Sustainable Housing as a Social Determinant of Health and Wellbeing

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

 

The paper offers an important discussion around sustainable housing. There are however several sections and at times it isn’t clear how they all connect to the argument. I’d suggest the authors revisit their argument and ensure that each section relates (and elevates) that argument. The substance is all here, it just needs some reorganizing to ensure the reader fully understands the argument that’s developed throughout. I’ve offered additional comments below organized by heading. It seems that the paper not only promotes sustainable housing as an SDH but also argues that there is a need for equity centered and health protected approaches.

Abstract

• The abstract is quite long and could be more concise. What is the paper doing and how does it do so? This paper serves as an important theoretical intervention and makes important contributions that could be more clearly highlighted with strong active voice that brings in the author’s argument. As it is it waters down the contributions and sounds more like a literature review without a clear direction.

1. Introduction
   • The argument is introduced at the end and could include some more signposts for the reader regarding what’s coming next. How does the paper project sustainable housing as a SDH? The paper reviews existing literature and brings it together with empirical studies – these contributions should be clearly introduced here!
2. Sustainable housing
   • Table 1 needs some more introduction and discussion. The argument shortly prior to the table is that existing literature focuses on the environmental elements and yet the table seems to include them as well. I really like the table and think it’s a helpful addition, but it needs to be better integrated into the discussion. Is this how sustainable housing is discussed in the literature? Are the authors here making the connections between health outcomes and designs? Why? This would help the reader understand the overall point of the table and what they should be taking away from it in relation to this paper.
   • The many definitions are helpful but it is unclear how the authors are defining sustainable housing. What is the definition chosen and how does it help us see sustainable housing as a SDH? Is it a combination of what’s found in various bodies of literature?
3. Sustainable housing and health equity in theoretical context
   • The introduction here could be reframed to strengthen the argument and present the theoretical contributions more clearly. Introducing this section with the argument that sustainable housing is a SDH and then arguing that to see it as such there’s a need to combine multiple theoretical traditions would be one way to go about this.
   • I’m not convinced that Figure 1 is needed. A figure that shows all the theories and their relationships (the purpose of this section) would be more effective here.
4. Empirical evidence linking sustainable housing to health outcomes
   • Figure 2 and table 2 are great!
   • I’m a bit confused about why 4.1 is a subheading. It’s not necessary given it’s the only subheading in this section and the introduction is very much related to what follows.
5. Integrating sustainable housing into public health policy
   • The connection to SDH could be made to strengthen the purpose of this section. SDH’s require integrated responses, and policy is needed to ensure sustainable housing, for example.
6. (and 7.) both these sections need to be connected to the argument, is it that as an SDH there’s a need for these approaches? How do they relate to the claims made above or not? Are they examples of policy approaches (perhaps they can be subsections of 5. If so).
7. How does climate resilience relate to the argument around sustainable housing? Again, with clear definitions and direction earlier on it will be easier to tie together each of the sections.
8. Future directions
   • This section is very well done, as is the conclusion (although it might need some edits once the earlier comments are addressed!).

 

Author Response

The paper offers an important discussion around sustainable housing. There are however several sections and at times it isn’t clear how they all connect to the argument. I’d suggest the authors revisit their argument and ensure that each section relates (and elevates) that argument. The substance is all here, it just needs some reorganizing to ensure the reader fully understands the argument that’s developed throughout. I’ve offered additional comments below organized by heading. It seems that the paper not only promotes sustainable housing as an SDH but also argues that there is a need for equity centered and health protected approaches.

Response: Thank you for positive note, thoughtful feedback and your time reviewing the manuscript. I have carefully revised the structure and flow of the paper to ensure that each section clearly contributes to and reinforces the central argument. In particular, I have strengthened the narrative thread that positions sustainable housing as a social determinant of health while highlighting the need for equity-centered and health-protective approaches. I believe these revisions have significantly improved the coherence and clarity of the manuscript.

 

Abstract

• The abstract is quite long and could be more concise. What is the paper doing and how does it do so? This paper serves as an important theoretical intervention and makes important contributions that could be more clearly highlighted with strong active voice that brings in the author’s argument. As it is it waters down the contributions and sounds more like a literature review without a clear direction.

Response: Thank you for the feedback. I have revised the abstract as per the suggestion. Please refer Page 1.

 

1. Introduction
   • The argument is introduced at the end and could include some more signposts for the reader regarding what’s coming next. How does the paper project sustainable housing as a SDH? The paper reviews existing literature and brings it together with empirical studies – these contributions should be clearly introduced here!

