The second edition of the Healthy and Climate-Resilient Cities report details what city leaders of the future need so that they can put health at the heart of the design of urban environments. The edition builds on the recommendations of the 2023 report, which included the creation and resourcing of multisectoral city leadership groups and embedding a health-centred, climate-resilient approach to urban redesign.

This year was the hottest in recorded history, with unprecedented heatwaves and extreme weather events becoming more frequent in every continent. In addition, ocean temperatures have reached record-breaking levels, and atmospheric CO₂ continuing to soar.

And yet greenhouse gas (GHG) emissions have continued to grow, and cities continue to be exposed to extreme heat, flooding, toxic air pollution, rising sea levels and wildfires. In under 30 years’ time, more than 1.6 billion city residents will face extreme heat, 800 million will be at risk from flooding, and 650 million will experience increased freshwater insecurity.

In this context, city leaders and urban designers of the future will need to be equipped with the knowledge and skills to protect the population from the devastating impacts of climate change, while continuing to substantially reduce GHG emissions. To achieve this, the report calls for city leaders to prioritise health-focused urban design including:

• regarding health as the foundation for equitable and just climate-resilient city planning
• driving sustainable city interventions that support people’s health
• prioritising health and prevention as a driver of climate action
• accelerating adaptation efforts that will build city resilience and health resilience to climate change.

The report also outlines the support that future city leaders and urban designers need to realise this new model of cities. This includes:

• supporting to develop detailed methodologies that calculate impact, cost-benefits and return of investment of health-focused urban interventions;
• better understanding of the data available to city leaders and designers to help them make assessments of these interventions;
• a clear overview of the incentives available to ensure long-term healthy sustainable change and how they could be unlocked to prioritise health-focused urban interventions;
• training on how to assess community needs and engage with those using spaces to encourage active mobility, and create vibrant social public spaces and mixed-use land areas; and
• more in-depth insights and examples of how healthcare works and can play an active role in driving preventative health interventions.

Nigel Sullivan, chief sustainability and people officer at Bupa, said: “At Bupa, we believe healthcare can no longer be thought of as something confined solely to clinical provision, such as hospitals. Our approach to health must be woven into the fabric of our cities, support healthier lifestyles for citizens, and improve accessibility to healthcare for more people through digital solutions.

“This report reinforces our commitment to upskilling the leaders of tomorrow so that they create urban environments that foster healthier lives and harness technology to meet demand in ways that are sustainable and equitable for all. By reimagining cities with health at the centre, we can lead the way in a new era of healthcare that doesn’t just treat illness but helps communities thrive.”

Norman Foster, president of the Norman Foster Foundation, said: “The Norman Foster Institute's Programme on Sustainable Cities is empowering the next generation of urban leaders to place the health and wellbeing of city dwellers at the heart of their designs. By fostering a holistic approach to urban interventions, we cannot only create healthier, more vibrant cities but also drive meaningful progress towards our global climate goals.

“The report underscores the critical importance of interdisciplinary collaboration, bringing together knowledge and innovation to address the complex challenges of modern urban living. Through such efforts, we’re paving the way for cities that are healthier, resilient and sustainable for generations to come.”

Dr Kevin Austin, deputy executive director at C40 Cities, said: “City leadership is key to fostering innovation and building resilience, ensuring that impactful solutions are implemented faster, contributing to healthier, fairer, and more resilient cities worldwide. Together, cities are leading the way in creating models of local leadership and global collaboration in what is fast emerging as one of the most effective responses in tackling the biggest crisis of our times: climate breakdown.”

The report coincides with the close of the first year of the Norman Foster Institute’s Sustainable Cities Master’s programme, where 24 international post-graduate students, from architecture, urban design and policy backgrounds, engage in one year of practical learning to upskill them to create sustainable, healthy and climate resilient urban environments. As the health partner of the programme, Bupa convened leading cross-sectoral experts, including public and urban health specialists, climate and health campaigners, sustainability professionals and clinicians to debate, explore and discuss with the students how to practically prioritise health-focused urban design to support people in a changing climate. This knowledge exchange between cross-sectoral experts and students forms the basis of the report’s findings.

The insights from Bupa’s collaboration with the Norman Foster Foundation will also be incorporated in Bupa’s global Healthy Cities programme, which encourages people to do things that keep them and the planet healthy. In return, Bupa funds urban nature projects in partnership with local authorities and NGOs.