The purpose of this paper is to systematically review the recent literatures to obtain a summary of significant items (see Table B1) for better student backpack design for health improvement, as well as to identify gaps for further research. A systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), targeting papers of the last 20 years. Thirty-six studies were included, assessed and synthesised. Four categories of design-related items were summarised: Biomechanical consideration, Strap, Dimension and Carrying method. Quality assessments were completed for the included studies by utilising different tools. The major health outcomes associated with the design-related items were posture, perception, metabolic cost, lung function, contact pressure of foot or shoulder, and muscle activity. An optimal location for the centre of mass of a backpack could not be ascertained from this review in the aspect of spinal curvature and postural displacement, and there was usually no best input that induced the best outcome in every dimension. Oscillation in the medial-lateral direction should be minimised, and wider shoulder strap should be utilised, together with hip straps. Different carrying methods, such as double pack, BackTpack, modified backpack, and frontpack, were superior to the traditional backpack, whereas the single-strap pack should be avoided. Some gaps, such as lack of standardised protocol and evidence for clinical significance, were identified. Meanwhile, the risk of bias is commonly high for recent studies.