The Next Epoch of Urban Growth: Integrating Climate, Health, and Cities
By Vanshica Kant
Part I
Introduction
The climate conversation has traditionally revolved around sectors such as energy, transport, and industries; a greater spotlight on the intersection of climate change and social development has only recently begun to emerge. The effects of climate change on public health are gaining much-needed attention and action. Urban spaces are at the forefront of this nexus. Cities make up 70% of global energy use and 75% of total CO2 emissions. It is expected that by 2050, eight times more city dwellers will be exposed to high temperatures and 800 million will be at risk from climate hazards. Yet cities receive a dismally low amount of international climate finance, let alone health-focused climate funds. This two-part piece highlights the gap at the intersection of climate, health, and cities, and the role of the international development arena in catalyzing the necessary momentum and impact.
Reorienting Climate Action Toward Social Development
Climate change has impacted public health by affecting 5.6 billion people and costing $1.5 trillion over the past 30 years. Currently, it is estimated to push more than 100 million people into extreme poverty by 2030. Climate-fuelled weather hazards have reached unprecedented levels in 2024. Climate change manifestations can be broadly divided into four areas: extreme weather, air quality, food and water risk, and infectious agents. These in turn have several direct health outcomes and indirect health determinants. Since the climate emergency is a public health emergency, health sector adaptation and resilience are increasingly critical.
The health sector, often the first responder to climate-related crises, is also a significant contributor to climate change, accounting for approximately 5.3% of net global emissions. Under a business-as-usual scenario, health sector emissions will triple by 2050. If the health sector were a country, it would be the fifth largest emitter on the planet. As one of the largest and fastest-growing segments of the world economy, the health sector must move quickly to embrace mitigation efforts and achieve net zero by transforming and aligning its development with the Paris Agreement goals.
It is crucial that climate policy and operations, particularly within the health sector, reorient in favor of human and social development. Although 25% of the global disease burden is linked to environmental risk factors, only 0.5% of international climate finance goes to health. Leading barriers include limited evidence of context-specific climate–health information and data, weak institutional and technical capacity to plan, program, and respond to climate and health hazards, low climate preparedness at the health service delivery and community level, lack of advocacy champions for multisector coordination, and insufficient funding for action on both the climate and health sides. Focusing on human capital will be the lynchpin to achieving people, planetary, and animal health.
The 21st Century: An Urban Era
Cities are home to 60% of the world’s population and 80% of the global GDP, yet they occupy less than 2% of the earth’s surface. By 2050, 2.5 billion more people will settle in cities, and 90% of that movement will be in Asia and Africa. Besides being global economic, social, and cultural hubs, they are also climate change hotspots. By 2050, eight times as many city dwellers will be exposed to high temperatures, and 800 million will be at risk from hazards.
Today, more than 13,000 cities and over 200 regions have committed to long-term climate plans and voluntary action. At COP28, cities’ vital role in fighting the climate crisis was recognized when more than 70 national governments signed the Coalition for High Ambition Multi-Level Partnership (CHAMP) agreement to include city and local governments when developing climate plans or Nationally Determined Contributions (NDCs). Embedding a targeted health focus within urban multilateralism is pivotal.
Intensifying heat waves and heat stress, air pollution and respiratory diseases, flooding and waterborne diseases, extreme weather events, and vector-borne diseases are major urban challenges. Due to high population density, poor urban planning and infrastructure, inadequate public health services, and social and economic inequalities, disaster life and asset losses are much larger in cities than in the countryside. Cities are also experiencing climatic impacts such as the Urban Heat Island (UHI) effect due to built-up environments that are facing temperatures 15 degrees above nearby rural areas. Rapid urbanization and temperature change are transforming the dynamics of the transmission of vector-borne diseases, such as malaria and dengue, that predominantly affect rural areas.
