Applying the proactive health concept in built environment research: progress, trends, and insights across multiple spatial scales

This study investigates the application of the “proactive health” concept in built environment, aiming to improve health outcomes through design optimization. Despite such research is receiving increasing attention, spatial-scale patterns and systematic mechanisms linking design interventions to health benefits remain insufficiently quantified. We conducted bibliometric analysis and systematic review of relevant literature published between 2015 and April 2025 and performed a systematic review to identify research progress, application trends, and key challenges across macro, meso, and micro-scales. The key findings are: 1) Quantitative analysis reveals a significant publication imbalance, with over 90% of evidence generating from developed regions in Asia, Europe, and North America. 2) While high-frequency terms initially cantered on “physical activity” and “green space,” recent clusters have pivoted toward data-driven topics such as “machine learning”, “social environment”, and “equity”. 3) The research focus has shifted from macro-urban form to micro-level elements, health impacts arise mainly through three pathways: promoting physical activity, reducing pollution exposure, and influencing psychological perceptions. Social and economic determinants remain underexplored. By synthesizing these trends, this study establishes a theoretical link between built environment design and health mechanisms. It provides a foundation for future evidence-based strategies to operationalize “proactive health” principles across diverse socio-economic contexts.