Response: Thank you for the feedback. I have revised the introduction as per the suggestion and added suggested content to the end of the introduction. Please refer Page 2.

 

2. Sustainable housing
   • Table 1 needs some more introduction and discussion. The argument shortly prior to the table is that existing literature focuses on the environmental elements and yet the table seems to include them as well. I really like the table and think it’s a helpful addition, but it needs to be better integrated into the discussion. Is this how sustainable housing is discussed in the literature? Are the authors here making the connections between health outcomes and designs? Why? This would help the reader understand the overall point of the table and what they should be taking away from it in relation to this paper.

Response: Thank you for the feedback. I agree with the comment and believe that the table would be better positioned elsewhere. Given that this topic is also discussed in Section 4.3, I have moved Table 1 to that respective section to enhance the narrative flow. Placing it in synchrony with the section on “Sustainable Housing Interventions” allows for a more cohesive and contextually relevant discussion. Thank you for raising this point. Please refer Page 6.

 

• The many definitions are helpful but it is unclear how the authors are defining sustainable housing. What is the definition chosen and how does it help us see sustainable housing as a SDH? Is it a combination of what’s found in various bodies of literature?

Response: I agree that the definition of sustainable housing requires clarification. In response, I have added a sentence in Section 2 (“What is sustainable housing?”) explicitly stating the definition adopted in this manuscript. This integrative definition draws from urban planning, environmental science, and public health literature, and frames sustainable housing as encompassing environmental performance alongside affordability, safety, inclusivity, and health-promoting design, thus clearly positioning it as a social determinant of health. Please refer Page 3.

 

3. Sustainable housing and health equity in theoretical context
   • The introduction here could be reframed to strengthen the argument and present the theoretical contributions more clearly. Introducing this section with the argument that sustainable housing is a SDH and then arguing that to see it as such there’s a need to combine multiple theoretical traditions would be one way to go about this.

Response: Thank you for the helpful comment. In response, I have revised the introduction in the revised version to enhance the flow of ideas and strengthen the framing of sustainable housing as a social determinant of health. Please refer Page 2.

 

• I’m not convinced that Figure 1 is needed. A figure that shows all the theories and their relationships (the purpose of this section) would be more effective here.

Response: Based on the suggestion, I believe that Figure 1 is better positioned in the newly added Section 3.1, “Where Housing and Health Theories Intersect,” as proposed by another reviewer. Accordingly, I have moved the figure to this section. If the reviewer still believes that the figure does not add value, I am happy to consider removing it. However, I believe the figure enhances the readability of the manuscript, as many readers benefit from a visual representation of how the theories align with the narrative presented.

 

4. Empirical evidence linking sustainable housing to health outcomes
   • Figure 2 and table 2 are great!

Response: Thank you for the positive note.

 

• I’m a bit confused about why 4.1 is a subheading. It’s not necessary given it’s the only subheading in this section and the introduction is very much related to what follows.

Response: Based on the comment from another reviewer and the above feedback, I have added subsection headings with more detail in Section 4.

 

5. Integrating sustainable housing into public health policy
   • The connection to SDH could be made to strengthen the purpose of this section. SDH’s require integrated responses, and policy is needed to ensure sustainable housing, for example.

Response: Thank you for the comment. I agree with the suggestion to more thoroughly integrate the Social Determinants of Health (SDH) into the discussion around policy. Accordingly, I have revised Section 5 extensively. Please refer Page 10 and 11.

 

6. (and 7.) both these sections need to be connected to the argument, is it that as an SDH there’s a need for these approaches? How do they relate to the claims made above or not? Are they examples of policy approaches (perhaps they can be subsections of 5. If so).

Response: To strengthen the connection between topics in section 6, 7 and 8 and the central argument around sustainable housing as a social determinant of health, I have revised all those sections incorporating comments from other reviewers as well.

 

7. How does climate resilience relate to the argument around sustainable housing? Again, with clear definitions and direction earlier on it will be easier to tie together each of the sections.

Response: To strengthen the connection between climate resilience and the central argument around sustainable housing as a social determinant of health, I have revised the Section 8. The updated section explicitly discusses how climate-resilient design features contribute to health protection, particularly for vulnerable populations, and underscores their essential role within the broader framework of sustainable housing. Please refer Page 12 and 13.

 

8. Future directions
   • This section is very well done, as is the conclusion (although it might need some edits once the earlier comments are addressed!).

