Healthy Homes, Healthier Cities:
Reflections from the World Urban Forum
Dr. José M. Zuniga, President/CEO, Fast-Track Health
Cities are where humanity’s greatest challenges and greatest opportunities increasingly converge. More than half of the world’s population already lives in urban areas, and by 2050 nearly 70% of humanity is expected to reside in cities. Urbanization is reshaping how people live, work, move, and experience health. but while cities generate innovation, economic growth, and cultural dynamism, they also expose deep inequities that too often determine who thrives and who is left behind.
At the center of this urban reality is a simple but profound truth: health begins where people live. Housing is not merely shelter. It is public health infrastructure. The quality, affordability, safety, and location of housing influence respiratory disease, cardiovascular health, mental well-being, infectious disease vulnerability, exposure to climate-related hazards, and even life expectancy. The World Health Organization (WHO) has long emphasized that inadequate housing contributes to preventable illness and premature death, while the United Nations Human Settlements Programme (UN-Habitat) warns that nearly 3 billion people could lack access to adequate housing by 2030 if current trends continue.
For too long, however, housing policy and public health policy have operated in parallel rather than in partnership. At last week’s World Urban Forum in Baku, Azerbaijan, I spoke on a panel focused on the “Pulse of Healthy Homes.” I addressed how a healthy home is more than four walls and a roof. A healthy home requires safe water and sanitation, ventilation, clean indoor air, climate resilience, temperature regulation, and protection from overcrowding and environmental hazards. But healthy housing also depends on healthy neighborhoods – places connected to transportation, healthcare, pharmacies, schools, healthy food, employment opportunities, and green spaces.
In the era of climate change, housing policy must also become climate policy. Extreme heat, flooding, wildfire smoke, and vector-borne disease outbreaks are increasingly urban housing issues. Vulnerable communities – particularly low-income populations, migrants, older adults, and historically marginalized groups – disproportionately bear these burdens. Yet addressing these overlapping challenges requires more than better architecture or stronger building codes. It requires breaking down silos that continue to fragment urban health efforts.
The greatest threats facing cities today do not exist in isolation. HIV, tuberculosis, chronic diseases, mental health conditions, climate-related illness, housing instability, food insecurity, and social exclusion are interconnected. Real people do not experience their lives through the separate funding streams and institutional structures that governments and organizations often impose. A person struggling with housing instability may simultaneously face diabetes, depression, HIV vulnerability, unemployment, transportation barriers, and exposure to extreme heat.
Still, many urban systems remain fragmented – governed by separate agencies, separate budgets, separate datasets, and separate political priorities. This fragmentation comes at a cost. The COVID-19 pandemic exposed both the dangers of siloed governance and the transformative potential of coordinated urban leadership. Cities that aligned public health, housing, transportation, social services, community organizations, and data systems were often better positioned to respond rapidly and equitably.
The lesson is clear: healthier cities require integrated approaches. Urban health initiatives must increasingly move beyond disease-specific or sector-specific thinking toward whole-person and whole-community models. Housing policy should be evaluated not only by the number of units built, but also by its impact on asthma rates, mental health, social cohesion, climate resilience, and avoidable hospitalizations. Similarly, climate adaptation plans should be assessed not only by infrastructure metrics, but also by their ability to protect vulnerable populations from widening health inequities.
This shift also demands new forms of governance and financing. Cities need cross-sector coordination between housing, health, planning, transportation, environmental, and finance departments. National governments and multilateral institutions should support municipalities through financing mechanisms that recognize housing investments as health investments. Prevention-oriented strategies often reduce long-term healthcare expenditures while strengthening social and economic resilience.
Equally important is the role of communities themselves. Communities should not merely be consulted after decisions are made. Residents must help shape, govern, and evaluate the policies that affect their lives. Lived experience provides insights that no dataset alone can fully capture — including the realities of stigma, safety, informal economies, displacement, mobility, and distrust of institutions.
Community leadership is not symbolic; it is operationally essential. The most effective urban health initiatives globally have consistently elevated community voices, peer leadership, and participatory governance. Community health workers, tenant associations, youth leaders, and grassroots organizations often understand barriers and opportunities long before formal systems do.
Informed by our experience with Fast-Track Cities, at Fast-Track Health we believe cities are uniquely positioned to lead this transformation. Urban leadership operates closest to implementation realities and closest to communities themselves. Initiatives such as the global Fast-Track Cities network have already demonstrated the power of city-led, data-informed, community-engaged action to improve health outcomes and strengthen accountability.
But the next chapter of urban health must go even further. The future demands integrated urban ecosystems that align housing, climate resilience, public health, social protection, and equity agendas rather than treating them as separate conversations. It requires interoperable data systems, collaborative financing, and governance models built around people rather than institutions.
Ultimately, healthier homes are foundational to healthier cities, and healthier cities are foundational to healthier societies. The question before us is no longer whether urban health initiatives should work together. The complexity of today’s challenges has already answered that question for us. The real question is whether we are willing to redesign our systems quickly enough – and boldly enough – to meet the moment.