Background Developing urban and rural areas affects the environment, which can in turn affect the risk of unintentional injuries. The process to evaluate development proposals includes statutory appraisal methods that should consider any health consequences.

Aims/Objectives/Purpose To evaluate whether statutory appraisal processes used on spatial plans consider unintentional injury risk, and whether changes to proposed developments result.

Methods A systematic review collated and narratively synthesised studies between 1987 and 2010 that evaluated appraisals of plans where health issues, including injury risk, were considered.

Results/Outcome Twenty reports meeting the inclusion criteria were identified from 6161 citations sourced from electronic databases, website searches, and grey literature. All 135 different case studies described were from high income countries and none from low or middle income countries. Twenty-two used Health Impact Assessment (HIA) methods, and 113 used Strategic Environmental Assessment (SEA) or other integrated methods. Unintentional injury was included in 13 of 22 HIA reports (usually within transport plans/strategies) but there was very little evidence that this resulted in recommendations that were implemented or subsequently evaluated. Unintentional injury was less likely to be considered in SEA or other integrated appraisal methods.

Significance/Contribution to the Field The potential for using spatial planning appraisal to consider the impact of developments on unintentional injury risk and to make changes to reduce risk appears to be underused and under-evaluated. Where used, there is a risk of bias (no independent evaluation), lack of detail and a lack of triangulation of results.