Background: Low Emission Zones (LEZ) and Congestion Charging Zones (CCZ) have been
implemented in several cities globally. We systematically reviewed the evidence on the impacts of
these air pollution and congestion reduction schemes on a range of physical health outcomes.
Methods: We searched MEDLINE, Embase, Web of Science, IDEAS, Greenfile, and TRID databases
through 4 January 2023. We included studies that evaluated the effect of the implementation of a
LEZ or CCZ on air pollution-related health outcomes, including cardiovascular and respiratory
diseases, birth outcomes, dementia, lung cancer and diabetes, or road traffic injuries (RTI) using
longitudinal study designs. We excluded studies without empirical health data. Two authors
independently assessed papers for inclusion. Results were narratively synthesised and visualised
using harvest plots. Risk of bias was assessed using the Graphic Appraisal Tool for Epidemiological
studies for correlation studies. The protocol was registered with PROSPERO (CRD42022311453).
Findings: Of 2,279 studies screened, sixteen were included. Eight studies assessed LEZ in London,
Milan, Tokyo, and several German cities, seven assessed the London CCZ and one the Stockholm
CCZ. Several LEZ studies identified positive effects on air pollution-related outcomes, with reductions
in at least some cardiovascular disease subcategories in five out of six studies investigating this
outcome, although results for other health outcomes were less consistent. Six out of seven studies
on the London CCZ reported reductions in total and/or car RTIs, although one reported an increase
in cyclist/motorcyclist injuries and one reported an increase in serious/fatal injuries.
Interpretation: Studies were limited in number and varied in design, intervention, and outcomes.
Current evidence suggests LEZ schemes reduce air pollution related health outcomes, with the
strongest impact on cardiovascular disease. Evidence on CCZ is mainly limited to London but
suggests they reduce overall RTIs.