As engines of growth, centers of innovation, and microcosms of countries, cities are at the forefront of change. For cities to progress sustainably, they need an interdisciplinary approach to tackle the twin emergencies of climate and health. Despite nearly 70% of city leaders recognizing climate-related health threats, and more than 90% reporting economic losses from such events, less than a third of cities have a resilience plan that integrates climate and health, according to a recent report produced by the Rockefeller Foundation. International and national institutions need to profoundly accelerate lending, servicing, and partnering to and with cities.
The Climate, Health, and City Nexus
Only 21% of tracked climate-related multilateral development bank financing went to urban projects in low and middle-income countries (LMICs) between 2015 and 2022. Despite rising urbanization, this share has remained relatively constant. As a result, urban areas hold enormous investment potential for climate-related opportunities. In LMICs, this is projected to exceed USD 29.4 trillion by 2030.
By prioritizing climate, health, and urban resilience, cities can improve their air, water, and land while protecting residents’ health and creating sustainable communities. To unlock mutual benefits, cities must introduce greater climate-resilient urban planning and deliver better public health services and readiness to enhance overall ease of living. Solutions tailored to meet each city’s unique needs are required. Some approaches include:
- Smart Cities — Cities are increasingly converging cyber-physical-social infrastructure for better urban management and liveability. This entails smarter urban transport networks, upgraded water supply and waste disposal facilities, and more efficient ways to light and heat buildings. Health infrastructure is beginning to gain greater traction within the smart city discourse.
- Urban Adaptation — Countries are focusing on resilient urban infrastructure. For instance, China launched the Sponge City Initiative in 2015, investing in projects that absorb floodwater. With 80% of its urban areas capable of absorbing and reusing at least 70% of rainwater, projects are ongoing in 30 cities, including Shanghai, Wuhan, and Xiamen.
- Phenomenon-Specific Interventions — Cities are at the forefront of urban heat. In 2021, the Adrienne Arsht-Rockefeller Foundation Resilience Center (Arsht-Rock) created and piloted the world’s first Chief Heat Officers (CHO), who oversee city governments’ responses to extreme heat, starting. Tools like UHeat, for example, built on data science and microclimate modelling, can identify the heat-inducing buildings, structures and materials, and cooling spots based on proximity to nature and vegetation in global cities like London, Madrid, Mumbai, and Los Angeles.
- Digital Public Infrastructure — Cities are increasingly using digital solutions to benefit civilians and businesses. Precision healthcare is a rising new intervention. It is a public health surveillance process that tracks, traces, and analyzes environmental agents, correcting information asymmetries and enhancing health system responsiveness in the process, to generate early warnings. Use cases include wastewater surveillance, assessing air quality, participatory and event-based surveillance, and geospatial analytics.
- Municipal Finance — Several novel ways of tapping city-level finance are emerging. Municipal Green Bonds and Urban Bonds, alternative financing mechanisms, are enabling ULBs (Urban Local Bodies) — such as in Toronto, Cape Town and San Francisco — to decrease dependence on state grants. These are facilitating infrastructure development, attracting business, and improving citizens’ quality of life. Another example is Nigeria’s use of plastic credits, which incentivizes residents to deposit plastics at authorized points and provide healthcare credits in exchange.
- Nature-Based Solutions — Cities are championing afforestation. Miyawaki forestry, named after the Japanese vegetation ecologist Dr. Akira Miyawaki, is a technique for creating dense forests in urban areas. These biodiverse, native, pocket-sized forests re-establish full-functioning ecosystems. The Miyawaki technique ensures that 40-50% of planted trees are commonly found in the neighborhood, making plant growth 10 times faster and vegetation 30 times denser. Scalable and replicable, this nature-based climate solution has multiple benefits including cooling, increased biodiversity, and communal resilience.
- Green Innovation — Metropolises are cradles of brands producing sustainable and innovative products. One green commercial product that has been expanding globally is the plant-based meat industry. Its production emits 30-90% less greenhouse gas emissions than the production of conventional meat. Among the top 10 global plant-based meat brands by sales, such as Beyond Meat and Impossible Foods, most are headquartered in cities such as Chicago, Los Angeles, and Seattle in the United States.
