanced from the city center and large dwelling size were associated with less back pain. Living in highly dense neighborhoods was associated with less frequent back pain. Living in apartments was associated with less headache and back pain [114]. Neighborhoods that are positively influenced by natural and built environments allow higher levels of physical activity such as walking, contributing to overall physical health [107]. Public spaces with access to greenery such as parks encourage physical activity for citizens as a safe environment is related to a lower homicide rate [60].

Heart Rate, Cardiovascular, and Stroke

There is tentative evidence to support the positive impact of greenery on heart health over time when utilizing self-reporting and statistical approaches at a population level [60,63,66,67,71,79,87,107,117]. The studies determined that neighborhood, greenery, surrounding environment, urban architecture, and accessibility are impactful on heart-related conditions, but the effects are difficult to confirm at an experimental level [117]. A decrease in the risk of heart disease and stroke seems to be correlated with the level of greenery, variability, greenery area size, greenery connectedness, and access [107]. Having access to moderate or high levels of greenery shows great potential for population health improvements as it has been reported to lower the risk for cardiovascular disease by approximately 25% [107] and there is a correlation between size and effect [63].

Cancer

Nine papers assessed the effect of the built environment on cancer [62,70,72,80,82,86,90,106,107]. The research found that artificial light, greenery, safety, and public spaces impact cancer and survival after treatment. Living in a neighborhood with a lower socioeconomic status (SES) with a more dense population and more parks was associated with a lower chance of survival. Living in neighborhoods without liquor stores and fast food restaurants was more associated with physical activity [62]. A positive correlation between breast cancer and light pollution was found in a study of over 10 years [82]. An elevated rate of breast cancer was observed in neighborhoods with higher cumulative light pollution which emphasizes the potential exposure–response relationship [106]. There was not a significant association between prostate cancer and light pollution. The incidence of breast cancer in neighborhoods with more exposure to cumulative light pollution of more than 21 pixels was higher and an increase of 10.9 cases per 100,000 population-years could be expected in the district exposed to this light [82]. Night-shift work combined with being exposed to light at night (LAN) increased the risk of breast cancer [106].

Blood Pressure

Four studies investigated the built environment’s impact on blood pressure and found that greenery and relaxation areas have a considerable impact on blood pressure levels [15,87,112,117]. Green areas are considered beneficial in reducing high blood pressure [87]. Of the different types of blood pressure, which were systolic blood pressure, diastolic blood pressure, and hypertension, the systolic blood pressure in the age group of 18 to 44 had a significant relation with walking (p-value 0.01). In the age group of 45 to 64 the diastolic blood pressure had a significant relation with a p-value of 0.017 and hypertension had a significant relation with a p-value of 0.041 [112]. Systolic blood pressure (SBP) was lower after walking in a forest environment (3.1 mmHg) compared to walking in an urban environment [117].

4.2.2. Mental Health

Studies emphasized the environmental factors that positively and negatively affect mental health. Thirty papers investigated this association [15,61,64,65,70,72,73,74,77,79,83,90,94,95,97,98,100,101,103,105,109,110,111,112,115,118,119,120,121,122] and highlighted that surrounding environment, public spaces, greenery, amenities, neighborhood, urban architecture, and accessibility affect mental health.

The mood disturbance was reduced after walking in a forest and a significant fall in variables such as fatigue–inertia and total mood disturbance was observed. The variables of tension–aggression, depression–dejection, anger–hostility, and confusion–bewilderment were significantly higher values in urban environments. Mood improvement by sitting in the forest setting was observed to have an improved rate compared to sitting in the urban setting [117]. Residents in the urban fringe had more feelings of happiness, motivation, focus, and relaxation compared to residents living in city centers. The streets near residential areas and close to blue spaces were associated with positive social emotions. Vegetation and land were associated with positive mood indicators [121]. Neighborhoods with high social isolation have an 11 percent higher incidence rate ratio for non-affective psychoses. Urban environments with lower greenery and higher density have an impact on the incidence of first-episode psychosis (FEP) [72]. The perception of crime, overcrowding in homes, social and entertainment facilities and community facilities, access to greenery, and noise were associated with poorer mental health. Feeling unsafe to go out during the day and night was related to low scores in mental health [70]. Living area size affects depression in residents. One increase in house units in high building blocks can increase depression by 11 percent [94].

Stress and Cortisol Level

Twelve papers investigated the impact of the built environment on stress and one paper specifically examined the impact of the neighborhood on cortisol levels [60,65,67,77,95,100,112,114,119,121,123]. Studies emphasized the impact of urban architecture, accessibility, greenery, surrounding environment, and neighborhood on stress levels.

