Cities matter. City leadership, governance and urban development are critical for future population and planetary health.

A briefing for city activists, city politicians, urban and transport professionals, public health practitioners, community organisations, urban NGOs and civic leaders at all levels.

For good or for ill, how cities decide to respond to their populations’ resource needs and lifestyle demands will now be the determining factor in local and global health.  

City leadership, at all levels from mayors, to official and community interests, have a clear path to follow. This path is made up of layers of robust urban policy, built on a foundation of scientific evidence, and surfaced by the innovative actions of several trailblazing city networks. The path leads away from city development driven purely by economic goals, ignoring the dire impacts on population and planetary health, and instead provides a route to a more sustainable and human-centred future. With ecologically sustainable well-being and health equity for urban populations as their goal, innovative coalitions of disciplines and sectors will be able to forge creative solutions, with the city as a laboratory for change. It won’t be easy; all actors needs to keep focused on the common goal, on both scientific evidence and innovative exploration; and importantly on developing multi-sectoral partnership, multi-level leadership and participatory engagement with citizens and communities.

We already know:  The alignment of three global trends now demands that we re-assess the impact of cities on human futures. Each trend has been well evidenced, with scientific knowledge starting to influence international and national policy. The first trend is the growth in the scale of impact on planetary life support systems inherent in the prevailing urban lifestyles in high and middle–income countries. The second is the continual rapid urbanisation of the human population that too often attempts to follow urban lifestyles of 20th century high-income countries. The third is growing inequities in health, wealth, power and resource use between and within countries. The combined result is that the most damaging lifestyles, in terms of resource use, habitat destruction, waste generation and climate change, and their impact on population health, continue to grow apace. Cities are at the forefront of the problem, but also have the potential to contribute manifold solutions.

What’s new: This paper sets the agenda for the new Routledge journal ‘Cities & Health’. It adds ‘human health’ as a vital, but underplayed, dimension to the impact of cities on human futures and planetary resources. Positive outcomes for human health are undermined by the impact of cities on natural resources and global processes, by the lifestyles people have to adopt to manage everyday urban existence, and by growing and persistent inequality. Using the lenses of city planning, city leadership and citizen inclusion, and a wide range of urban health research, we demonstrate how cities hold the key to human health in the 21st Century.

Implications for city policy and practice: Leadership in cities takes many forms; from mayoral and public responsibilities, through professions that can make a difference to business and community leaders and interest groups. A binding goal for everyone must be supporting healthy citizens and reducing health inequity, while remaining within finite planetary resource boundaries.  Evidence from research, both empirical and case studies, is demonstrating the importance of spatial city form, including the planning of the city-region and the peri-urban hinterlands. Design and control of physical form, at all scales, has a key impact on overall energy use, transport, housing, quality of and access to natural areas, water quality and availability, access to food and food growing, community safety and street life and community resilience. These are all wider determinants of health and will ultimately either support or undermine population health, well-being and health equity as well as ecological sustainability.  Everywhere, the universal costs and demands on health services and social care provision are being magnified by demographic and social trends, including migrations, ageing populations, social disruption, intolerance and cultures of violence. Cities and national and provincial/state governments cannot afford to overlook city development, management and planning, and governance as an essential toolkit for supporting health and reducing the societal burden of illness.

Full article: Cities and health: an evolving global conversation

Authors: Marcus Grant, Caroline Brown, Waleska T. Caiaffa, Anthony Capon, Jason Corburn, Chris Coutts, Carlos J. Crespo, Geraint Ellis, George Ferguson, Colin Fudge, Trevor Hancock, Roderick J. Lawrence, Mark J. Nieuwenhuijsen, Tolu Oni, Susan Thompson, Cor Wagenaar and Catharine Ward Thompson.