What do we talk about when we talk about spatial determinants of health? A systematic review.

Objectives: Spatial determinants of health are increasingly recognised as important because the uneven distribution of risks, resources, and exposures across geographic space shapes health outcomes and inequalities, highlighting the need for consistent definitions and operationalisation in public health. The objective of this systematic review is to synthesise how spatial determinants of health (SpDoH) are defined, what their components are, and how they are conceptually positioned relative to other health determinants in the published literature. Study design: Systematic review. Methods: A systematic review was conducted in EBSCOhost (including CINAHL, MEDLINE and PsycInfo databases), Scopus, and PubMed on 1 September 2025, supplemented by citation chaining and targeted Google Scholar searches. Eligible studies included peer-reviewed publications addressing human health or related topics including empirical studies and non-empirical formats such as editorials, commentaries, letters, conference papers, and book chapters. Inclusion criteria required explicit discussion of SpDoH or related concepts and/or description of their components and/or relationships with other health determinants. Studies were excluded if SpDoH could not be clearly distinguished as a separate determinant. Due to the conceptual nature of the field, no formal risk-of-bias tool was applied; instead, publication type and source were used as proxies for evidential robustness. A total of 59 publications were included, and data were synthesised narratively. The study was not registered in any registries. It was funded by the Provintial Secretariat for Higher Education and Scientific Research of the Autonomous Province of Vojvodina, Serbia. Results: Only three (5.1%) studies explicitly defined spatial determinants of health. Spatial factors were most often embedded within social, environmental, or economic determinants rather than treated as a distinct category. In some cases, they were conceptualised as geographic variation rather than determinants with inherent spatial properties. Three key domains were identified: spatial structures and urban configuration, accessibility, mobility and connectivity, and neighbourhood context. However, substantial heterogeneity in terminology and framing indicated a lack of conceptual coherence across the literature. The review was limited to academic, English-language sources, potentially excluding relevant grey literature and non-English conceptual work. Variability and implicit reporting of SpDoH across studies constrained extraction and synthesis, likely underrepresenting spatial factors not explicitly framed as such and contributing to observed heterogeneity. Conclusions: The absence of consistent definitions and frameworks for SpDoH limits cumulative knowledge development, comparability across studies, and translation into policy and practice. Clearer conceptualisation of SpDoH as a distinct domain may support improved measurement, theory development, and integration into public health research.