Related to greenery’s impact on stress, residents considered landscapes and green spaces very capable of impacting and being beneficial for their health [95]. Streets with vegetation were considered as a less stressful environment [123]. Green spaces had a protective effect against stress. ALAN showed the greatest association with stress levels [67]. Urban and semi-urban green spaces reduced the stress level in the absence of exposure to wilderness nature. Walking in green urban nature was associated with improving mood status [77]. After an investigation of brain activity by functional magnetic resonance imaging (fMRI) related to stress in nature and urban environments, it was found that amygdala activity decreased after a one-hour walk in nature. The amygdala activity remained stable after an hour’s walk in an urban environment. The perceived restorativeness was also higher after a walk in nature than in the urban environment [119]. Regular visits to a natural environment have a significant relation with low PA (mean 0.085) and recommended PA (0.18) with a p-value of 0.001. The availability of public spaces and rooms for meeting people also had a significant relation (p-value 0.025). The number of regular visits to a natural environment had a strong influence on stress reduction and level of physical activity [112]. Sufficient and accessible urban leisure and recreational facilities such as cultural amenities, health and sports facilities, and shopping malls were defined as helpful for urban citizens under pressure. The therapeutic landscape, aesthetic urban scenery, and well-designed architecture were considered impactful on stress levels. The matching of facilities’ function with the target group’s needs contributes to the effective use of facilities and reduces the psychological pressure in the rapid living pace of the urban environment [100]. Neighborhoods with social cohesion, aesthetics, and safety affect stress and anxiety. Well-designed public spaces and safe pathways enhance the sense of belonging and mental health [118]. Neighborhood and home violence, liquor, and convenience stores affect physiological and cellular markers of stress. All neighborhood stressors were associated with shorter telomere length and cortisol functioning. An increased number of liquor stores or convenience stores in a 500 m radius of children’s houses caused a 0.004 decrease in telomere mean length and violent crime in a 500 m radius of children’s houses was associated with a 0.006 decrease in telomere length. The effect of liquor and convenience stores impacted shallow recovery after cortisol awakening response (CAR) and cortisol was less likely to be reduced after reaching its peak [65]. Living in larger dwellings was linked to lower stress. Higher anxiety was related to tree cover and higher neighborhood density [114].

4.2.3. Social Health

Six studies focused on the association of social health with the built environment and public spaces, greenery, urban architecture, and accessibility were considered to have a significant impact on social health [72,83,97,102,114,124]. Neighborhood density, living in apartments, and tree cover were negatively associated with personal relationship satisfaction. Local facilities were positively associated with personal relationship satisfaction [114]. A neighborhood´s higher social isolation was correlated with an increased rate of psychosis risk. Social cohesion and supporting networks in neighborhoods with diversity were related to lower risk levels of non-affective psychoses [72].

4.2.4. General Health

Studies investigated the relation between general health and the built environmental factors. Greenery, urban architecture and accessibilities, safety, surrounding environment, public spaces, light, neighborhoods, and amenities were found to be impactful on general health [15,16,60,61,63,64,65,66,69,73,74,75,76,79,83,84,85,86,88,90,91,92,93,95,105,109,110,111,113,114,115,118,122,125]. Environmental factors such as accessibility, diversity, street network connectivity, infrastructure, and safety were connected to the reduction of stress levels, increasing physical activity, and enhancing overall health status [118]. Urban infrastructure such as street lighting and crosswalks were associated with a lower adult homicide rate. Parks and well-maintained vacant spaces as green and clean spaces were related to a decrease in homicide rates [60]. The increase in residential greenness and reduction in air pollution have a positive impact on the general health condition of residents [86]. Connected parks for more accessibility and effective spatial greenery strategy contribute to health promotion and health equity. Increasing exposure to greenery leads to a decreased risk for various diseases [63]. The view of blue spaces from residential areas was effective on the general health conditions of individuals [91]. Dwelling size was positively associated with overall health and leisure satisfaction [114].

Mortality

Three papers focused on investigating the mortality rate connected to the built environment. Results showed that greenery and sunlight are related to the mortality rate [63,84,86]. An increase in the amount of greenery and decrease in air pollution will cause a lower mortality rate. A small decrease in greenery by 1% in NDVI and an increase of 10 μg/m³ in PM2.5 (inhalable particulate matter) will lead to an increase of 1% in the risk of death [86]. Adding 1 square meter of greenery will reduce the overall death in areas with larger green spaces by 0.002 percent and in areas with smaller green spaces by 0.011 percent. Greenery areas that are designed in different small and disconnected areas were associated with higher death risk [63].

