Urban Innovation: Trends in Building “Resilient Cities” to Address the Health Risks of Climate Change
Urban residents, particularly in low- and middle-income countries, face increasing health risks as a result of climate change. Due to high population density, cities become more vulnerable to extreme climate events, while many residents live in informal settlements that lack basic infrastructure such as clean water, sanitation, and health services. With the growing number of people in urban areas, there is an urgent need for specialized research and the implementation of effective strategies to address these challenges. In the absence of such measures, the health impacts of climate change in cities will continue to intensify.
The book Building Resilient Cities: Adapting to the Health Impacts of Climate Change, published by the Observer Research Foundation in 2024, addresses the factors that increase the vulnerability of cities to climate change. It also explores the reasons why some communities disproportionately bear the burden of these impacts. In addition, it highlights a wide range of climate-related health impacts, ranging from heat stress to risks arising from infrastructure. The book also examines how a multi-level governance framework can effectively respond to these challenges, with a focus on policies and measures that prioritize the needs of vulnerable communities.
Climate Change Challenges
Climate change constitutes a fundamental threat to human health, with disproportionately negative effects on vulnerable groups such as children, women, and the poor. Evidence is rapidly accumulating worldwide about its worsening health effects. These impacts are particularly evident in cities, which host more than half of the world’s population and account for nearly three-quarters of energy-related greenhouse gas emissions. While cities represent critical challenges for climate action, they also offer opportunities to implement cross-sector climate policies and local solutions. For example, increasing green spaces in cities can help reduce the severity of the Urban Heat Island (UHI) effect, thereby decreasing heat-related deaths.
In this regard, the main climate risks in cities include: extreme temperatures, flooding (from storms, sea-level rise, or other causes), poor air quality, wildfires, and increased rainfall. These climate problems interact with social factors, leading to issues such as forced displacement (which exacerbates food insecurity, limited access to basic health services, and overcrowding in unhealthy urban conditions), as well as increased risks of vector-borne and waterborne infectious diseases.
Similarly, the severity of health impacts of climate change varies across different demographic groups within urban populations, with the most severe consequences observed in poor neighborhoods. In addition, heat and pollution interact in multiple ways, including through the effect of high temperatures in altering the chemical composition of particles, which increases their toxicity. Hence, there is a need to adopt a comprehensive approach to understand and reduce the interlinked factors affecting urban health as a result of climate change.
In this context, the transport sector is one of the main areas requiring mitigation measures, given its major role in greenhouse gas emissions in cities. For instance, strengthening public transport systems through the development of mass rapid transit networks can help reduce emissions and support the transition to a more sustainable economy.
Overall, climate change represents a grave threat to humans, particularly the poor and marginalized. Carbon dioxide emissions, global greenhouse gases, deforestation, and the loss of water bodies worsen the heat impacts on those who lack access to cool spaces or air conditioning. Urban temperatures are usually 3 to 5°C higher than rural areas due to lack of greenery. Consequently, about 91% of urban residents breathe polluted air, 40% lack sanitation and drinking water facilities, and globally, 9 out of 10 people breathe air below WHO standards, while more than 2 billion people still lack access to clean energy.
Climate Change and Health
Manifestations of climate change often cause respiratory, cardiovascular, and metabolic diseases. Prolonged exposure to heat leads to several consequences, most notably heat stress, which damages cerebral blood vessels and causes circulatory failure that can result in death. Under extreme heat, living organisms face continuous pressure to maintain optimal body temperature. This thermal balance—through sweating and redirecting blood to the skin—forces the heart to work harder, which may cause cardiovascular failure. The strain also extends to the respiratory and circulatory systems, increasing the risk of lung failure and stroke. Without sufficient water intake, the body quickly succumbs to dehydration.
Extreme heat worsens many health conditions and reduces the effectiveness of medications, making it difficult to fully assess its life-threatening risks. Nevertheless, heat waves are consistently linked to mortality peaks. High temperatures also amplify air pollution, exacerbating its documented health consequences, especially respiratory diseases.