Response: Thank you for the positive note. I have revised this section based on the comments from other reviewers as well.

Reviewer 2 Report

Comments and Suggestions for Authors

This study integrates social determinants of health theory with ecological systems frameworks to systematically demonstrate how sustainable housing influences population health and equity through environmental, social, and economic mechanisms. Drawing on interdisciplinary evidence, it proposes an integrated pathway prioritizing climate-resilient design, equity-centered policies, and longitudinal research. The topic highlights innovative cross-disciplinary convergence between public health and urban planning. Even if it contains some insightful points, to improve the quality of the paper the following revisions are required.

1. [line 46-48] The literature coverage is incomplete. The review of “housing as a social determinant of health” cites only early studies and omits recent systematic syntheses published after 2020, such as The Lancet’s 2023 Health and Housing series.
2. [line 58-60] A critical perspective is lacking: the paper fails to examine the policy controversies surrounding the concept of “sustainable housing,” such as the intensification of health inequities through green gentrification (e.g., reference [8] is merely mentioned without in-depth analysis).
3. In Section 2, the definition of sustainable housing remains vague. While the imbalance among environmental, social, and economic dimensions is noted, the paper does not offer an integrated operational definition—such as how to quantify “social sustainability”—nor does it address cross-cultural variations in the perception of sustainable housing.
4. Section 4 exhibits a geographic bias: the case studies concentrate on Europe and North America (e.g., South Bronx, Italy) and lack data from Asia and Africa.
5. Section 5 relies on a narrow set of policy examples—only Enterprise Green Communities and LEED are discussed—while omitting initiatives from developing countries such as China’s “Green Building Action Plan.” Moreover, it neglects to examine policy failures, for instance the exclusion of low-income households resulting from the high costs of Germany’s “Passive House” policy.
6. Section 8 shows methodological limitations: it fails to mention big-data approaches such as mobile-phone signaling data to track residential mobility and health outcomes, nor does it address the use of AI for predicting housing-related health risks. Additionally, it overlooks ethical concerns, omitting any discussion of privacy and health-ethics controversies that may arise from digital technologies like smart-home surveillance.

Author Response

This study integrates social determinants of health theory with ecological systems frameworks to systematically demonstrate how sustainable housing influences population health and equity through environmental, social, and economic mechanisms. Drawing on interdisciplinary evidence, it proposes an integrated pathway prioritizing climate-resilient design, equity-centered policies, and longitudinal research. The topic highlights innovative cross-disciplinary convergence between public health and urban planning. Even if it contains some insightful points, to improve the quality of the paper the following revisions are required.

Response: Thank you for your positive note and for taking the time to review the manuscript. I appreciate your thoughtful feedback. Based on your suggestions, I have revised the manuscript to address the required improvements and enhance its clarity, coherence, and analytical depth.

 

1. [line 46-48] The literature coverage is incomplete. The review of “housing as a social determinant of health” cites only early studies and omits recent systematic syntheses published after 2020, such as The Lancet’s 2023 Health and Housing series.

Response: Thank you for the feedback. I have revised the sentence with the addition of a new reference, namely the 2023 Lancet paper, as advised. Please refer Page 2.

 

2. [line 58-60] A critical perspective is lacking: the paper fails to examine the policy controversies surrounding the concept of “sustainable housing,” such as the intensification of health inequities through green gentrification (e.g., reference [8] is merely mentioned without in-depth analysis).

Response: Thank you for the feedback. I have revised the paragraph as advised. Please refer Page 2.

 

3. In Section 2, the definition of sustainable housing remains vague. While the imbalance among environmental, social, and economic dimensions is noted, the paper does not offer an integrated operational definition—such as how to quantify “social sustainability”—nor does it address cross-cultural variations in the perception of sustainable housing.

Response: Thank you for the feedback. I have revised the paragraph as advised. Please refer Page 3.

 

4. Section 4 exhibits a geographic bias: the case studies concentrate on Europe and North America (e.g., South Bronx, Italy) and lack data from Asia and Africa.

Response: Thank you for the comment. I agree that a more depth of the synthesis specially in Global South is required. In response, I have revised Section 4 to incorporate thematic categorization based on geographic region. This re-structuring highlights contextual nuances in the health impacts of sustainable housing, allowing for clearer comparison across diverse settings. Please refer Page 6 and 7.

 

5. Section 5 relies on a narrow set of policy examples—only Enterprise Green Communities and LEED are discussed—while omitting initiatives from developing countries such as China’s “Green Building Action Plan.” Moreover, it neglects to examine policy failures, for instance the exclusion of low-income households resulting from the high costs of Germany’s “Passive House” policy.