Part II
Global Agenda and Coalition Building
In August and September 2023, G20 Health Ministers and the G20 New Delhi Leaders Declaration asserted their collective commitment to prioritizing and mobilizing resources for inclusive, adaptive, resilient, low-carbon, sustainable health systems. In December 2023, COP28 in UAE hosted the first-ever ‘Health Day’ in the entire history of UNFCCC. This historic moment culminated in the endorsement of the UAE Declaration on Climate and Health by 120 countries. The declaration called to strengthen cross-sectoral collaboration to curb greenhouse emissions, enhance finance for climate and health solutions, build climate-resilient health systems, and maximize the health benefits of climate action. In addition, donors pledged $1 billion in climate and health funding to climate-proof health systems, safeguard vulnerable communities, and tackle the environmental determinants of health.
These developments are being shaped by international institutions that are taking significant steps to align and operationalize climate and health agendas. The World Health Organization’s Alliance for Transformation Action for Climate and Health (ATACH) has been a bedrock to realize the ambition set at COP26 to build climate-resilient and sustainable health systems, using the collective power of WHO Member States and other stakeholders to drive the agenda forward at pace and scale and to promote the integration of climate change and health into national, regional, and global plans. The COP28 Guiding Principles on Climate and Health, developed in partnership with the Global Fund, Green Climate Fund, Rockefeller Foundation, and the WHO, have made bold bets on climate and health solutions.
Multilateral development banks are also playing a leading role. The World Bank has its longstanding GRID (green, resilient, and inclusive development) framework for urgent investments needed in human, physical, natural, and social capital – key areas include urban systems, energy, food and land use, and transportation — in an attempt to simultaneously end extreme poverty and create shared prosperity. Under its Climate and Health program, the World Bank is making significant climate-related health investments; 80% of the budget has been allocated to adaptation interventions such as urgent nutrition support, surveillance systems, and emergency response centers. The Asian Development Bank is committing $120 billion to climate finance and 75% of its operations to climate by 2030. Launched at COP28, the Climate and Health Initiative (CHI) is a seminal platform for intersectional knowledge, finance, innovation, projects, and partnerships to strengthen climate and health policies and practices to deliver climate-resilient and low-carbon healthcare systems. Besides its public sector focus, it is introducing private sector engagement and philanthropy for climate and health. In June 2024, the Multilateral Development Bank’s Joint Roadmap for Climate-Health Finance and Action was rolled out to coordinate synergistic investments, review the joint methodology for climate adaptation finance, and identify global best buys.
Country and Sector Operationalization
The world must urgently foster climate-resilient health systems and decarbonize healthcare capable of anticipating, responding to, and adapting to climate-related shocks and stresses in urban contexts. Design and development of urban climate health solutions should be country-driven, gender-responsive, participatory, and inclusive. Urgent operationalization in the Asia Pacific (APAC) region — Low & Middle Income Countries (LMICs) countries and Small Island Developing States (SIDs) including Bangladesh, India, and Nepal in South Asia, Cambodia, Philippines, Thailand, and Vietnam in South East Asia, and Papua New Guinea, Vanuatu, and the Solomon Islands — is crucial since this region hosts a disproportionate share of climate vulnerabilities. The APAC region is estimated to be affected by 80% of natural disasters globally and puts more than two-thirds of annual global GDP at risk. It is estimated that $11 billion is needed for LMICs to adapt to climate and health impacts annually.
Cross-border technology transfer, financial flows, and capacity-building between Global North and Global South cities and within South-South cooperation will be valuable. At an urban level, initial outputs may take shape in the form of city-level investment frameworks and feasibility studies in climate and health, urban climate and health programs and projects, and strengthening urban institutional capacities to implement integrated climate and health solutions.
