Designing green and blue spaces for health: A systematic literature review of current spatial design recommendations for healthy and thermally comfortable urban environments

Green and blue spaces (GBS) have been extensively researched for their direct and indirect effects on human health outcomes. These effects have been found to follow different pathways, including mitigation, restoration, and instoration. However, while research has been conducted on these individual pathways, a lack of comprehensive reviews currently exists that integrate the promotion of human health and the creation of climate-adaptive urban environments. Thus, approaches that promote potential synergies between these pathways remain largely absent in the literature. This paper systematically reviews studies that have identified associations between GBS and health effects and recommends spatial solutions for designers looking to integrate various health benefits. This review focuses on local scale designs within cities in European and North American countries with temperate climates. We used the databases Scopus and Web of Science to conduct a review in January 2024 and 2025, identifying 152 studies that provided spatial recommendations. Our results show that these studies primarily focused on the mitigation pathway, as this topic yielded the highest number of spatial recommendations. Conversely, relatively fewer studies offered solutions concerning blue spaces. In addition, we found that the collected recommendations mainly addressed the selection, design, or maintenance of GBS, with maintenance receiving the least attention. This imbalance, coupled with the lack of integrative approaches across all three topics, underscores the need for further research to identify potential synergies. Thus, this review offers a holistic perspective on the various recommendations for the design of GBS that can assist spatial designers in creating healthier urban environments. • Recommendations can be categorized into selection, design, and maintenance of GBS. • Spatial recommendations are primarily focused on the mitigation pathway. • The impact of blue spaces on health remains insufficiently researched. • Further research should evaluate the health implications of maintenance practices.