Inaction in Urban Climate Policy Undermines Health

Dear Editor,

Cities, accounting for 70% of global emissions and approximately 75% of energy consumption, ¹ occupy a critical position at the intersection of climate change and public health challenges. The escalation in urban emissions from 62% in 2015 to an estimated 75% by 2023 ² underscores the need for robust climate strategies that address the complex health issues faced by urban populations. This increase signals an urgent call to action for policymakers, urban planners, and public health officials to adopt an integrated approach that prioritizes both environmental sustainability and public health. The Coalition for High Ambition Multilevel Partnerships (CHAMP) initiative, endorsed by over 70 countries, covering about 33% of the global populace and 58% of the global GDP, ² reflects a growing global recognition of the pivotal role cities play in influencing climate and health outcomes on a worldwide scale.

The impending release of the Intergovernmental Panel on Climate Change (IPCC) Special Report on Climate Change and Cities, guided by the Global Research and Action Agenda (GRAA) and the Cities Research Innovation Agenda (CRIA), marks a significant step forward in aligning climate interventions with public health benefits. By emphasizing strategies that lead to substantial reductions in air pollution, responsible for 4.2 million premature deaths globally each year, ³ the report aims to highlight the dual benefits of climate strategies for enhancing public health.

However, an analysis conducted by UN-Habitat on the urban content in Nationally Determined Contributions (NDCs) highlights concern, as a significant portion of cities lack strong urban climate strategies, ² thereby missing out on crucial opportunities to enhance public health. This gap underscores the pressing need to elevate the health benefits of climate action within urban planning and policy-making processes, ensuring that health considerations are integral to the development and implementation of urban climate strategies.

The inadequacy of urban content in NDCs is a glaring issue, with significant implications for public health. About 66% of CHAMP-endorsing countries have not fully incorporated urban climate strategies into their NDCs, ² indicating a vast potential for public health enhancement through more integrated climate policies. This deficiency suggests that economic concerns, governance complexities, and the lack of a cohesive framework for merging health and climate objectives might be deterring the inclusion of comprehensive urban health strategies in climate action plans. The underrepresentation of urban health strategies in NDCs not only undermines global efforts to mitigate climate change but also misses the crucial opportunity to address urban health challenges directly.

Strategic investments in urban climate initiatives serve as direct investments in the health of city dwellers. Urban green spaces, for instance, mitigate the urban heat island effect and potentially reduce heatwave-related mortality rates. Studies have shown that increasing urban greenery can lower local temperatures by up to 5°C, ⁴ significantly impacting heatwave-induced mortality, which can rise by 7.9% with every 1°C increase in temperature. ⁵ Furthermore, these green spaces provide essential areas for physical activity and mental health improvement, contributing to the overall well-being of urban residents.

Transitioning toward sustainable transportation systems can also have a dramatic impact on air quality, thereby addressing a major source of respiratory and cardiovascular diseases. Out of the 4.2 million people dying prematurely each year from diseases caused by ambient air pollution, the WHO attribute 38% to ischemic heart disease, 20% to stroke, 18% to chronic obstructive pulmonary disease (COPD), 18% to acute lower respiratory infections, and 6% to lung cancer. ⁶ Implementing policies that encourage the use of public transportation, cycling, and walking can thus significantly reduce the concentration of harmful pollutants in the air, leading to substantial health benefits. In this vein, the 15-Minute City stands as a viable alternative to sprawling policies. ⁷

Despite the ambitions of the CHAMP initiative, about 66% of endorsing countries have yet to fully integrate health-focused urban climate strategies into their NDCs. This indicates a significant potential for enhancing public health through more comprehensive and integrated climate policies. The reluctance to incorporate substantial urban health content into NDCs may stem from a variety of factors, including economic concerns, governance complexities, and the absence of a clear framework for integrating health and climate objectives.

The financial aspect of integrating health into urban climate strategies cannot be overstated. While current investments in climate actions are substantial, with an estimated $384 billion directed annually toward climate-related programs, ⁸ there remains a critical funding gap. To fully realize the health benefits of urban climate resilience, an estimated investment of $4.5 to $5.4 trillion is required. ⁹ This investment is necessary to develop infrastructures that support both health and climate resilience, indicating a substantial shortfall in the current funding levels.

The upcoming 2025 NDC revision cycle represents a crucial opportunity for embedding health imperatives into urban climate strategies. By prioritizing actions with quantifiable health outcomes, such as reducing mortality and morbidity from air pollution, enhancing access to green spaces for physical and mental well-being, and improving resilience to heat stress, cities can become exemplars of how climate action supports human health.

This imperative for integration requires a concerted effort to redefine urban climate strategies, ensuring they not only aim to reduce emissions but also contribute to creating healthier, more livable cities. It calls for a comprehensive view that recognizes urban areas as ecosystems where climate and health are intricately connected, thereby promoting policies that are mutually reinforcing.