Urban design is key to healthy environments for all

Rapidly increasing urbanisation along with ageing populations, climate change, environmental degradation, COVID-19, and other pandemics present substantial challenges for people living in cities and other communities. The capacity to identify and respond to urban challenges related to health, equity, and sustainability varies greatly across national and subnational governments around the globe, because of the available human and financial resources, structures of governance and participation, and existing policy frameworks, which are all important determinants of healthy and sustainable urban environments. The status of the social and physical urban environments will also determine the magnitude of the challenge and the urgency of the response for each setting.¹

Identifying key challenges and opportunities for interventions is crucial to improving the health and wellbeing gains of urban dwellers and reducing exposure to stressors, shocks, and hazards, while also contributing to fostering wellbeing and reducing health inequalities. Policies and indicators that bring several agendas together can also improve multisectoral action and help maximise gains. For this reason, we very much welcome the Lancet Global Health Series on urban design, transport, and health to support global efforts to develop systems of policy and spatial indicators for healthy and sustainable cities.

The title of the Series’ introductory Comment by Giles-Corti and colleagues declares: what gets measured gets done.² We agree, and argue that what gets done should also get regularly measured for continuous improvement, making best use of planned interventions, existing policies, and natural experiments to advance knowledge, build expertise, and monitor progress, including on health and wellbeing outcomes. This practice will help us understand how and what to change for the creation of healthy and sustainable urban environments,³ which is relevant everywhere, but particularly in places and intervention areas where evidence is still scarce (eg, low-income settings).⁴

Ensuring and protecting health and wellbeing through improvements in the design of urban environments can only be achieved through the application of an integrated and multisectoral, multistakeholder approach, guided by policy frameworks that ensure that human and environmental health go hand in hand.⁵ Interventions on urban design and transport have the potential to provide large, long-lasting, and immediate benefits for health, and hence are key to healthy and sustainable urban environments for all. If designed with this perspective in mind, urban design and transport policies (along with other interventions) can provide multiple benefits, including: reducing the upward trajectory of greenhouse gas emissions,¹ protecting the environment,¹ fostering equity and intergenerational solidarity,⁶ and improving our resilience to future potential pandemics.⁷

The Series’ last paper by Giles-Corti and colleagues⁸ highlights the need to enable city planning policy and spatial indicators to track progress and unmask and address spatial inequities in access to health-supportive built environments, support decision making and allocate limited resources, and accelerate the transition towards healthy and sustainable urban environments with multiple benefits for ecosystem, human, and planetary health. We could not agree more.

WHO acknowledges the importance of urban design and transport for human and planetary health throughout its programme of work as part of a broader approach to urban health,1, 9, 10 and strives to provide leadership to effectively protect the health and wellbeing of everyone—in this generation and future generations—through changes to the urban environment.1, 5, 9, 10 The findings, expansion of the methods, and open-source tools created in this Series provide a highly valuable source of knowledge. We will build on that knowledge and continue to strengthen our work to support countries and cities with the normative guidance, tools, data, capacity building, and leadership needed to develop and deliver solutions for the health and wellbeing of everyone.