Obesity

Four studies emphasized the role of neighborhoods, safety, urban architecture and accessibilities, and amenities on obesity [61,66,109,118]. The neighborhood environment condition impacts physical activity, obesity, and sedentary behaviors. A higher level of familiarity and connection with the neighborhood are connected to a higher level of physical activity [66]. Neighborhoods that were benefitting from well-structured walking paths and neighborhood safety were associated with better health [118]. Children living in neighborhoods that are perceived to be less safe by their parents are at more risk of obesity. Seventeen percent of children (4–5 years old) living in the least safe neighborhoods were overweight while this percentage decreased to four percent in the safest neighborhoods [61].

4.2.5. Well-Being

Fifteen studies highlighted the impact of the built environmental factors on well-being [64,67,68,77,78,80,81,90,91,96,104,109,111,118,126]. Factors such as urban architecture and accessibilities, greenery and relaxation areas, surroundings, neighborhoods, public spaces, aesthetics and attraction, and blue spaces had a considerable impact on well-being. Neighborhoods that support social inclusion and had elements for supporting social interaction and physical activity had the highest positive correlation with well-being. Citizens’ perceptions of environmental characteristics such as safety, walkability, neighborhood acknowledgment and value, and a sense of community were positively associated with subjective well-being [118]. Citizens making regular visits to blue spaces were more likely to have good mental well-being. Duration, activity intensity, and regular visits to blue spaces were found to be effective in the well-being outcome [91].

4.2.6. Happiness

Six studies focused on the impact of the built environment on happiness. Urban architecture and accessibilities, greenery, public spaces, aesthetics, and attraction were found to be impactful on happiness levels [76,102,114,118,120,123]. The perception of happiness was increased in people with short exposure to green infrastructure and street vegetation [123]. An increase in distance from the city center was positively associated with happiness. Tree cover and local facilities were negatively associated with happiness [114]. The streets close to blue spaces and residential areas were more associated with positive social emotions and people felt happier, focused, and relaxed [120]. Neighborhood characteristics such as aesthetics, social cohesion, well-maintained public spaces, and safety were correlated positively with happiness [118].

4.2.7. Quality of Life

Nine studies investigated the impact of the built environmental factor on quality of life. Studies showed that surrounding environments, greenery, urban architecture and accessibilities, and neighborhoods have associations with the quality of life [68,83,89,111,114,116,120,127,128]. The density of the neighborhood and living in apartments were associated negatively with life satisfaction. Park areas and dwelling size were positively associated with life satisfaction [114]. Quality of life acted as a mediator between urban greenness and vegetation with the perception of the environment, social inclusion, and urban management. An increase in vegetation affects quality of life [127]. An overview of findings related to associations of the different built environmental factors with various health and well-being aspects can be found in

Table 3. Associations of the built environmental factors with various aspects of health and well-being. No. (%): number (percentage). Colors define the level of association between factors with dark blue color as the strongest association and white as no association.

	General Health No. (%)	Mental Health No. (%)	Physical Health No. (%)	Social Health No. (%)	Well-Being No. (%)	Happiness No. (%)	Quality of Life No. (%)
Greenery	20 (28.1)	21 (29.5)	20 (28.1)	3 (4.2)	9 (12.6)	3 (4.2)	5 (7.0)
Urban architecture	14 (19.7)	14 (19.7)	10 (14.0)	3 (4.2)	6 (8.4)	5 (7.0)	4 (5.6)
Neighborhood	11 (15.4)	14 (19.7)	12 (16.9)	2 (2.8)	5 (7.0)	3 (4.2)	4 (5.6)
Surroundings	11 (15.4)	12 (16.9)	12 (16.9)	2 (2.8)	4 (5.6)	1 (1.4)	2 (2.8)
Dwellings	1 (1.4)	2 (2.8)	1 (1.4)	1 (1.4)	0 (0.0)	1 (1.4)	1 (1.4)
Urban Amenities	16 (22.5)	16 (22.5)	15 (21.1)	2 (2.8)	5 (7.0)	3 (4.2)	4 (5.6)
Aesthetics	2 (2.8)	3 (4.2)	1 (1.4)	0 (0.0)	3 (4.2)	1 (1.4)	1 (1.4)
Safety	9 (12.6)	6 (8.4)	6 (8.4)	1 (1.4)	3 (4.2)	2 (2.8)	0 (0.0)
Light	1 (1.4)	1 (1.4)	3 (4.2)	1 (1.4)	1 (1.4)	1 (1.4)	1 (1.4)
Public spaces	9 (12.6)	10 (14.0)	6 (8.4)	2 (2.8)	6 (8.4)	1 (1.4)	4 (5.6)
Blue spaces	1 (1.4)	0 (0.0)	0 (0.0)	0 (0.0)	2 (2.8)	0 (0.0)	0 (0.0)