Response: Thank you for the comment. I agree that a more depth of the synthesis specially in Global South is required in line to comment number 4. In response, I have revised Section 4 as well as Section 5, per advice to add on that. Please refer Page 6, 7 and 10.

 

6. Section 8 shows methodological limitations: it fails to mention big-data approaches such as mobile-phone signaling data to track residential mobility and health outcomes, nor does it address the use of AI for predicting housing-related health risks. Additionally, it overlooks ethical concerns, omitting any discussion of privacy and health-ethics controversies that may arise from digital technologies like smart-home surveillance.

Response: Thank you for the comment. I have added a new section “7. Digital technologies in sustainable housing” as per suggestion. Please refer Page 11 and 12.

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript titled “Sustainable Housing as a Social Determinant of Health” aims to position sustainable housing as a crucial social determinant of health, review existing literature, and explore how integrating environmental sustainability, affordability, safety, and inclusivity in housing can mitigate health risks, reduce inequities, and promote resilient urban futures. It seeks to address the lack of a people-centered definition of sustainable housing and advocate for its integration into public health and urban development agendas.The article highlights sustainable housing’s role in advancing health equity, environmental justice, and community resilience amid urbanization and climate change. It fills gaps in existing research by emphasizing social dimensions of sustainability (often overshadowed by environmental aspects) and calls for policy innovations and cross-sector collaboration, providing a theoretical and empirical foundation for actionable strategies.However, the manuscript requires revisions to enhance its academic rigor and practical relevance.

Comments 1:The article would benefit from a more systematic classification of empirical studies (e.g., by geographic region, housing type, or target population) to enhance clarity on contextual differences in the impact of sustainable housing on health.

Comments 2:The integration of theoretical frameworks could be strengthened. A more explicit discussion of how these theories interact (e.g., how the Life Course Perspective complements Environmental Health Theory) would deepen the analytical rigor.

Comments 3:The section on digital technologies in sustainable housing (e.g., smart sensors) is underdeveloped. Expanding on specific applications, potential risks (e.g., digital inequity), and real-world case studies would enrich the discussion.

Comments 4:More concrete indicators for measuring health outcomes linked to sustainable housing (e.g., specific metrics for mental health improvements or respiratory illness reduction) are needed to enhance the practical relevance for policymakers and practitioners.

Author Response

The manuscript titled “Sustainable Housing as a Social Determinant of Health” aims to position sustainable housing as a crucial social determinant of health, review existing literature, and explore how integrating environmental sustainability, affordability, safety, and inclusivity in housing can mitigate health risks, reduce inequities, and promote resilient urban futures. It seeks to address the lack of a people-centered definition of sustainable housing and advocate for its integration into public health and urban development agendas. The article highlights sustainable housing’s role in advancing health equity, environmental justice, and community resilience amid urbanization and climate change. It fills gaps in existing research by emphasizing social dimensions of sustainability (often overshadowed by environmental aspects) and calls for policy innovations and cross-sector collaboration, providing a theoretical and empirical foundation for actionable strategies. However, the manuscript requires revisions to enhance its academic rigor and practical relevance.

Response: Thank you for the feedback. I have revised the manuscript as per the suggestion and do believe the comments have improved the narration of the manuscript. Recent literature and clearer policy implications have also been incorporated to improve clarity and impact as per suggestion.

 

Comments 1: The article would benefit from a more systematic classification of empirical studies (e.g., by geographic region, housing type, or target population) to enhance clarity on contextual differences in the impact of sustainable housing on health.

Response: Thank you for the comment. I agree that a more systematic classification of empirical studies enhances the clarity and depth of the synthesis. In response, I have revised Section 4 to incorporate thematic categorization based on geographic region, housing type, and target population. This re-structuring highlights contextual nuances in the health impacts of sustainable housing, allowing for clearer comparison across diverse settings. Please refer Page 6 and 7.

 

Comments 2: The integration of theoretical frameworks could be strengthened. A more explicit discussion of how these theories interact (e.g., how the Life Course Perspective complements Environmental Health Theory) would deepen the analytical rigor.

Response: Thank you for the comment. In response, I have added a new subsection (Section 3.1) to explicitly discuss the interaction between key theoretical frameworks, including how the Life Course Perspective complements Environmental Health Theory and the Social Determinants of Health approach. Please refer Page 4.

