Transforming Urban Futures: A Strategic Blueprint for Healthier, Fairer and Stronger Cities

The World Health Organization (WHO), together with its Department of Social Determinants of Health and global research partners, presents this executive guide at a moment when the world’s rapidly growing cities have become decisive arenas for public health. As urban populations expand and density increases, these institutions warn that contemporary city life is shaping health outcomes in profound and uneven ways. The imagery captured on page 3, showing a Santiago mural thanking healers, reflects the deep human stakes and social gratitude threaded throughout the guide. Yet beneath these symbols lies a harsher truth: decades of progress have not erased the dramatic inequalities that separate well-served urban communities from those living in overcrowded, underserved settlements. The COVID-19 pandemic exposed these divides brutally, demonstrating how easily health systems are strained when cities are approached through fragmented, short-term interventions instead of cohesive, long-term strategies. Cities as Drivers of Risk and Opportunity The guide explains that health in cities is never shaped by one sector alone. Transport networks, housing quality, infrastructure, green spaces, waste systems, governance arrangements, and economic opportunity all intersect to influence health outcomes. Urban health, therefore, emerges from complex interactions, interactions that often cross institutional boundaries and blur lines of responsibility. The result is a landscape where accountability can be difficult to assign, even as the consequences of poor coordination become increasingly visible. The WHO argues forcefully that urban health must be treated as a strategic, society-wide project rather than a collection of disconnected initiatives. Only by embracing complexity, integrating multiple sectors, and anchoring actions in equity can cities move from reactive fixes to resilient, long-term solutions. A Multidimensional Case for Strategic Action To broaden political and public support, the guide constructs its case across epidemiological, economic, equity and sustainability dimensions. Epidemiologically, urban residents carry a heavy disease burden, with slum populations facing the gravest risks. Yet rapid improvements in some cities show that cross-cutting, systems-oriented interventions can create substantial health gains. Economically, the cost of ill health is enormous, while strategic investment in prevention and healthier environments produces high returns through reduced spending and higher productivity. From an equity standpoint, urban health action is portrayed as essential for dismantling deep-rooted disparities and enabling fuller civic and economic participation. And in sustainability terms, since climate, energy, waste, food and biodiversity challenges are fundamentally urban, strategic health action can generate significant co-benefits for resilience and environmental goals. The authors emphasize that aligning health priorities with high-salience issues, migration, demographic change, climate shocks, digital transformation and emergencies, helps build political traction and opens policy windows for reform. Building the Machinery of Strategic Urban Health The guide details the institutional foundations required to sustain strategic action. Effective governance must establish clear mandates, defined responsibilities and robust coordination across sectors and levels of government. Financing systems should move away from narrow, siloed budgets and instead support multisectoral initiatives that match the complexity of urban health. Human and institutional capacities must be strengthened continuously so that organizations can work collaboratively, innovate and adapt. Data systems, covering upstream determinants, economic valuations, disaggregated indicators and policy processes, must become more comprehensive, accessible and ethically governed. Turning data into actionable insight requires strong evidence-based mechanisms, interdisciplinary tools and continuous monitoring and evaluation. The guide also encourages cities to nurture innovation ecosystems that allow safe experimentation and scaling of promising solutions. Partnerships with civil society, academia, private actors and communities are portrayed as indispensable, while meaningful participation by residents is framed as a foundation for trust, legitimacy and better outcomes. A Long-Term Vision for Thriving Urban Futures In its final reflection, the guide asserts that comprehensive, integrated strategies, anchored in long-term commitment and adaptive learning, are the backbone of successful urban health transformation. Progress will rarely be linear, but with deliberate coordination and shared responsibility, cities can evolve into powerful engines of public well-being, equity and sustainability. The WHO concludes with a clear message: as urbanization accelerates, the future of global health will be shaped in cities. Whether that future becomes one of thriving or heightened vulnerability depends on how urgently and strategically governments act today.