Advancing equitable and sustainable urban health

Cities house most of humanity and will continue to grow, particularly in low- and middle-income countries. Rapid, unmanaged growth can generate adverse health impacts, including non-communicable diseases, infectious diseases and injuries, while magnifying social and environmental inequities. Urban health is shaped by intertwined social and physical environments that act over the life course and are embedded in upstream social and economic systems. In this Perspective, we outline four research priorities for equitable and sustainable urban health. First, sharper descriptive work is needed to expose within- and between-city health gaps and to track trends to spur action. Second, stronger causal studies-using longitudinal data, quasi-experiments and systems modeling-can clarify how urban factors impact health across diverse settings. Third, rigorous evaluations and simulations of the effects of transportation, housing, fiscal and climate policies are needed to quantify cobenefits for health, equity and sustainability, and guide multi-sector action. Fourth, meaningful engagement with communities and policymakers, from agenda setting to dissemination, will ensure that evidence is locally relevant and politically usable. Cities are uniquely positioned to reduce health inequities and contribute to environmental sustainability. Doing so requires political will, robust evidence, and multisectoral collaboration to build healthier, more equitable, and more sustainable urban futures.