Healthy Cities

With well over half of all human beings living in cities, the urban environment has become the predominant human habitat. And, while cities tend, on average, to offer health advantages to residents, they also cause significant harms through infrastructure, services, and institutions designed and implemented without consideration for health. Cities are also responsible for the lion’s share of greenhouse gas emissions and other environmental impacts, and thus for major long-term health threats.

Cities can be designed and managed in ways that protect and nurture both people and planet—in fact, many climate solutions are also health solutions. Creating healthy cities requires leveraging the knowhow of a broad range of actors, including researchers, government, business and industry, civil society, and communities, in participatory processes, as well as a focus on equity—not only is there a moral imperative to care for all members of society, but where marginalized groups suffer, negative outcomes proliferate for everyone. Because cities are complex systems, systems thinking is also essential to lasting solutions for urban health.

Selected Readings

While many of the ideas underpinning healthy city action can be traced back through history, Trevor Hancock and Leonard Duhl pulled these strands together in their 1988 text, which dates to the birth of the modern WHO Healthy Cities movement. Over the decades that followed, urban health has become deeply entwined with global development, including the 2030 UN Sustainable Development Agenda. At the landmark Paris climate meeting in 2015, I gave a talk on the potential for cities to leverage the urban transition for health and sustainability, later adapted into a piece for a Climate and Health collection in Public Health Reviews. In 2016, the WHO’s Global Report on Urban Health updated the urban health picture with a focus on equity in the run-up to the landmark United Nations Conference on Housing and Sustainable Urban Development (“Habitat III”). My team at the UN University International Institute for Global Health also contributed to Habitat III, organizing and hosting a major Urban Thinkers Campus (UTC) in Kuching, Malaysia that led to a trio of outputs: the Kuching statement on healthy, just and sustainable urban development; Thrive Urban, a pamphlet designed to stimulate thought and ideas on environmental health in cities through the power of visual art and associated text; and the UTC report which articulates a broad set of recommendations and needs for urban health and wellbeing. Exciting advances continue in the framing of healthy cities; for example, Helen Pineo describes the new THRIVES framework for healthy urbanism that centers on the existential threat of planetary change and the importance of equity and inclusivity in achieving the goals of sustainable development.