Beyond heat, other climate-related diseases (such as those linked to flooding) include cholera, typhoid, and dengue fever, all of which strain health systems. Furthermore, climate change affects food production. With intensifying climate-related events, food systems have become increasingly unstable, threatening food security and diet quality.
Healthier Cities
The book proposes developing climate-smart cities and implementing co-benefit measures to enhance adaptability to climate change. Urban planning must consider heat impacts when designing infrastructure, such as increasing urban greenery, which provides a more comprehensive solution to environmental pollution. Expanding the use of “cool pavement” technology can reduce surface temperatures exposed to sunlight through reflective materials. Additionally, transitioning from fossil fuels to renewable energy—including in the health sector—reducing the carbon footprint of buildings, improving public transport, providing safe walking spaces, and promoting cycling are all necessary steps. These measures foster physical activity, which positively affects population health and urban quality of life.
In this regard, urban planning policies should focus on developing resilient infrastructure in low-income areas, such as building flood-resistant housing and improving drainage systems. Existing programs targeting women and children should be strengthened, with increased resources allocated to accelerate the achievement of Sustainable Development Goals and address the disproportionate effects of climate change on these groups. This requires stronger partnerships between government and community sectors to ensure that adaptation plans reflect real needs on the ground. Long-term, multidisciplinary, community-integrated studies are also essential to understand the overall effects of climate change on mental and physical health, social structures, livelihoods, migration, and the role of women in society.
At the same time, multilateral organizations such as the United Nations and the World Health Organization, along with intergovernmental bodies like the Intergovernmental Panel on Climate Change (IPCC), play crucial roles in setting standards, developing frameworks, and promoting international cooperation. In this context, global governance mechanisms should focus on integrating health into climate agreements, which have historically emphasized emissions reductions and energy transitions without adequate attention to health aspects.
There is also a need to establish global financial mechanisms designed to support multi-level urban interventions. Vulnerable cities in the Global South often face a shortage of financial resources to implement climate and health interventions. Therefore, initiatives such as the Green Climate Fund and international financial institutions should prioritize funding climate adaptation programs that focus on health, especially in urban areas with high climate risk exposure.
The book also emphasizes the importance of employing emerging innovations and digital solutions as a key foundation for environmentally sustainable policies and plans, alongside the development of early warning systems. As the “emerging ecosystem” linking climate and health expands, cities that invest in predictive analytics for climate-related diseases and pests will be able to strengthen vector control innovations and climate-resilient infrastructure. These efforts should be part of community-led collaborative initiatives aimed at building a healthier, more resilient future for all.
Finally, building cities resilient to the health impacts of climate change requires a holistic approach that integrates green infrastructure, sustainable housing, and climate-adaptive public health systems. Accordingly, the book stresses the need for collaboration between urban planners, policymakers, and public health officials to incorporate climate resilience into all aspects of city design and governance, and to improve local solutions. By adopting a green infrastructure model, stakeholders can provide natural solutions for cooling cities, improving air quality, managing stormwater, and ensuring sustainable housing away from extreme weather and heat. At the same time, strong public health systems are essential to respond to emerging climate-related health threats. By adopting these strategies, cities can reduce climate-related health risks and promote healthier, more livable urban environments for all residents.
The book concludes that the intersection of climate change, health, and cities requires urgent attention from stakeholders, especially in rapidly urbanizing regions of the Global South. Using innovative approaches to improve urban design, safety, and well-being holds great potential. However, these promising opportunities must not overshadow the existential threat that climate change poses to cities worldwide. The first step is to understand the interaction between heat and humidity levels and their implications for human health, in order to enhance urban preparedness for extreme heat. It must be recognized that adaptation alone cannot fully protect cities from climate change impacts; bold political action and transformative efforts are necessary to control emissions and preserve the environment to prevent catastrophic heat impacts on vulnerable populations.
Source:
Vikrom Mathur & Aparna Roy, eds. Building Resilient Cities: Adapting to the Health Impacts of Climate Change. Observer Research Foundation, 2024.
