Taking a strategic approach to urban health: a guide for decision-makers

Overview

The World Health Organization (WHO) launched a new guide for decision-makers titled Taking a Strategic Approach to Urban Health, offering practical strategies to advance a new phase of urban health action. This guide responds to the growing need for integrated approaches that address health challenges while promoting overall well-being in urban contexts. It represents the first comprehensive framework to support governments in strategically planning urban health, ensuring that evidence effectively informs policy and practice.

The guide was released on World Cities Day. Currently, more than 4.4 billion people—over half of the global population—live in urban settings, and this figure is projected to reach nearly 70% by 2050. Cities are where health, inequality, environmental, and economic factors intersect, creating both significant challenges and opportunities for progress. However, the most serious health burdens are often concentrated in slums and informal settlements, where residents experience unsafe housing, poor sanitation, food insecurity, and increasing exposure to floods and extreme heat. At present, around 1.1 billion people live in such conditions, a number expected to triple by 2050. (WHO)

Purpose and scope of the Guide

This Guide has five objectives:

• to provide conceptual clarity, defining urban health and its scope
• to make a compelling case for strategic action
• to offer broad practical recommendations for those looking to take a strategic approach
• to suggest a roadmap for implementing this guidance
• to illustrate strategic action through concrete examples.

The Guide targets public-sector policy-makers and practitioners at national and subnational scales – but its insights are relevant to all urban health stakeholders. Building on prior WHO work, it profiles the political and policy context for urban health, explicitly emphasizes complexity science, highlights enabling frameworks for sectoral action, and proposes unified urban health strategies.

A strategic approach to urban health: Recommendations

The Guide presents three overarching ways that governments can act more strategically for urban health.

1) Recognizing and managing complexity

• Train urban health practitioners and policy-makers at all levels to understand and manage the impacts of complexity on urban health.
• Extend monitoring and evaluation processes to capture unanticipated results of urban health policy and practice.
• Anticipate intended and unintended results using scenario-based modelling.
• Design decision-making and implementation processes to operate more effectively in the face of complexity.
• Adopt adaptive governance and build adaptation into interventions, policies and strategies.

2) Leveraging entry points

• Build and maintain awareness of the landscape of political, policy and public opinion at city, national and global scales.
• Document and track local cross-cutting initiatives relevant to urban health at project, programme and policy scales.
• Prepare for the emergence of entry points by scoping and planning urban health strategy in anticipation of opportunities for implementation.
• Ensure that entry points are a stepping stone for broader action.

3) Strengthening the means of implementation
Governance:

• Establish a whole-of-government political mandate for urban health.
• Define urban health responsibilities clearly and create accountability.
• Establish or strengthen coordination mechanisms.

Financing

• Expand assessment of the costs and benefits of urban health action.
• Restructure financial mechanisms to support strategic urban health policy and practice.
• Increase the scope, resilience and sustainability of urban health financing.

Human, institutional and systemic capacity

• Conduct iterative assessment of capacities and capacity needs.
• Integrate capacity development as a standard component of urban health practice.
• Account for capacity assets, deficits and needs in designing urban health policy and practice.

Data generation and management

• Strengthen urban health data systems by expanding data coverage, types and sources.
• Adopt best practices for managing urban health data.
• Adopt a high-value set of urban health indicators.

Evidence-based decision support

• Institutionalize evidence-based policy and practice in urban health.
• Support the application of interdisciplinary and transdisciplinary insights to decisionmaking.
• Increase local capacity and external links for evidence-based decision-making.
• Implement a robust monitoring and evaluation system.

Innovation

• Cultivate an innovation ecosystem for urban health.
• Create dedicated spaces for urban health experimentation.
• Develop processes to identify and scale up promising novel solutions.

Partnerships

• Where appropriate, adopt a partnership model to deliver urban health needs.
• Foster an environment that encourages collaboration.
• Provide resources to support effective urban health partnerships.

Participation

• Institutionalize participation as a key value and component of public-sector action for urban health.
• Improve communication around urban health.
• Encourage nongovernmental actors to participate in urban health.

Developing comprehensive strategies: The culmination of the strategic approach is a comprehensive strategy that elevates urban health as a societal goal and provides the authorities, mechanisms and resources needed to attain and sustain it.

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