On October 31, 2023, the World Health Organization (WHO) urged national and city leaders to reimagine urban areas as vital hubs for health, equity, and sustainability. With over 4.4 billion people currently residing in cities—a figure expected to rise to nearly 70% by 2050—the challenges and opportunities for enhancing health in these environments are profound.
As urban populations grow, health disparities become more pronounced, particularly in slums and informal settlements. Today, approximately 1.1 billion people live in conditions marked by unsafe housing, inadequate sanitation, and food insecurity. This number is projected to triple by 2050, underscoring the urgent need for effective urban health strategies.
In response, WHO introduced the guide titled “Taking a Strategic Approach to Urban Health.” This comprehensive framework is designed to assist governments in planning urban health initiatives that integrate evidence into policy and practice. According to Jeremy Farrar, Assistant Director General for Health Promotion, Disease Prevention and Care at WHO, “This is a moment for decision-makers at every level to act together.”
Addressing Urban Health Inequities
Urban areas face multiple health risks, with a recent study of 363 cities across nine Latin American countries revealing life expectancy gaps of up to 14 years for men and 8 years for women between the healthiest and least healthy cities. Common challenges include air pollution, unsafe transportation, and inadequate housing. Air pollution alone claims around 7 million lives annually, and nearly all urban residents breathe air that does not meet WHO quality guidelines.
The dense populations in cities also elevate the risks of infectious diseases such as COVID-19 and dengue fever. Limited access to green spaces contributes to the prevalence of noncommunicable diseases, highlighting the need for strategic action to address these interconnected issues. Urban environments now significantly influence human health while also contributing to global challenges like climate change and growing inequality.
WHO emphasizes that urban health cannot be the responsibility of a single sector. Decisions regarding air quality, housing, mobility, and digital access made by urban authorities impact the health of billions. The guide encourages aligning these daily choices to build healthier, fairer futures where urban systems work in concert to advance equity and sustainability.
Implementing Strategic Health Actions
“Cities are key to advancing public health,” stated Dr. Etienne Krug, Director of Health Determinants, Prevention and Promotion at WHO. The guide serves as a roadmap for governments to create operational links with broader global policy issues, including climate change and migration.
In practical terms, WHO’s guide outlines steps that municipalities can adopt to enhance urban health. Examples include engaging community voices in the design of health initiatives, as seen in the Dandora neighborhood of Nairobi, Kenya, and other cities like Suva, Fiji, Makassar, Indonesia, and Coimbra, Portugal. By fostering collaboration across sectors, local and national leaders can create urban environments that promote health and well-being.
In conjunction with the guide, WHO is launching the first three modules of an Urban Health E-learning course, hosted by the WHO Academy. This initiative aims to strengthen collaborative efforts in urban contexts and enhance the capacity of decision-makers to implement effective health strategies.
As urban populations continue to grow, the call to action from WHO is clear: strategic urban health initiatives are essential for creating resilient, equitable, and sustainable cities where all residents can thrive.
