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Urgent cross-sector action needed to address climate and health threats facing people living in cities

  • A new report from Bupa, C40, the Lancet Countdown and the Norman Foster Foundation calls for health to be at the centre of city design, architecture, and urban planning
  • The report outlines growing health risks due to climate change including heat related deaths, mental health issues, and spread of infectious diseases
  • Health-centred actions in cities will help address the climate crisis and protect health in urban areas. Such actions include increasing green space, increasing fair, affordable, and just access to clean renewable energy, phasing-out fossil fuels for all sources of urban energy supply, implementing early warning systems for hazardous climate events, and more zero-emissions public transport

Ahead of the first ever dedicated health day at the Conference of the Parties (COP28), a new report identifies growing climate and health threats facing urban populations and calls for urgent cross-sector action – with collaboration across healthcare professionals, governments, businesses, urban planners, engineers, and architects, working in partnership with local communities – that can transform the worlds' cities to become healthier and more climate-resilient places to live.

Climate change presents a fundamental threat to human health, especially in urban environments1. In a scenario where no further climate action is taken, research has shown that over 1.6 billion residents in 970 cities will face extreme heat, 800 million residents in 570 cities will be at risk from flooding as a result of sea-level rises and 650 million people in 500 cities will experience increased freshwater insecurity2. Currently, 56% of the world's population (4.4 billion people) live in urban centres, and with this expected to rise to 70% by 20503, cities across the globe must take centre stage in addressing the health impacts of climate change.

The report draws on expertise from Bupa (the global healthcare company), C40 (global city mayors committed to climate action), the Lancet Countdown (a global academic collaboration tracking the connections between climate change and health), and the Norman Foster Foundation (promotes interdisciplinary thinking and research to help new generations anticipate the future).

Drawing on data from the 2023 report of the Lancet Countdown on Health and Climate Change, the ‘Healthy & Resilient Cities Briefing Paper’ (PDF, 10.8 MB) outlines the key health hazards impacting global urban communities and calls for health-centred action in cities to unlock health benefits while also supporting climate mitigation and adaptation efforts:

  1. Increase fair, affordable, and just access to clean renewable energy, phasing out the use of fossil fuels for all sources of urban energy supply.
  2. Create and resource multi-sectoral, city-level, leadership groups that can develop and implement climate and health action plans.
  3. Transition away from fossil-fuel powered vehicles in cities including both private and public transport vehicles.
  4. Increase the coverage of quality green space by protecting existing sites, developing new areas, and integrating greenness into urban planning.
  5. Conduct thorough city-wide health and extreme weather event risk and vulnerability assessments.
  6. Implement climate-informed surveillance, early warning, and early response systems, in alignment with the World Health Organisation recommendations4.
  7. Build resilient, sustainable, and zero-emission health systems in alignment with the COP26 Health Programme and following the recommendations, priorities, and targets of the WHO's Alliance for Transformative Action on Climate and Health.
  8. Embed a health-centred, climate-resilient approach to urban redesign.
  9. Proactively engage local communities and other key stakeholders in the design and management of urban environments.

Nigel Sullivan, Chief Sustainability and People Officer at Bupa, said: “As a business operating in cities around the world, we're seeing first-hand the health impacts of climate change. To help keep people healthy in urban environments, we must put health at the heart of urban design so that cities can become places that encourage healthier lifestyles, promote wellbeing and prevent avoidable illnesses. We know that our clinical and patient insights are just one piece of the puzzle – cross-sector expertise and collaboration is critical to tackling the health hazards facing urban populations.”

Marina Romanello, Executive Director at the Lancet Countdown, said: “The latest global data paints a sobering picture of our health and well-being as our planet heats – with cities on the frontline of these hazards. People living in cities face higher temperatures than rural areas, they are exposed to harmful levels of air pollution, and cities can act as hotspots for the transmission of climate-sensitive infectious diseases. But with accelerated, ambitious climate action, cities can be stewards of transformative change for health. At COP28 we must turn pledges to action to phase out fossil fuels from urban living, deliver a just transition to clean energy, and build stronger, better prepared health-supporting cities that offer a thriving future for present and future generations.”

Norman Foster, President at the Norman Foster Foundation, said: “The future of our society is the future of our cities — they are our greatest invention. The Norman Foster Institute (NFI), in a time of climate change, is addressed to those who wish, through practice or education, to improve the quality of life in cities worldwide. Sustainable design in urban planning and good governance supported by objective and measurable criteria are essential in achieving the mission of the NFI and the Norman Foster Foundation. As we tackle these challenges, COP28 provides a significant platform to discuss and implement sustainable urban solutions.”

