Transforming City Governance: WHO Initiative Aims to Boost Global Urban Health Equity

WHO’s Initiative on Urban Governance for Health and Well-being outlines how participatory, multisectoral and equity-focused governance can transform rapidly growing cities into healthier, more resilient and inclusive environments. It highlights reforms across six pilot cities and charts a global roadmap for scaling Healthy Cities approaches through strengthened leadership, community engagement and institutionalized governance mechanisms.

The World Health Organization’s Initiative on Urban Governance for Health and Well-being arrives at a critical moment in global urbanization, drawing on research support from WHO’s Regional Healthy Cities Networks, the WHO Regional Office for the Western Pacific, and academic partners engaged in the UrbanLead leadership programme. As cities swell, expected to house nearly 70% of the global population by 2050, the initiative argues that governance is becoming one of the most decisive factors shaping health and equity. Rooted in the long-standing Healthy Cities movement and aligned with WHO’s Fourteenth General Programme of Work, the document underscores that cities are not merely administrative hubs but complex social ecosystems where policy, environment, culture, and economics intersect to determine population well-being. COVID-19 exposed how fragile these systems can be, highlighting the urgent need for participatory, multisectoral, and multi-level governance approaches that place citizens at the center of decision-making.

Building Cities Around People, Not Systems

Launched in 2020 with support from the Swiss Agency for Cooperation and Development, the initiative seeks to move cities away from top-down governance toward models anchored in community involvement and cross-sector collaboration. Drawing on the Geneva Charter for Well-being, it promotes tools such as participatory budgeting, citizen assemblies, and Health in All Policies to ensure that sectors like housing, water, transport, education, and youth development integrate health into their core agendas. Governance, WHO argues, is not only about institutions managing services, it is a shared process requiring trust, transparency, and diverse voices. This ethos is being tested and refined in six cities: Khulna (Bangladesh), Bogotá (Colombia), Douala (Cameroon), Mexico City (Mexico), Pasig City (Philippines), and Tunis (Tunisia). Each, supported by mayors, municipal teams, and community organizations, identified challenges such as informal settlements, under-resourced public services, and weak social cohesion as priorities requiring governance transformation.

Governance Innovations Taking Root in Six Cities

Phase 1 (2020–2024) produced early but tangible reforms across these urban settings. In Mexico City, seven boroughs began applying the Healthy Municipalities, Cities and Communities criteria to shift planning frameworks toward social determinants of health. Tunis expanded youth engagement through joint efforts of the Ministries of Health and Youth, and Sports, enabling young advocates to voice their well-being needs. Khulna advanced a Healthy City Action Plan and established cross-sectoral coordination mechanisms to integrate health into non-health sectors. Bogotá is prepared to elevate its Intersectoral Health Committee into a mayor-led commission to improve coordination of social and public services. Douala adopted a Healthy City Action Plan (2022–2025) with community-led water management committees that expanded access to safe drinking water, while Pasig City strengthened participatory planning by aligning Barangay Development Plans with broader city strategies.

Leadership Training Driving Systemic Change

Supporting these reforms is WHO’s UrbanLead programme, adapted from the earlier ProLead model and designed to cultivate urban leaders capable of driving governance innovation. Through participatory planning, intersectoral problem-solving, and continuous quality improvement tools, local officials and academic partners learned how to turn governance principles into practical, community-centered projects. By the end of Phase 1, a US$10 million investment had trained more than 600 urban champions influencing policies affecting over 25 million people. The initiative also strengthened Regional Healthy Cities Networks across five WHO regions, now encompassing more than 5,000 municipalities. Nearly 30 city-to-city exchanges and around 20 technical and advocacy tools further broadened the global community adopting similar governance approaches.

Scaling Up Towards a Healthier Urban Future

The report outlines an ambitious Phase 2 (2025–2028), focused on institutionalizing participatory and multisectoral governance mechanisms, deepening systems change, expanding regional networks, and amplifying city-level innovations through global exchanges. WHO argues that sustained investment can consolidate gains in the six pilot cities and create a critical global mass of Healthy Cities capable of advancing the Sustainable Development Goals, particularly SDG 3 on health and SDG 11 on inclusive, safe, and resilient cities. Ultimately, the initiative frames cities as crucial arenas for confronting the intertwined challenges of climate change, inequality, and public health. When governance is inclusive, collaborative, and equity-focused, the document asserts, cities can evolve into places where collective well-being becomes not just a political aspiration but an achievable reality.