Background
The built and natural environment and health are inextricably linked. However, there is considerable debate surrounding the strength and quality of the evidence base underpinning principles of good practice for built and natural environment design in promoting health. This umbrella review aimed to assess relationships between the built and natural environment and health, concentrating on five topic areas: neighbourhood design, housing, food environment, natural and sustainable environment, and transport.

This study presents three cost-optimal calculations. The overall aim is to provide a deeper analysis and to provide additional guidance on how to properly implement the cost-optimality methodology in Member States. Without proper guidance and lessons from exemplary case studies using realistic input data (reflecting the likely future development), there is a risk that the cost-optimal methodology may be implemented at suboptimal levels.