Climate change increases the frequency and intensity of heatwaves, amplifying heat-related health risks in cities worldwide. Inequities in heat vulnerability arise from disparities in heat exposure, built and natural environments and population attributes that impact heat sensitivity, and socio-economic determinants of adaptive capability. A lack of internationally consistent and accessible heat vulnerability metrics creates barriers to assessing inequities and benchmarking urban heat vulnerability between cities worldwide. To address this need, we developed the Global Urban Heat Vulnerability Index (GUHVI), applicable to cities worldwide, using open data to identify spatial inequities in heat vulnerability at the neighbourhood scale. Built from an Australia-specific heat vulnerability index, the evidence-informed framework developed for the GUHVI evaluates heat exposure, heat sensitivity and adaptive capability to holistically assess heat vulnerability. Quantitative validation for eight Australian cities demonstrated strengths of the GUHVI in spatial resolution and assessment coverage of the grid-based framework. Qualitative validation for nine diverse cities internationally was performed in collaboration with local subject matter experts with knowledge of each city context. The GUHVI addresses critical gaps in existing methods by enabling systematic and comparable measurement of heat vulnerability in diverse cities internationally. Available through our customizable open-source global indicator software, the GUHVI provides evidence on modifiable risk factors of urban heat vulnerability, to inform targeted adaptation strategies that promote climate resilience and reduce health impacts from heat.

Cities are major contributors to global greenhouse gas emissions, and urban residents are experiencing escalating health impacts from climate change. It is therefore essential that city planning focuses on creating resilient, healthy built environments. This research explored the key determinants of healthy, climate resilient cities and identified indicators that could inform evidence-based planning internationally. We conducted a scoping review of academic and grey literature on healthy and climate resilient cities indicators. We identified three groups of determinants and indicators: climate hazard-specific, general resilience to climate hazards, and policy-specific. Across these groups, there were 12 categories of determinants, and 371 indicators. There was some consensus about urban heat, air pollution and flood being key climate-related health hazards, and the importance of green space; building quality; access to diverse amenities; low-carbon transport; and policymaking processes that promote urban climate resilience. However, the number and diversity of indicators may provide limited guidance to researchers and policymakers about optimal measures of healthy, climate resilient cities. We highlight specific gaps in current indicators and measurement considerations, including the need to validate indicators for cities internationally. Indicators that measure urban adaptive and transformative capacity are needed to track and guide policy progress towards healthy, climate resilient cities.

Creating healthy and sustainable cities should be a global priority. Some cities prioritize 15-minute cities as a planning approach with co-benefits for health, climate change mitigation, equity, and economic recovery from COVID-19. Yet, as our recent Lancet Global Health series on “Urban Design, Transport, and Health” showed, many cities have a long way to go to achieve this vision. This policy guideline summarizes the main findings of the series, which assessed health and sustainability indicators for 25 cities in 19 countries. We then outline steps governments can take to strengthen policy frameworks and deliver more healthy, equitable, and sustainable built environments.

The Lancet Global Health series provided clear evidence that cities need to transform urban governance to enable integrated planning for health and sustainability and commit to policy implementation. Evidence-informed indicators should be used to benchmark and monitor progress. Cities need policy frameworks that are comprehensive and consistent with evidence, with measurable policy targets to support implementation and accountability. The series provided evidence-informed thresholds for some key urban design and transport features, which can be embedded as policy targets. Policies and interventions must prioritize identifying and reducing inequities in access to health-supportive environments. Governments should also invest in open data and promote citizen-science programmes, to support indicator development and research for public benefit. We provide tools to replicate our indicators and an invitation to join our 1000 Cities Challenge via the Global Observatory of Healthy and Sustainable Cities.

Urban liveability is a global priority for creating healthy, sustainable cities. Measurement of policy-relevant spatial indicators of the built and natural environment supports city planning at all levels of government. Analysis of their spatial distribution within cities, and impacts on individuals and communities, is crucial to ensure planning decisions are effective and equitable. This paper outlines challenges and lessons from a 5-year collaborative research program, scaling up a software workflow for calculating a composite indicator of urban liveability for residential address points across Melbourne, to Australia’s 21 largest cities, and further extension to 25 global cities in diverse contexts.

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

Benchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. We show this framework by calculating spatial indicators—for 25 diverse cities in 19 countries—of urban design and transport features that support health and sustainability. We link these indicators to cities’ policy contexts, and identify populations living above and below critical thresholds for physical activity through walking. Efforts to broaden participation in crowdsourcing data and to calculate globally consistent indicators are essential for planning evidence-informed urban interventions, monitoring policy effects, and learning lessons from peer cities to achieve health, equity, and sustainability goals.

Pedestrian accessibility is an important factor in urban transport and land use policy and critical for creating healthy, sustainable cities. Developing and evaluating indicators measuring inequalities in pedestrian accessibility can help planners and policymakers benchmark and monitor the progress of city planning interventions. However, measuring and assessing indicators of urban design and transport features at high resolution worldwide to enable city comparisons is challenging due to limited availability of official, high-quality, and comparable spatial data, as well as spatial analysis tools offering customizable frameworks for indicator construction and analysis. To address these challenges, this study develops an open source software framework to construct pedestrian accessibility indicators for cities using open and consistent data. It presents a generalized method to consistently measure pedestrian accessibility at high resolution and spatially aggregated scale, to allow for both within- and between-city analyses. The open source and open data methods developed in this study can be extended to other cities worldwide to support local planning and policymaking. The software is made publicly available for reuse in an open repository.