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Australia drifted away from the Healthy Cities movement it helped start. It can still get back on track.

For residents of Sydney's Western Parkland City, decades of urban planning decisions have led to stark differences in people’s health and their access to the resources and services that promote health.

The situation presents big challenges, but also an opportunity to re-engage with what a healthy city means.

In this  region of Greater Sydney, far from the postcard view of the city’s famous harbour, socioeconomic levels vary widely across eight local government councils, and nearly 40 percent of residents speak a language other than English at home. Some local councils rank among Australia's most disadvantaged, while others sit above the national average.

There are significantly  compared to NSW state averages: higher asthma-related deaths and respiratory conditions (particularly in children), more cardiovascular disease and greater incidence of psychological distress.

Limited job opportunities, long commute times and poor public infrastructure, as well as vulnerability to climate hazards like extreme heat, bushfires and flooding demonstrate how urban planning choices can deeply affect community health.

High car dependency and limited public transport options contribute to physical inactivity and the daily stresses of lengthy travel times. During heatwaves and poor air quality days, residents with cardiovascular disease and respiratory conditions face increased health risks.

This situation isn’t unique to Western Sydney. It’s a snapshot of what is happening in cities around the country — and across the Asia-Pacific region.

Renewing a commitment

Australia was one of the original leaders of the  launched in the 1980s by the World Health Organization, but rapid development of urban areas has eclipsed many of its aims.

The basic principle of the movement is about creating urban environments that truly promote human health. The key lies in addressing all the factors that affect people’s health and living conditions, and in getting everyone involved in finding workable solutions – government, the private sector and especially community groups and individuals.

At the recent 10th Global Conference of the Alliance for Healthy Cities, held in September, global city leaders reinforced this urgency, sharing ways they're tackling complex urban health challenges in settings ranging from small island nations to active conflict zones.

With its wealth of resources, Australia has a clear opportunity to reinvigorate its role in the Asia-Pacific region by prioritising the health of its communities and future generations in urban policymaking.

Understanding urban health: Four views

The way practitioners and policymakers approach urban health has been shaped by , each offering valuable insights into how cities can promote wellbeing.

The first views cities through a "medical-industrial" lens, with urban development driven through a focus on healthcare infrastructure and technology. This approach has given rise to health precincts and innovation districts, but it can overlook broader social determinants of community health and health equity, such as access to affordable housing or healthy local food environments.

The second perspective, "urban health science", emphasises data-driven, evidence-based interventions and measurable outcomes. This approach has helped researchers understand how specific aspects of urban design – from walkability to green space – can impact public health. While valuable, this view sometimes reduces complex social issues to purely technical challenges, missing the “human element”.

The "healthy built environments" viewpoint is the third way of looking at urban health. Rooted in urban planning concepts, it advocates for integrating health considerations into every aspect of city design. This has led to innovations in planning guidelines and development assessments, but implementation often faces political and economic barriers.

The fourth perspective, the "health social movements" approach, emphasises the commitment to community empowerment and equity and the idea that a healthy city is not merely determined by its epidemiological health status. It recognises that healthy cities must be shaped by residents' needs and aspirations.

�ճ���� demonstrates how different approaches to urban health don't just compete – they coexist and often complement one another.

In practice, successful urban health initiatives often draw from multiple perspectives simultaneously. For instance, when planning public spaces, cities might combine the evidence-based metrics of urban health science with the community empowerment emphasis of health social movements while working within the practical frameworks of healthy built environments.

Reimagining healthy cities in the Asia-Pacific

The challenges facing Western Sydney are echoed in many Asian megacities, where the pursuit of economic growth through massive urban development has often come at the cost of community health and wellbeing.

The recent Global Conference of the Alliance for Healthy Cities in Seoul demonstrated the power of committed leadership in advancing urban health. The Korean Healthy Cities Partnership exemplifies this commitment, with over 100 member cities – 40 percent of all local governments in Korea – actively prioritising health in urban policies.

Cities such as Kuching, Malaysia, which has maintained a strong healthy cities program since 1994, show how this commitment can be sustained over time, despite changes in political leadership.

The key to success for healthy cities lies in combining insights from all four perspectives on urban health. This means following a few basic guidelines: Moving beyond just building health infrastructure to creating environments that promote wellbeing, using evidence-based approaches while acknowledging local context and community values, integrating health considerations into all aspects of urban planning, and empowering communities to shape their own environments.

Implementing this vision for healthy cities also requires leadership that can navigate and integrate multiple perspectives.

City leaders must act as bridges between different approaches, recognising that no single paradigm holds all the answers. It calls for an understanding of how different perspectives complement each other rather than compete, and knowing how to build partnerships that bring together diverse viewpoints and expertise.

Leaders must create governance structures that can handle complexity, with mechanisms that allow city budgets, reporting requirements and accountability measures to be adjusted in response to community needs and changing local contexts.

These approaches move beyond seeking simplistic solutions, while ensuring community members, not just technical experts, have a central role.

The path to healthier cities isn't about choosing between different approaches – it's about skilfully combining the ones that are needed. Leaders must embrace this complexity while making it manageable for everyone involved.

Dr Jinhee Kim is Scientia Academic at the Cities Institute. Her research interests include understanding the complexities of urban health paradigms relevant to addressing the spatial impacts of urban environments on human health.

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