World Health Organization (WHO)

Founded in 1948, the World Health Organization (WHO) works with 194 member States to achieve better health for everyone, everywhere. Headquartered in Geneva, it has a large presence in the field with 50 country offices and 6 regional offices. WHO runs global health prevention and promotion campaigns, produces global standards in a broad array of health-related areas and it also works on the ground, alongside governments and health professionals to strengthen national health systems. Its main governing body is the World Health Assembly, to which all WHO member States participate.

Urban challenges & opportunities

Urbanization as one of the leading global trends of the 21st century has a significant impact on health.  Most of the 4.2 billion people living in cities suffer from inadequate housing and transport, poor sanitation and waste management, and air quality that fails WHO guidelines. 91% of people in urban areas breathe polluted air. Other forms of pollution, such as noise, water and soil contamination, so-called ‘urban heat islands’, and a lack of space for walking, cycling and active living make cities potential epicenters of noncommunicable disease epidemics and drivers of climate change. Around 40% of urban growth occurs in slums that lack safe water and sanitation. When it comes to healthy diets, urbanization increases the distance from farm to fork, driving demand for unhealthy, processed foods.

As a result, cities face the triple health burden of infectious diseases like HIV/AIDS, tuberculosis, pneumonia, dengue and diarrhea; noncommunicable diseases like heart disease, stroke, asthma, cancer, diabetes and depression; and violence and injuries, including road traffic injuries.

Rapid and unplanned urbanization can have many negative social and environmental health impacts, which hit the poorest and most vulnerable the hardest. The COVID-19 pandemic has shown that cities often bear the brunt of health emergencies.

However, the COVID-19 pandemic has also demonstrated the crucial role of cities in leading the frontline response, delivering essential services and spearheading long-term recovery. Sustainable and well-planned urbanization can bring health and economic benefits. Cities can create opportunities for better health, cleaner environments and climate action. Strong urban policies must prioritize health, as it is essential for fostering good urban livelihoods, building a productive workforce, creating resilient and vibrant communities, enabling mobility, promoting social interaction and protecting vulnerable populations.

WHO & urban health

By 2023, WHO aims to achieve the Triple Billion targets, which outline an ambitious plan for the world to achieve good health for all, using science-based policies and programmes:

• 1 billion more people benefitting from universal health coverage,
• 1 billion more people better protected from health emergencies,
• 1 billion more people enjoying better health and well-being.

In line with that ambitious plan, WHO supports cities in building and shaping adequate health policies and actions. Indeed, urban health is of critical importance to the broader global health agenda. Thus, WHO addresses urban health in multiple cross-cutting ways, focusing on better air quality, water and sanitation and other environmental determinants; healthy urban planning; healthier and smoke-free environments; safe and healthy mobility; preventing violence and injuries; healthy food systems and diets; environmental management of vector-borne diseases; emergency preparedness and responses in urban settings.

Working across sectors with all relevant stakeholders and ensuring the coherence of policies across different areas is key to creating supportive and enabling environments for health and ensuring that health and equity considerations are integrated throughout the planning process, investments and policy decisions at the local level.

WHO supports the strengthening of the evidence-base to allow policy-makers to make informed decisions when addressing health risks. WHO leads and engages in partnership activities fostering city-to-city exchanges and helps develop institutional and policy frameworks for good urban governance for health and well-being in cities.

For that matter, WHO has created a repository of resources on urban health, which includes resources that provide technical support and offers strategic reports and guidelines, health impact assessment tools, and other products relevant to urban health and cities.

WHO city networks and initiatives

WHO takes a holistic approach to urban health and supports cities to work on specific topics. It has developed diverse networks and supports initiatives, such as :

1. WHO Healthy Cities in the six different regions

A Healthy City aims to:

• create a health-supportive environment,
• achieve a good quality of life,
• provide basic sanitation and hygiene needs,
• supply access to health care.

Being a Healthy City includes not only health infrastructures, but also a commitment to improve a city’s environs and a willingness to forge the necessary connections in political, economic, and social arenas.

Based on that definition, WHO supports a global movement of Healthy Cities to put health high on the social, economic and political agenda of city governments. The movement takes different forms in the six regions. The WHO Regional Office for Europe runs a network of designated cities based on clear commitments, and it also supports national networks. The Regional Office for the Eastern Mediterranean has a system of awarding Healthy Cities status to cities in the countries of the region, based on a local self-assessment and evaluation. Healthy Cities in the Western Pacific Region is supported by the Western Pacific Alliance of Healthy Cities, a non-governmental organization run by the Tokyo Medical School, and includes a system of presenting awards to successful cities. The Healthy City approach is also applied in the African region, in the Americas and in South-East Asia. Some regions regularly convene mayors’ meetings and others issue statements supporting Healthy Cities in different domains.

2. WHO Urban Health Initiative

The WHO Urban Health Initiative (UHI) aims to reduce deaths and diseases associated with air and climate pollutants – saving lives by linking health, environment and sustainable development. UHIIt aims to equip the health sector with the data, tools and capacity to demonstrate to the public and decision-makers the full range of health and climate benefits that can be achieved from implementing local emission reduction policies and strategies. There are currently two pilot cities on this initiative: Accra (Ghana) and Kathmandu (Nepal).

3. WHO Global Network for Age-friendly Cities and Communities

This network was established in 2010 to connect cities, communities and organizations worldwide with the common vision of making their community a great place to grow older in. It stimulates and enables cities and communities around the world to become increasingly age-friendly by inspiring change – showing what can be done and how it can be done, connecting cities and communities worldwide to facilitate the exchange of information, knowledge and experience, and supporting cities and communities to find appropriate innovative and evidence-based solutions. Age-friendly practices, most of which led by local governments part of the network, spam across different sectors (e.g. transport, housing, outdoor spaces, health and social care) and topics relevant for healthy ageing (e.g. social isolation and loneliness, intergenerational connections, assistive technology), and can be found at WHO Global Database of Age-Friendly Practices. The WHO Global Network for Age-friendly Cities and Communities currently includes over 1500 cities and communities in more than 50 countries, covering over 300 million people worldwide.