. The numbers of papers discussing the associations between factors from the total sample of papers (71 papers) are mentioned in each cell with the percentage. The colors used in Table 3 show the frequency of the topic in the literature of the study. White represents no association, and the darkest blue color indicates the most frequent associations found in the scoping review’s final database of papers.

4.3. Built Environment

4.3.1. Greenery

Greenery was found to be the focus of the majority of research, covering nearly 60 percent of finalized data. Forty-two papers discussed the impact of greenery on physical health, mental health, general health, social health, well-being, quality of life, and happiness [15,16,60,62,63,64,67,68,69,70,72,73,76,77,78,79,81,84,86,87,88,89,90,95,96,97,103,105,107,108,109,110,112,113,114,117,119,121,122,123,127,128].

Urban greenness and vegetation affected citizens’ quality of life [127]. Dissatisfaction with access to green spaces was associated with lower mental health [70]. The presence of greenery reduces the risk of psychosis [72]. Greenery had a positive association with positive mood indicators such as happiness, motivation, focus, relaxation, and positive social emotion [121]. Park areas in the neighborhood were positively associated with life satisfaction and lower anxiety levels. Tree cover was negatively associated with happiness and was related to higher anxiety [114]. Greenery and empty settings that are well-maintained are effective on neighborhood health and safety [60]. Well-connected and complex shape designs of greenery increase the number of visits of citizens to use the area for activities [63]. The location of the green spaces was more impactful than the type of activity in reducing stress [77]. Large green areas with connectivity and cohesion are more impactful in reducing the death rate for all-cause and cause-specific mortality than small and fragmented greenery [63]. The largest scale of green intervention had the highest impact on safety and decreased the stress level [123]. Greenness is associated with lowering mortality risk. The reduction of mortality rate due to an increase in greenery is more significant in urban areas [86].

There is a significant relation between the number of visits to green spaces and relaxation areas and hypertension. A small number of visits to greenery and accessible relaxation areas was associated with an increase in the odd ratio of hypertension, and 90 mmHg of diastolic blood pressure was also associated with infrequent visits to nature. Accessing available relaxation areas impacted hypertension and blood pressure [112]. People living in areas with high greenness variability had a lower risk of stroke and coronary heart diseases. Also, the risk of hospitalization for these people was 37 percent less compared to areas with low greenery variability. The variability of greenery showed a stronger impact than the amount of greenery in reducing heart stroke and heart disease risk [107]. Higher NDVI and SAVI within a 500 m distance are strongly associated with lower cardiovascular disease risk by 26–27 percent. Within a distance of 1000 m, the CVD prevalence reduction was around 21–22 percent. The higher greenness level reduces the risk of high blood pressure, type 2 diabetes, and hypercholesterolemia [87]. The green environment was more efficient in reducing amygdala activity than the urban environment [119].

4.3.2. Public Spaces

Public spaces were considered to have a high impact on physical health, mental health, general health, social health, well-being, and quality of life by twenty-three papers [16,62,68,70,72,75,76,80,83,89,92,95,98,100,101,104,105,112,118,124,125,126,128]. Public spaces and places to meet other people close to residential areas were considered by participants as a parameter impacting the level of physical activity to meet the recommendation [112]. The absence of enough places for people to stop by and have conversations and dissatisfaction with social and entertainment facilities were associated with lower mental health and vitality scores [70]. Environments that encourage social interaction such as parks, community centers, and public squares reduce social isolation. Environments that increase social isolation are related to an increased psychotic disorder incidence rate [72]. Public spaces that provide opportunities for users to carry out social and leisure activities such as marketplaces that give the perception of safety contribute to mental health and well-being [118].

