Sarcouncil Journal of Internal Medicine and Public Health

Abstract: The patterns of housing, accessibility, and environmental exposure define health equity in American cities and are controlled by urban zoning and land-use policies. Even though mounting evidence uses Geographic Information Systems (GIS) to study spatial health disparity, evidence about the connection between zoning policy, GIS-enabled planning, and quantifiable health outcomes is still discrete. This paper is a systematic review of the current GIS-based research to explain how zoning is a structural determinant of health equity. The systematic literature review was performed according to PRISMA 2020. The search of the ScienceDirect database was structured into a Boolean search involving the identification of peer-reviewed articles published between 2020 and 2026. Articles were limited to those (1) that concern the United States, (2) that involve the use of GIS or spatial analytic techniques and (3) that discuss zoning, land-use policy, housing regulation, accessibility, or environmental exposure about health or health equity outcomes. Having screened 142 records, 100 studies were eligible. Information abstraction considered the context of the study, GIS practices, policy agenda, health outcomes, and equity. The quality of the studies was assessed with modified MMAT criteria with the focus on transparency, spatial rigor, and policy relevance. The review concludes that the effect of zoning on health is an upstream determinant of health because housing segregation, unequal access to necessary services and green space, and disproportionality of exposure to environmental hazards are found. Geographic disparities have been revealed through the application of GIS techniques and especially accessibility modeling, exposure mapping, spatial regression and composite equity indices. Nonetheless, most of the literature is based on cross-sectional designs, and few longitudinal or quasi-experimental analyses of zoning reform exist. The heterogeneity of methodology and the lack of unified incorporation of policy analysis restrict causal inference. It has been shown that zoning reform is to be considered a form of public health intervention that has quantifiable equity consequences. Moving towards the equity-based, data-driven zoning, it is necessary to incorporate health-related measurements into the land-use decision-making, enhance participatory GIS practice, and enhance longitudinal assessments of policy effects.