What Do We Talk About When We Talk About Environmental Determinants of Health? A Systematic Review

Background: Environmental determinants of health (EnvDoH) are widely recognised as shaping health and behaviour, yet little attention has been given to how they are conceptually defined. This is notable given their use across disciplines and the lack of a consistent definition of “environment,” which contributes to inconsistencies in research, policy, and practice. Methods: Following PRISMA 2020 guidelines, we conducted a systematic review of peer-reviewed English-language publications addressing EnvDoH definitions, components, or relationships with other determinants. Searches of Scopus, PubMed, and EBSCOhost databases (including CINAHL, MEDLINE, and PsycInfo) included studies published up to 31 August 2025. Definitions and relationships were synthesised narratively, and components were analysed using inductive thematic analysis. Results: Among 1157 included publications, 52.3% originated from the United States, United Kingdom, Canada, and Australia, and 47.5% were published from 2020 onwards. Only in 77 publications (6.7%) we were able to identify a definition of EnvDoH, ranging from broad descriptions (“everything that is not genetic”) to multidimensional frameworks encompassing physical, natural, built, social, political, and behavioural domains. Components identified in 1147 (99%) publications were grouped into 56 themes and 12 domains, with food and physical/natural environments most frequently represented. Discussion: The absence of conceptual consensus on EnvDoH limits comparability across studies and may hinder research, policy, advocacy, and education. Greater conceptual clarity is needed to strengthen public health responses to accelerating environmental change. Limitations include single-reviewer screening for some full texts, possible omission of implicit determinants, exclusion of non-English publications and grey literature. Funding was provided by the Provincial Secretariat for Higher Education and Scientific Research of the Autonomous Province of Vojvodina, Republic of Serbia. The study was not registered.