Abstract
Landscape architecture influences environmental conditions related to health, but evidence on how design features impact health is scattered across disciplines. The review aims to assess the evidence, identify pathways to health, and guide collaboration between landscape architects and public health professionals. Following PRISMA and JBI Umbrella Review guidelines, systematic searches were conducted in PubMed, Web of Science, Academic Search Complete, and GreenFILE. Exposures included landscape design features, while outcomes captured pathways such as instoration, restoration, mitigation, adaptation, and direct health effects. The review is registered with PROSPERO (CRD420251058826). Fifty-six systematic reviews and meta-analyses were included, covering 2,654 studies, most published from 2021 to 2025. Frequently, landscape types included parks, forests, recreational spaces, streetscapes, health gardens, and educational landscapes. Instoration pathways consistently increased physical activity and active transportation. Restoration pathways improved social inclusion, particularly in hospital gardens and green schoolyards. Mitigation pathways demonstrated reductions in heat and noise and improved thermal comfort. Adaptation pathways such as green roofs and other green infrastructure reduced heat stress and supported outdoor use. Reported health outcomes included improved psychological well-being, some cardiometabolic benefits, and reduced behavioral symptoms in clinical contexts; however, the quality of the evidence remains limited. Findings indicate that landscape architecture practice can improve health by encouraging physical activity and social cohesion, but climate mitigation and adaptation have been less studied. Despite standards that promote active living and climate resilience, systematic evaluation of health-focused landscape projects remains lacking. Collaboration between health and design is necessary to create evidence-based landscapes that enhance health and environmental quality.
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