Strategic Urban Health: WHO’s Guide to Making Cities Engines of Equity and Sustainability

The WHO’s Taking a Strategic Approach to Urban Health urges governments to treat city health as a cross-sectoral, long-term priority linking equity, sustainability, and governance. It envisions cities as living systems where coordinated policies, not isolated projects, create healthier, fairer, and more resilient urban futures.

The World Health Organization’s 2025 publication Taking a Strategic Approach to Urban Health: A Guide for Decision-Makers, developed with the London School of Hygiene & Tropical Medicine, UN-Habitat, and the International Institute for Global Health, urges a radical rethinking of how governments approach cities and well-being. It argues that health is not a product of hospitals or ministries alone but of the entire urban system, the interplay between people, institutions, and environments. As cities expand and house the majority of the world’s population, their design, governance, and inclusivity increasingly determine global health outcomes. The report presents cities as both hubs of progress and hotspots of inequality, calling for leadership that treats urban health as a strategic, long-term societal mission, not a patchwork of isolated projects.

The Urban Challenge

Cities, the guide notes, are where modern life’s contradictions are most visible. They drive innovation and economic growth but also amplify inequities, pollution, and vulnerability. The COVID-19 pandemic revealed how fragile urban systems can be when equity and preparedness are neglected. Urbanization, aging populations, climate change, and migration now combine to create unprecedented pressure on city infrastructures. The WHO warns that piecemeal interventions, focusing narrowly on single issues like transport or waste, ignore the city’s complexity and often produce unintended consequences. To make lasting progress, the report calls for integrated, multi-sectoral governance that aligns housing, mobility, environment, and social policy around a shared vision of health equity.

Defining Urban Health

The report defines urban health as both an art and a science: the art of creating environments where people and systems interact harmoniously, and the science of improving health equity through sustainable, resilient urban systems. Health in cities emerges from the sum of social, economic, and environmental factors, from access to green spaces and clean air to safe housing, education, and employment. By treating health as a societal outcome, not merely a medical one, WHO pushes decision-makers to look beyond hospitals and adopt “Health in All Policies” thinking. Every zoning regulation, budget decision, or climate plan, it insists, shapes population well-being and must be seen through a health lens.

The Strategic Case for Action

WHO builds a compelling case for why urban health must be strategic. The epidemiological argument is clear: addressing environmental and social determinants prevents disease more effectively than treating it later. Economically, healthier cities are more productive and less costly to maintain. The equity case is perhaps the most urgent; one in four city residents lives in informal settlements without secure housing or clean water. Meanwhile, the sustainability argument links health to climate resilience and the Sustainable Development Goals. The guide spotlights examples such as Sharjah’s “child- and age-friendly city” programmes, which integrate urban design, social inclusion, and climate adaptation, demonstrating how health-centered planning can drive cross-sector innovation.

Managing Complexity and Moving from Vision to Action

Borrowing from systems science, WHO describes cities as “problems of organized complexity.” Decisions in one sector can ripple across others. Expanding green parks might improve mental health, but also trigger gentrification and displacement. The guide recommends adaptive governance, transparency, and participatory planning to navigate these dynamics. Its implementation protocol outlines four practical steps for governments: declare a public commitment to urban health, conduct a situational analysis, assess needs, and develop a local action plan linking short-term goals to long-term strategy. The process must be inclusive, drawing on local communities, businesses, and academia to ensure legitimacy and effectiveness.

Strategic entry points, the guide suggests, are crucial, moments when public interest, political will, and resources align. These may arise after disasters, during infrastructure overhauls, or in response to social movements. Used wisely, such openings can launch lasting institutional reforms. Sustaining them requires strong governance, steady financing, quality data, and collaborative partnerships. WHO urges cities to use disaggregated data to identify inequities and to embed learning mechanisms that adapt policies as conditions change.

A Vision for Healthier, Fairer Cities

In its final message, Taking a Strategic Approach to Urban Health envisions a world where every city becomes an engine of equity, resilience, and well-being. The measure of urban progress, it concludes, is not the skyline but how well a city enables all its residents to live healthy, dignified lives. By embedding health into all aspects of urban planning and governance, the guide turns public health into a universal policy compass, one that aligns environmental sustainability, economic vitality, and social justice. WHO’s vision is both pragmatic and aspirational: a call for mayors, ministers, and citizens to see cities not just as places to live, but as collective systems capable of nurturing life itself.