4.3.3. Safety

Environmental design that leads to feeling safe and a reduced crime rate was explored by fourteen papers and found to be related to physical health, general health, mental health, and well-being [60,62,65,70,80,84,85,90,92,93,115,118,123,124]. Perceived neighborhood safety and crime rates have significant impacts on health and well-being. The environments that support effective safety measures and social inclusion such as safe pathways contribute to an increase in physical activity levels and reduction in stress levels [118]. Parents’ perception of the neighborhood safety level impacts the obesity rate of children [61]. Fear of crime and harassment leading to feeling unsafe going out during the day and night was connected to poor mental health [70]. A street with vegetation was estimated to be safer by participants [123]. Environmental features like street lighting, access to public transportation, and well-maintained greenery are related to a lower rate of homicide [60].

4.3.4. Urban Facilities and Amenities

Twenty-one papers investigated the association of amenities and facilities and their accessibility with physical health, mental health, general health, well-being, and quality of life [61,62,64,70,73,74,76,79,83,90,92,93,95,100,101,109,110,111,114,116,118]. Local facilities were positively associated with life satisfaction [114]. Sufficient urban facilities that match the target group’s needs efficiently reduce psychological pressure. Leisure facilities such as sports and health facilities, cultural amenities, and shopping malls that ease negative psychological states are considered impactful [100]. Social and entertainment facilities that were dissatisfying were connected to poor mental health. A low vitality score was associated with dissatisfaction with community facilities such as libraries and community centers [70]. Amenities’ inaccessible distance from residential areas, such as of community centers, recreational facilities, and parks, enhances the overall health and satisfaction rate [118]. Access to amenities such as after-school activities is linked to a higher perception of safety in the neighborhood and a lower level of obesity. Children living in neighborhoods with limited after-school structured activities and facilities were at higher risk of obesity [61].

4.3.5. Urban Architecture and Accessibility

Urban architecture and accessibility were highlighted by twenty-five papers. It was found that urban architecture and accessibilities have a relation with physical health, general health, mental health, social health, well-being, quality of life, and happiness [60,64,65,67,72,75,76,78,79,80,83,85,92,93,98,101,102,108,110,111,116,118,120,123,125]. Well-designed urban architecture was associated with stress relief. In fast-paced urban life and densely populated areas the existence of well-designed public spaces and landscapes such as riversides and parks helps relieve mental pressure by providing people with a sense of comfort and peace [100]. The layout and design of urban spaces, commercial and industrial buildings, and population density as a part of urban architecture were related to mental health. High urban population density and limited access to greenery were connected to an increase in mental health issues. Urban areas with more non-domestic buildings like commercial and industrial buildings were related to a high risk of psychosis [72]. Row home structures were related to a higher rate of homicide. The visibility of public transportation was connected to a lower rate of homicide [60]. Urban architecture factors such as street design and connectivity, walkability, infrastructure, and accessibility enhance physical health and mental health [118].

4.3.6. Neighborhoods

Neighborhood environmental situations were investigated by twenty-three papers. Studies found that the neighborhood environment has an impact on physical health, mental health, general health, social health, well-being, and quality of life [61,62,65,66,70,71,72,78,79,80,89,90,93,94,95,107,108,110,111,114,118,120,121]. Neighborhoods with high density were negatively associated with life satisfaction. The location of a neighborhood far from the city center was associated with less back pain and positively associated with happiness [114]. The neighborhood’s perceived and structural conditions have a profound impact on adults’ health behaviors. Meeting physical activity guidelines was more likely to happen in neighborhoods where residents had a high number of acquaintanceships [66]. The neighborhood’s features such as social isolation and diversity play a crucial role in mental and social health. Deprived and socially isolated neighborhoods increase the risk of psychosis. Neighborhoods with diversity and social cohesion that support social connectedness showed lower rates of non-affective psychosis [72]. Neighborhoods with high social cohesiveness are linked to lower obesity rates and better health outcomes. The level of safety perceived by parents of the neighborhood is linked to a lower obesity rate [61]. Neighborhoods with strong social inclusion, frequently used pathways, and safe environments are linked to better well-being [118]. Neighborhoods with higher building block density were linked to depressive symptoms [94]. The natural and built environment structure of the neighborhood could affect the physical activity of residents and their overall health [107]. Streets close to the neighborhood and residential area and close to blue spaces and vegetation were related to positive moods [121].