Mark Watts, Executive Director, C40 Cities, said: "The climate crisis is not only harmful to our planet, it is also endangering the health of billions. We must act now to protect our health and the planet from the impacts of toxic air, food insecurity, infectious diseases and extreme weather events like heat, droughts and floods. Cities are both the epicentre of the crisis and the heart of the solution. Mayors have the power to shape the health of their citizens. C40 mayors are aligned in a shared mission of coming together to address the key health challenges of the future with science-based plans to lower carbon emissions to make cities healthier, safer, and fairer for everyone."

The report will be presented to a group of key stakeholders including representatives from the World Health Organisation, global city mayors, and global businesses at COP28 to rally action among cross-sector and cross-border actors.

The key principles of the paper will be applied to the Norman Foster Institute for Sustainable Cities programme which launches in January 2024, with Bupa as the exclusive Health partner. The findings will also be incorporated into Bupa's Healthy Cities initiative in 2024, a global physical activity challenge which unlocks investment in regenerating the natural environment.

Download the full Healthy and Climate-Resilient Cities report (PDF, 11.085KB).


Notes to editor

1 World Health Organisation: climate change factsheet

2 C40: The future we don't want: How climate change could impact the world's greatest cities

3 The World Bank: Urban Development Overview

4 2021 WHO Health and Climate Change Survey Report

About Bupa

Bupa's purpose is helping people live longer, healthier, happier lives and making a better world. We are an international healthcare company serving over 43 million customers worldwide. With no shareholders, we reinvest profits into providing more and better healthcare for the benefit of current and future customers. We directly employ around 82,000 people, principally in the UK, Australia, Spain, Chile, Poland, New Zealand, Hong Kong SAR, Türkiye, Brazil, Mexico, the US, Middle East and Ireland. We also have associate businesses in Saudi Arabia and India.

For more information, visit bupa.com

Read more about Bupa's sustainability strategy.

About C40

C40 is a network of nearly 100 mayors of the world's leading cities working to deliver the urgent action needed right now to confront the climate crisis and create a future where everyone, everywhere, can thrive. Mayors of C40 cities are committed to using a science-based and people-focused approach to help the world limit global heating to 1.5°C and build healthy, equitable and resilient communities. C40 works alongside a broad coalition of representatives from labour, business, the youth climate movement and civil society to support mayors to halve emissions by 2030 and help phase out fossil use while increasing urban climate resilience and equity.

The current co-chairs of C40 are Mayor Sadiq Khan of London, United Kingdom, and Mayor Yvonne Aki-Sawyerr of Freetown, Sierra Leone; three-term Mayor of New York City Michael R. Bloomberg serves as President of the Board. C40's work is made possible by our three strategic funders: Bloomberg Philanthropies, Children's Investment Fund Foundation and Realdania.

To learn more about the work of C40 and C40 cities, please visit c40.org or follow us on X, Instagram, Facebook and LinkedIn.

About the Lancet Countdown

The Lancet Countdown: Tracking Progress on Health and Climate Change exists to monitor the links between public health and climate change, and the transition from health threat to opportunity. We are a global collaboration of almost 300 leading experts from academic institutions and UN agencies across the globe, bringing together climate and health scientists, engineers, economists, political scientists, public health professionals and doctors. Each year our findings are published annually in medical journal The Lancet ahead of the UN climate change negotiations. Our data makes clear how climate change is affecting our health, the consequences of delayed action and the health benefits of a robust response.

For more information, visit lancetcountdown.org and follow at @LancetCountdown

About the Norman Foster Foundation

The Norman Foster Foundation promotes interdisciplinary thinking and research to help new generations anticipate the future. The first mission of the Norman Foster Foundation is to make visible the centrality of architecture, infrastructure and urbanism for the betterment of society. To this end, the second mission is to encourage new thinking and research across traditional boundaries in order to help younger generations anticipate the challenges of future change. In particular, the Foundation speaks to those professionals who are concerned with the environment — architects, engineers, designers, urbanists, civic leaders, planners and artists. This is at the heart of the Foundation's holistic approach to design and is ever more relevant as populations shift to cities. With the implications of climate change, robotics and artificial intelligence, sustainable design is not about fashion but about survival.

The Norman Foster Foundation operates from the United Kingdom, the United States and Spain with its headquarters based in Madrid.