Stronger city governance emerges as WHO’s key strategy for healthier, more resilient societies

WHO’s Urban Governance Initiative outlines how strengthening participatory, multisectoral city governance can transform health outcomes in rapidly urbanizing environments, drawing on lessons from six pilot cities worldwide. It emphasizes embedding equity, community engagement and cross-sector planning into urban systems to build resilient, health-promoting cities for the future.

The World Health Organization’s Initiative on Urban Governance for Health and Well-being is shaped by collaboration with regional WHO research bodies, including WHO AFRO, WHO AMRO/PAHO, WHO EMRO, WHO SEARO, and WHO WPRO, along with academic institutions supporting the UrbanLead leadership programme. These organizations collectively guide how cities can become incubators of health-focused governance. The document situates this work within a rapidly urbanizing world where nearly 70% of people will live in cities by 2050, amplifying challenges such as inequality, climate risk, inadequate services, and pandemic vulnerability. WHO argues that robust urban governance is now a public health necessity, influencing sanitation, mobility, social cohesion, and even political trust.

Healthy Cities Legacy Meets Modern Urban Challenges

Launched in 2020 with support from the Swiss Agency for Development and Cooperation, the Initiative builds on the four-decade Healthy Cities movement, which now includes more than 5000 cities. Its approach aligns with the WHO’s 13th and 14th General Programmes of Work, emphasizing the need for community voice, health promotion, and participatory decision-making across all sectors. WHO Director-General Dr. Tedros Adhanom Ghebreyesus stresses that resilient and inclusive cities can only emerge when equity and well-being sit at the centre of political priorities. This requires shifting from a narrow biomedical model to one that recognizes social determinants, community co-design, and institutional transparency as critical pillars for public health.

Six Cities as Living Laboratories for Governance Reform

To turn these principles into operational models, WHO works closely with six pilot cities: Khulna (Bangladesh), Bogotá (Colombia), Douala (Cameroon), Mexico City (Mexico), Pasig City in Metro Manila (Philippines), and Tunis (Tunisia). Rapid situation analyses revealed three shared challenges: governance in informal settlements, weaknesses in basic public services, and declining social cohesion. Mayors are committed to addressing these through participatory governance and cross-sector collaboration. WHO’s five strategic levers, leadership, institutionalization, capacity building, research and advocacy, guide reforms such as creating multisectoral committees, issuing new policy frameworks, piloting participatory budgeting, and integrating health across local agencies. Capacity-building programmes have trained more than 600 urban leaders, while regional labs strengthen evidence generation and monitoring.

City Success Stories from Phase 1 (2020–2024)

Concrete examples illustrate how governance reform can reshape health outcomes. Mexico City integrated Healthy Municipalities criteria into seven boroughs, embedding social-determinant thinking into municipal planning. Tunis strengthened youth engagement by enabling ministries to empower young citizens to articulate well-being needs. Khulna advanced cross-sectoral coordination through its Healthy City platform, while Bogotá elevated its Intersectoral Health Committee into a mayor-led commission to align public and social services. Douala created a multisectoral Healthy City Action Plan and improved access to safe drinking water through community water committees. Pasig City refined participatory planning by aligning Barangay Development Plans with its city development agenda. Much of this progress was supported by WHO’s UrbanLead programme, which equips cities with tools for participatory planning, problem solving, and innovative governance.

Scaling Up for 2025–2028: A New Phase of Systems Change

During Phase 1, a US$10 million investment allowed the Initiative to influence the well-being of over 25 million people, expand the Healthy Cities network, host nearly 30 city-to-city exchanges, and produce around 20 technical tools. The success generated interest from other municipalities and attracted investment from governments and development partners. As Phase 2 (2025–2028) begins, WHO aims to consolidate and institutionalize the governance reforms tested during the pilot years. The focus now shifts to systems change: embedding multisectoral structures in city administrations, deepening community participation, scaling leadership development, and expanding national and regional Healthy Cities networks. The overarching goal is to build a critical mass of cities capable of sustaining equitable, health-promoting governance that endures beyond political cycles and transforms urban environments for generations to come.