 

Comments 3: The section on digital technologies in sustainable housing (e.g., smart sensors) is underdeveloped. Expanding on specific applications, potential risks (e.g., digital inequity), and real-world case studies would enrich the discussion.

Response: Thank you for the comment. In response, we have added a new section (Section 6) titled "Digital technologies in sustainable housing". Please refer Page 11 and 12.

 

Comments 4: More concrete indicators for measuring health outcomes linked to sustainable housing (e.g., specific metrics for mental health improvements or respiratory illness reduction) are needed to enhance the practical relevance for policymakers and practitioners.

Response: Thank you for your valuable suggestion. I have now added a paragraph in Section 8 that outlines specific and measurable health indicators. Please refer Page 12.

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

Comments to the Author：

In the manuscript titled Sustainable Housing as a Social Determinant of Health , the authors reframes sustainable housing as a critical social determinant of health (SDH), integrating environmental, economic, and social dimensions. It synthesizes theoretical frameworks (e.g., Ecological Systems Theory, Environmental Justice) and empirical evidence to demonstrate how sustainable housing reduces health inequities, enhances climate resilience, and improves well-being—particularly for vulnerable populations. The study advocates for embedding equity-centered sustainable housing into public health and urban policies.       

 

Comments 1:  Bridges public health, urban planning, and environmental science to position housing as a multisectoral SDH.

 

Comments 2: Highlights how sustainable housing mitigates disparities by addressing systemic barriers (e.g., green gentrification, digital divides).

 

Comments 3: Calls for cross-sector collaboration and climate-resilient design to address urbanization/climate challenges.

 

Comments 4:  Contextualizes evidence across high/low-income settings (e.g., U.S. LEED certifications, Bangladesh’s flood-resistant housing).

Comments on the quality of English language:

The manuscript needs to be touched up in the English language. Please have a native English speaker touch up the manuscript.

Author Response

Comments to the Author：

In the manuscript titled Sustainable Housing as a Social Determinant of Health , the authors reframes sustainable housing as a critical social determinant of health (SDH), integrating environmental, economic, and social dimensions. It synthesizes theoretical frameworks (e.g., Ecological Systems Theory, Environmental Justice) and empirical evidence to demonstrate how sustainable housing reduces health inequities, enhances climate resilience, and improves well-being—particularly for vulnerable populations. The study advocates for embedding equity-centered sustainable housing into public health and urban policies.      

Response: I sincerely thank the reviewers for their thoughtful feedback and constructive suggestions. Post your comments, the quality of the manuscript has indeed improved, and so has its readability. Below, a point-by-point response has been provided.

 

Comments 1:  Bridges public health, urban planning, and environmental science to position housing as a multisectoral SDH.

Response: Thank you for the comment. I have added a sentence explicitly highlighting how the approach integrates public health, urban planning, and environmental science to position housing as a multisectoral social determinant of health. Please refer Section 2.

 

Comments 2: Highlights how sustainable housing mitigates disparities by addressing systemic barriers (e.g., green gentrification, digital divides).

Response: Thank you for your comment. I have added this in the section on community-specific impacts to explicitly highlight how sustainable housing can mitigate health disparities by addressing systemic barriers such as green gentrification, digital divides, and inequitable access to safe, healthy housing. Please refer Section 9.

 

Comments 3: Calls for cross-sector collaboration and climate-resilient design to address urbanization/climate challenges.

Response:  Thank you for the comment and I agree with the point raised. I have also added a statement in the advocacy section emphasizing the importance of fostering cross-sector collaboration among public health professionals, urban planners, developers, and policymakers to implement climate-resilient housing solutions that effectively respond to urbanization and environmental challenges. Please refer Section 9.

 

Comments 4:  Contextualizes evidence across high/low-income settings (e.g., U.S. LEED certifications, Bangladesh’s flood-resistant housing).

Response: Thank you for your observation. I have added Section 4.4: Geographic and Contextual Variations in Evidence post first revision, which discusses examples from both high- and low-income settings, including LEED-certified housing in the U.S. and thermal comfort housing in South Asia.

 

Comments on the quality of English language: The manuscript needs to be touched up in the English language. Please have a native English speaker touch up the manuscript.

Response: I acknowledge the suggestion and have thoroughly revised the manuscript to improve readability and clarity. In addition, following your comment, the manuscript was reviewed by a native English speaker to ensure high-quality language throughout, and I have also reviewed it myself multiple times, drawing on my editorial experience and language interpretation skills.