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.@en

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.@en

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.@en