4.3.7. Surroundings

Twenty studies underlined the effect of the surrounding environments on mental health, physical health, general health, well-being, and quality of life [60,61,63,67,70,71,72,73,78,79,80,83,89,92,95,110,115,117,118,121]. Aesthetic and well-maintained surroundings in the neighborhood were related to happiness and satisfaction levels. Streets with accessibility, connectivity, and walkability opportunities were related to overall health and well-being [118]. The surrounding environment’s quality and safety are connected to obesity and health. A lower perception of safety of the neighborhood by parents impacts the level of physical activity, with a higher maternal depressive symptom level and higher obesity rate [61]. The surroundings in high-density areas were related to depressed feelings and surroundings close to the urban fringe with vegetation were associated with positive moods. Buildings were negatively associated with focused and happy emotions and were associated with depression [121]. Dissatisfaction with the design and maintenance such as the look of roads and estates was associated with lower mental health and vitality scores [70]. The neighborhood’s physical setup, including natural surroundings, street lighting, walking signs, and marked crosswalks, has a significant impact on safety and health. Environmental factors such as “walk” or “don’t walk” signs, marked crosswalks, and street lighting were associated with a lower rate of homicide [60]. The spatial design of greenery that is well-connected, has cohesion and complexity in shape design was shown to reduce the all-cause mortality death rate and also reduce cause-specific deaths [63]. The green spaces and the population density of an area are related to psychosis. Limited amounts of greenery and higher population density are linked to a higher rate of psychosis and a higher incidence of first-episode psychosis [72].

4.3.8. Dwelling Size and Type

Dwelling type, such as houses, flats, or other types, and size were highlighted by three papers, finding their impact on physical health, mental health, social health, general health, and quality of life [70,94,114]. Larger dwelling size was positively associated with overall health and related to less frequent back pain. A negative association was found between anxiety and dwelling size. Living in apartments was negatively associated with life satisfaction [114]. Feeling overcrowded in the home was associated with poor mental health [70]. Larger personal living spaces are beneficial for mental health and are linked to reducing depression. High-density buildings increase the risk of depression [94].

4.3.9. Blue Spaces

Three papers emphasized the impact of blue spaces on well-being, happiness, mental health, and general health [91,96,121]. Good mental health was more observed in citizens making visits to blue spaces and good general health was more reported in people who had a good view of blue spaces. Blue spaces that had facilities, wildlife, and perceived safety were more likely to be regularly visited by residents than only visited once. The number of visits to blue spaces affects the well-being of citizens [91]. Streets close to blue spaces were more associated with positive mood indicators such as happiness, focus, relaxation, and positive social emotion [121]. River improvement has a positive impact on stress level reduction and improvement of mental and physical health [96].

4.3.10. Aesthetics

Environmental aesthetics and attraction were found to be impactful on mental health, happiness, and quality of life by four papers [64,77,118,128]. The aesthetics and attractiveness of the neighborhood environment such as well-designed public spaces, historical elements and monuments, well-maintained buildings, and visually appealing environments have a significant impact on residents’ well-being and happiness [64,118]. The influence of aesthetics and attraction on happiness was illustrated by green roofs. The aesthetics and presence of a green roof provide calmness and positive moments related to memories and past experiences and it allows for escaping work-related stress and exhaustion even via a view from a window [64]. The existence of greenery and children’s playgrounds with night lighting and footpaths is considered to be related to the satisfaction level. The existence of greenery and increasing its level was not a sufficient factor and it needed to be paired with aesthetics, attraction, and cleanness to provide visual and experiential quality of the environment to the users [128]. Activities in outdoor green environments that are aesthetically pleasing are considered to be effective on mental health, social health, and encouraging physical activities [77]. The overall correlation flow between built environmental factors’ value to health and well-being value is shown in Figure 3.

4.4. Measurement Tools

To identify methods used for the exploration of complex interplay relations between the built environment, health, and well-being, methods in the examined literature in this study have been categorized based on type and frequency. Survey-based methods were the most frequent ones, used in 31 papers. The types of survey-based methods identified in this scoping review were questionnaires, web-based surveys, quasi-longitudinal surveys, and community-based observational surveys [16,61,62,64,66,67,68,70,71,78,80,85,87,89,92,94,95,97,103,104,108,109,111,112,113,117,122,124,126,127]. Statistical models for data were commonly Cox proportional hazard models, logistic regression, multilevel regression, odds ratio analysis, generalized linear models (GLMs), Heckman two-step models, structural equation modeling (SEM), linear regression, and interval regression models [60,62,63,65,72,73,74,79,83,86,87,88,89,96,106,108,109,110,111,125]. Geographic information system (GIS) and spatial analysis methods to find spatial patterns related to the environment and to quantify variables of the environment were used in 15 papers. Geographic information systems (GISs), spatial pattern analysis, remote sensing technologies (NDVI, satellite data), hot spot analysis, geographically weighted regression (GWR), street view images, and machine learning were the common tools used in gathering the data [63,71,73,79,82,83,87,88,89,106,107,116,117,119,121]. Eight studies used qualitative methods through photovoice, field research, and interviews [75,82,89,91,113,115,122,124] and seven papers used a mixed method [67,89,96,104,115,122,126]. Physiological measurements such as heart rate monitoring, blood pressure monitoring, electroencephalography (EEG), and MRI were only used in four papers [65,98,122,123].

