The world is increasingly becoming urban. Estimates show that 54.6% of the world’s population lived in cities in 2016 with a forecast of 60% by 2030 (UN Department of Economic and Social Affairs 2016). The 600 largest cities produce 70% of the world’s economic activity (McKinsey Global Institute 2011). The relatively recent rise of city living and associated human activity has led to huge impacts on the health and wellbeing of both people and planet. This chapter explores how urban planning and design policies are emerging as key policy sectors to respond to urban health threats, promote healthy behaviours and reduce health inequalities. First the chapter defines the role of cities in the earth’s ecology, how environment and health challenges are interlinked, and how the delivery of healthy sustainable urban communities requires complex interventions. Secondly, the chapter delves into the urban form and how it contributes to these urban environment and health challenges. Planning and design principles have emerged out of research in the field, increasing the scope for spatial and transport planning to shape the urban environment, reducing populations’ exposure to environmental threats and encouraging healthy or unhealthy habits. Yet neither the emergence of a strong evidence base for the role of the built environment on health nor the development of “healthy” urban planning principles, guidance or indicators will lead on their own to the rethinking of the way cities are planned and designed. Such changes require political will and the right governance to be in place. Hence finally, the chapter highlights how an international urban agenda is now developing, that is potentially able to galvanise positive change towards a sustainable and healthy urban future based on the strength of city governance and its planning and design policies.
To carry out the governance and policy analysis, the chapter draws from evidence reviews, academic and grey literature in social sciences, planning, public health, and environmental science including policy documents. It also draws from seminars discussions with key stakeholders in the UK for an ESRC project (Carmichael et al. 2016a, 2016b) and two consultation events with WHO officials and international stakeholders (Carmichael et al. 2017). While the chapter is international, most of the evidence base comes from high income countries, in particular European countries, in recognition that the direction of travel for low and middle income countries is similar and environmental health challenges can apply in different settings. The chapter only covers formal cities, although informal or refugee settlements might face similar threats, they will also face more complex sets of political, economic and social challenges