Background: One Health (OH) integrates human, animal, and environmental health to address complex public health threats. This review aims to reflect on OH research activities in Saudi Arabia, identify gaps, and outline strategic requirements for human, animal, and environmental health that are crucial to addressing global health challenges across nations. Methods: Seven electronic databases were searched for published studies between 1983 and 2024 that addressed human-animal-environment health interventions in Saudi Arabia. Studies included empirical, surveillance reports, and public health initiatives with overt intersectoral interests. The data were thematically coded, and bibliometric mapping was performed using VOSviewer and Tableau. Result: A total of 115 studies met the eligibility criteria. Most of the publications concerned human health, while environmental health was the least represented sector. The most common OH topics were zoonoses, antimicrobial resistance (AMR), vector-borne diseases, and food safety. Since 2015, the common operations have been genomic diagnostics, geographic information system (GIS) mapping, and multisectoral surveillance methods. The majority of the study's findings stated that implementation challenges arise from disjointed surveillance, governance, and coordination. Conclusion: The paper presents a systematic compilation of the development of OH research in Saudi Arabia, defining the sectors involved, shifts in activity, and gaps in the system over the four-decade period. The review combines thematic, methodological, and governance approaches and goes beyond traditional disease-based research to address pragmatic priorities in multisectoral surveillance, universal integration, and preparedness. The derived results provide policy-relevant information for reinforcing OH delivery across Saudi Arabia and the neighbouring region.