Effect of time on method usage trend:

• Consistent utilization of survey-based methods and statistical modeling can be seen over time as the most common type of method relying on self-reported data gathering in research related to the built environment, health, and well-being.
• There was a noticeable increase in using advanced geospatial analysis techniques.
• Mixed-method approaches such as the integration of quantitative and qualitative methods have gained popularity over recent years.
• Physiological measurements’ utilization in research is gaining attention but is still infrequent, with four papers, as objective indicators of health and well-being.

5. Discussion

To have a deeper understanding of the complex interplay relation between built environment, health, and well-being, three research questions were designed for this scoping review. Key elements have been identified from the built environment affecting various aspects of health and well-being. The key elements of the built environment were greenery, urban architecture and accessibility, neighborhood, surrounding environments, amenities, dwelling size, aesthetics, safety, light, public spaces, and blue spaces. These environmental factors positively and negatively affect various aspects of health and well-being in a bidirectional association.

5.1. Aspects of Health and Well-Being Affected by the Built Environment

Based on the findings of this scoping review, several factors of the built environment have an impact on various aspects of health. The impact can be positive or negative. For some aspects, such as stress, the findings pointed to similar results while, for other health aspects, controversial findings have been found.

Regarding stress, a paper emphasized that the existence of green infrastructure will cause a reduction in ALAN which has a significant impact and association with stress levels. The transformation to more green areas might have an impact on potential interventional change with long-lasting improvement effects on children’s and adults’ health and well-being [67]. Another study considered green spaces and landscapes as beneficial for health and mentions residents ranked stress recovery as the greatest benefit perceived from greenery. It also emphasizes that factors such as the perception of the landscapes benefiting health, enhancing social communication, and facilitating stress recovery could increase residents’ willingness to keep their environment green [95].

The studies related to cancer showed controversial findings. Studies emphasized the impact of neighborhood characteristics like light pollution, socioeconomic status, population density, retail foods, and the number of parks that were associated with survival among breast cancer patients and risk of breast cancer [62,82,106]. While the neighborhoods without parks were associated with better survival, it was emphasized that the quality, safety, and type of park might be more relevant to physical activity than the number of parks. The paper also emphasized that the location of districts with international residents will affect the survival level [62]. Considering that the population of the study was women, in another study with a male population it was observed that visiting green areas such as forests will enhance the number of natural killer (NK) cells, NK activity, and intracellular anti-cancer proteins in lymphocytes. The enhancement of NK activity after the forest visit lasted for 7 days. The study suggests that the phytoncides released from trees and a decrease in stress hormones might be associated with enhancement of the NK activity [129]. Another study emphasizes the impact of geographic location on the risk of breast cancer related to the gene tumor protein 53 (P53) which needs to be taken into consideration while considering the impact of the built environmental factor on the increasing rate of cancer [130]. Another study mentions that exposure to urban green areas was associated with a reduced risk of breast cancer and found a linear trend between the distance to urban greenery and the risk of breast cancer. The risk of breast cancer was reduced in participants with access to urban green spaces within less than 300 m in comparison to residents without access to green areas. The study indicates that the risk of breast cancer was increased in participants with agricultural areas within a 300 m distance. Comparing the results of people in non-agricultural areas, there seemed to be less risk of breast cancer in participants with access to agricultural areas within a 300–500 m distance [131]. Based on the different results obtained from the research, it seems like the distance to green areas and the type of greenery have an impact on reducing the risk of breast cancer. The existence of green areas seemed to be positive in reducing the risk of breast cancer but the design of the green areas and the type of greenery in natural green areas are highly impactful.