On the climate-to-health side, heat stress, air pollution, flooding, droughts and climate-resilient health systems are all key. On the health-to-climate side, climate-ready human resources for health, sustainable supply chains, and climate-first leadership and governance are major areas. The package of solutions and development pathways across the climate and health continuum includes a wide spectrum of activities including early warning systems for extreme weather events, heat mapping for urban built environments, digital health innovations for the urban disease burden, and National Health Adaptation Plans to align climate, health, and cities.
City Level Lessons and Learnings
A thriving city is green, resilient, and inclusive. The nexus of climate, health, and human development underscores the importance of integrated approaches to address the complex challenges posed by climate change. By prioritizing health in climate adaptation and mitigation strategies, cities can enhance resilience, improve health outcomes, and ensure a better quality of life for current and future generations. Implementing a Health in All Policies (HiAP) approach is critical to ensure health considerations are integrated into climate planning across urban sectors and stakeholders. Below are a few exemplary cities:
- Copenhagen, Denmark — The city’s 2025 Climate Plan lays out a path for the city to become the first carbon-neutral capital. The plan sets ambitious targets and detailed strategies to achieve a significant reduction in health sector emissions. Implementation of the plan will reduce city emissions to 400,000 tons by 2025.
- Pittsburgh, USA — Rethinking the budget to free up funds for climate action, local leaders replaced a legacy system of budgeting around specific line items with a system that budgets around outcomes. Pittsburgh’s priority-based budget identified 249 discrete programs, services, and activities across 23 departments and scored each against the city’s climate, equity, and economic recovery goals. Pittsburgh freed up $23 million from its operating budget and identified another $18 million in revenue opportunities to support a dedicated Climate Budget supporting sectors including health.
- Doha, Qatar — The city of Doha is testing a new cool pavement with cryogenic material on popular stretches of road. Traditional pavement can reach a whopping 150 degrees Fahrenheit in summer and pavements can cover an average of 30-45% of land in urban areas. Asphalt heat is a major contributor to rising temperatures and decreased indoor cooling. Cool paving materials reflect solar heat, reduce storm-water runoff, and improve water quality, thereby maintaining and protecting human lives.
- Beijing, China — Beijing’s air pollution success story is a lesson for any nation, district, or municipality. Over a short span of years, Beijing’s commitment to urban rail expansion, coordination with surrounding areas on air pollution control measures (such as the Beijing-Tianjin-Hebei region), and cutting-edge integrated air quality monitoring networks utilizing advanced technologies, such as high-resolution satellite remote sensing and laser radar, have substantially curbed lower birth rates and adult mortality — and increased the average living age.
- Ahmedabad, India – Recognized as a leader in city-level heat action plans, particularly for its pioneering efforts to combat extreme heat and protect vulnerable populations. Ahmedabad became the first South Asian city to develop a comprehensive Heat Action Plan (HAP) in 2013. The Indian Institute of Public Health, Natural Resources Defense Council (NRDC), and other stakeholders created the plan with elements ranging from early warning systems and public awareness campaigns to health infrastructure strengthening and cooling spaces.
- Rio De Janeiro, Brazil — In the face of climate change, the union between weather and health in our epidemiological analysis is essential. 77% of cities do not use meteorological data in health surveillance systems at present. By integrating both, Rio has developed an early warning system, based on predictive modelling, for dengue fever, a mosquito-borne viral disease.
Conclusion
It took us years to acknowledge the intersection of climate and health. Now, health must serve as an engine to drive climate action. Cities are at the forefront of making this alignment a reality. Urban spaces need better information, incentives, insurance, integration, and investments. Multilateral development banks, international organizations, sovereign governments, the private sector, and civil society must strengthen finance, action, and collaboration to build climate-resilient and low-carbon health systems in our world’s cities.
About the Author
Vanshica Kant is a Climate, Human & Social Development Expert with the Asian Development Bank and a Global Shaper with the World Economic Forum. She holds a Bachelor’s from St. Stephen's College, University of Delhi, India, a Master’s from the University of Oxford, United Kingdom, and is a Schwarzman Scholar from Tsinghua University, China.