Built Environment Determinants of Urban Health in Gulf Cooperation Council Countries: A PRISMA-Based Systematic Review.

BACKGROUND: Research on associations between the built environment (BE) and health has expanded globally, but evidence from Gulf Cooperation Council countries remains fragmented. OBJECTIVE: To systematically synthesize and critically appraise evidence on associations between BE attributes and health-related outcomes in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the UAE. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, Web of Science and Scopus were searched for peer-reviewed studies published between January 2000 and May 2024. Eligible studies quantitatively examined associations between BE attributes and health-related outcomes among Gulf Cooperation Council populations. Two reviewers independently screened studies, extracted data, and assessed methodological quality and risk of bias. Due to heterogeneity in BE measures, health outcomes, and study designs, findings were synthesized narratively. RESULTS: Of 371 records identified, 79 studies met the inclusion criteria. Nearly all were cross-sectional (n = 78), with only one longitudinal study. Evidence supported positive associations between neighborhood accessibility (eg, walking and cycling infrastructure, destination proximity, and public transport access) and land-use characteristics (eg, mixed use and green/open spaces) with physical activity, walkability, and quality of life. Car-oriented urbanization, extreme heat, and sociocultural constraints, particularly gender-related barriers to recreation, emerged as important contextual factors. Evidence linking BE attributes to dietary behaviors, chronic disease outcomes, and mental health was limited and generally of low certainty. CONCLUSION: Accessibility, land use, thermal environment, and urban form appear associated with health-related behaviors and outcomes in the Gulf Cooperation Council. However, methodological limitations constrain causal inference, highlighting the need for longitudinal and policy evaluation studies to inform healthy-city planning in hot-arid environments.