In line with the results obtained from some studies [82,106], other papers also emphasize the impact of LAN on the risk of breast cancer. Light exposure will impact the circadian system and suppress melatonin production. Light, as a primary stimulus for circadian pace, can act as a disruptor, suppress melatonin, and alter clock gene function. The decrease in melatonin may result in increasing reproductive hormone levels such as estradiol which may affect the proliferation of hormone-sensitive cells in breast cancer or increase gene p53. With the effect of night pollution, night shifts have received the 2A classification as “probable human carcinogen”. Considering the exposure of residents to districts with high cumulative light at night, the light intrusion into their interior environment in the evening or night, street lighting, and high levels of brightness during evening activities in outdoor environments can all affect the risk of breast cancer [132,133,134,135].

5.2. Specific Characteristics of the Built Environment Affecting Citizens’ Health and Well-Being

Based on this scoping review result, greenery, public spaces, safe environment, lighting, amenities and facilities, neighborhoods, dwelling size and type, urban architecture and accessibilities, aesthetics and attraction, and blue spaces were impactful on health and well-being. As we have described in the Results, most of the research was related to greenery with approximately 60 percent (42 papers) of the main data, while urban architecture and accessibilities studied in 25 papers and public spaces and neighborhoods in 23 papers were the other major topics investigated by research to explore their impact on health and well-being. Information on greenery, as the most researched topic that was considered impactful on all aspects of health and well-being, remained general and in only one paper was the distance of greenery from residential areas considered impactful in decreasing cardiovascular disease rates. The paper emphasized that a 500 m distance from greenery reduces the chance of cardiovascular diseases by 26–27 percent, compared to a distance of 1000 m, which reduces the risk by 21–22 percent [87].

While most of the studies emphasized the role of these factors on health and well-being, the information found was general, and specific characteristics that the mentioned environmental factors need to have were not mentioned. The comparative study of the characteristics’ changes and their conditions needs to be carried out.

5.3. Identifying Suitable Methods to Investigate the Complex Interplay Between the Built Environment, Health, and Well-Being

As we illustrated in Section 4.3, Most of the studies focused on survey-based methods and statistical modeling approaches in investigating the impact of the built environment on health and well-being. There were only four papers [65,98,122,123] focusing on physiological measurement tools. Considering the complexity and benefit of physiological measurement described in Section 2.4 of this paper, there is a need to use more physiological measurement methods in this type of complex interplay relation between concepts to be able to compare specific characteristics of the special factors of the built environment.

Several significant gaps were identified in this scoping literature review that need to be addressed in future research. One of the gaps was that the focus of most research was on residential areas and insufficient focus was on commercial and office areas. As a result, most of the findings such as distance to greenery or impact of factors on health and well-being were found in residential areas. Other gaps were that the specific type and character of the built environment factors that were found to be impactful were not mentioned. For example, greenery and public spaces were often mentioned as beneficial for all aspects of health and well-being but their type, amount, and design characteristics rarely examined. Another gap was longitudinal studies that were only found when the topic was about some health aspect related to cancer or mortality. Long-term studies on environmental factors’ impact on other aspects of health and well-being will provide valuable information for deeper insights into the lasting impact of the built environment on health and well-being.

This scoping review faced a limitation by focusing on the urban living environment and excluding rural areas. Considering the increasing trend of urbanization which will lead to 70 percent of the population living in cities in 2050, future cities need to be prepared and prioritize a healthy environment for their citizens in terms of urban development.

6. Conclusions

This research investigated the impact of the built environment on different aspects of health and well-being. It was identified that several environmental factors such as different scales of greenery, social and public spaces, neighborhood elements, safe environmental design, urban architecture and networking, accessibility, surroundings, dwelling size and type, amenities and facilities, aesthetics and attraction, artificial light, and blue spaces are positively and negatively impactful on health (mental, social, physical, mortality, longevity) and well-being (happiness, quality of life). These environmental factors, depending on their characteristics, were found to have a two-way association with health and well-being aspects such as cancer, cardiovascular diseases, stress, depression, and happiness. This comprehensive overview that mapped the complex interplay relations of the built environment, health, and well-being provides valuable theoretical, practical, social, and policy implications.

The scoping review provides a holistic theoretical overview of the built environment’s interplay effect on health and well-being. The information found in this paper could be used as the foundation for future research in related fields like engineering, architecture, public health, and psychology. Urban planners, architects, and public health experts can benefit from the findings for their project design and practice. Based on the gap found in the existing body of literature, future research is needed to address the specific design characteristics essential for environmental factors to be impactful on health or well-being. Case studies need to address environments other than residential areas. High-impact factors need to be identified to be implemented in future policies and city development. The data enriched by future research that addresses the gap could be used as guidelines for formulating new policies and regulations for integrating health promotion into urban planning.