4. The BreatheLife campaign

BreatheLife is a global campaign that mobilizes cities and individuals to take action on air pollution to protect our health and the planet. The campaign is led by WHO, the UN Environment Programme (UNEP) and the Climate & Clean Air Coalition (CCAC). It provides a platform for cities to share best practices and demonstrate progress in their journey to protect health from air pollution and meeting WHO air quality targets by 2030.

5. Bloomberg partnership for healthy cities

The Bloomberg Partnership for Healthy Cities is a global network of cities committed to saving lives by preventing noncommunicable diseases (NCDs) and injuries. It enables cities around the world to deliver a high-impact policy or programmatic intervention to reduce NCDs and injuries in their communities. Cities can receive support to implement interventions in 14 specific areas from creating a smoke-free city, through taxing sugary drinks, to promoting active mobility.

WHO’s normative work and programmatic areas

1. WHO guidance to strengthen health emergency preparedness in cities

One of WHO’s operational guidance document aimed at national and local authorities intends to support efforts on urban health emergency preparedness. The WHO guidance document “Strengthening health emergency preparedness in cities and urban settings: guidance for national and local authorities” identifies challenges in 8 key areas of health emergency preparedness (including governance and financing, multisectoral coordination, high population density and movement, community engagement, data, etc.). Given the importance of cities in preventing, preparing for, and responding to health emergencies, enhancing the focus on urban settings is necessary for countries to improve their overall health security. Various approaches and actions are put forward in the WHO guidance document to shape the ability of both national and local authorities to best prepare for a public health emergency in a city or urban setting.

In May 2022, the 75th World Health Assembly adopted a resolution on “Strengthening health emergency preparedness and response in cities and urban settings”. It recognizes the important role that cities and local authorities have in preventing, preparing for, and responding to health emergencies. The resolution urges Member States to give due attention to preparedness and response to health emergencies in cities and urban settings. It requests WHO to provide technical support to strengthen capacities and capabilities in urban health emergency preparedness and response.

2. WHO Air Quality Guidelines

WHO’s Air Quality Guidelines are an example that demonstrates the importance to include local governments for effective work on health issues. Healthy urban policies and planning play a key role for reaching the air quality levels recommended by WHO, generating positive health impacts and economic savings. The guidelines are a set of evidence-based recommendations of limit values for specific air pollutants developed to help achieve air quality that protects public health. The first release of the guidelines was in 1987. Since then, several updated versions (last update in June 2021) assure their continued relevance and support a broad range of policy options for air-quality management.

3. WHO Housing and Health Guidelines

Improved housing conditions can save lives, prevent disease, increase quality of life, reduce poverty, and help mitigate climate change. Housing is becoming increasingly important to health in light of urban growth, ageing populations and climate change. Published in 2018, the WHO Housing and Health Guidelines support country partners to develop tools and strategies for translating normative housing standards into national action. To do so, it collaborates with a broad network of international partners, including: WHO country and regional offices; ministries of health; ministries of building and construction; WHO collaborating centers; other United Nations agencies, particularly the United Nations Human Settlement Programme (UN-Habitat); and nongovernmental organizations.

4. WHO & UN Habitat Global framework for the response to malaria in urban areas

On the occasion of World Cities Day 2022 (31 October 2022), WHO and UN Habitat have produced the Global framework for the response to malaria in urban areas. The Framework provides guidance to city government officials, health professionals and urban planners for a comprehensive malaria response specifically in urban areas, where the dynamics of transmission and burden of vector-borne diseases can be different from that of rural areas. The Framework acknowledges that the global fight against malaria and other vector-borne diseases requires strong action from local governments, in areas such as health, housing and infrastructure. Indeed, city leaders are uniquely positioned to understand local needs and respond rapidly to changing conditions to safeguard health.

5. WHO Urban health research agenda

Urban health – a broad topic that includes better air quality, safe water supply and improved sanitation; healthy urban planning; smoke-free environments; road safety; prevention of violence and injuries; healthy food systems and diets; environmental management of vector-borne diseases; and preparedness for health and humanitarian emergencies – has become a growing priority for WHO. For that purpose, WHO has also launched on World Cities Day 2022 the Urban health research agenda, a comprehensive strategy to help cities build better evidence around what works to address urban health challenges. The agenda – a set of global urban health research priorities for 2022–2032 – calls for building evidence on the environmental, economic and social impacts of urban health policies, so that they can be addressed through a coordinated approach that involves the different sectors working together to improve the health of their residents.

Additional resources

• Urban health and key facts on Urban health 
• Creating healthy cities and Healthy cities effective approach to a rapidly changing world
• The Urban Health Initiative
• Breathelife 
• Bloomberg Partnership for healthy cities
• Global Network for Age-friendly Cities and Communities
• WHO Emergencies Programme
• Strengthening health emergency preparedness in cities and urban settings

Contact persons

• Ms. Nathalie Roebbel, Unit Head, Urban Health, roebbeln@who.int
• Mr. Thiago Hérick de Sá, Age-friendly Environments, Demographic Change and Healthy Ageing Unit, herickdesat@who.int
• Ms. Faten Ben Abdelaziz, Unit Head, Enhanced Wellbeing, benabdelazizf@who.int
• Mr. Ludy Prapancha Suryantoro, Unit Head, Multisectoral Engagement for Health Securit, suryantorol@who.int