Urban planning for health – experiences of building resilience in 12 cities

Emergencies can become transformative experiences for cities: an opportunity to rethink, replan and rebuild, and to push for changes that can make them more healthy, sustainable, equitable and resilient. Going back to “normal” may not be good enough – instead, cities should strive to build better urban futures. This report presents the results of a series of interviews with cities in the WHO European Region, which aimed to compile local insights on how to set priorities for becoming more resilient and for preparing for (or responding to) environmental and health crises. Interviews were conducted with local government representatives involved in urban planning, environment or health areas. They focused on how the cities had approached urban planning and infrastructure design as a response to specific disasters – or in a preventive manner for future ones – and how these efforts could contribute to healthier, more sustainable urban futures.

A total of 12 case study cities in 11 countries in the WHO European Region were interviewed using a questionnaire sent in advance. They included three small (<100 000 citizens), five medium (100 000–500 000 citizens) and four large cities (>500 000 citizens). Of these, 10 had experienced at least one emergency event in the last decade, including major floods, forest fires, earthquakes, hurricanes, industrial accidents, power outages, heatwaves and snowstorms. Several cities had experienced multiple disasters at the same time – a trend that is likely to continue in the future. These events caused a broad range of effects, including substantial impacts on health. Thematic analysis was applied to interview extracts to identify common topics, ideas and patterns.

Emergency preparedness is a key element of building the resilience of health systems and other systems, and a central component of emergency management frameworks. The interview extracts were therefore analysed using four distinct but interconnected phases of emergency management frameworks. These include two phases that take place during and after an emergency (response and recovery), and two to be carried out before a new emergency strikes (mitigation and preparedness).

The interview results identified some key factors for recovery after the event, including access to financial resources and contingency budgets, insurance coverage, flexibility in local supply and distribution chains and social awareness of the different exposures and health risks of the surrounding environment. In addition, the interviews outlined a number of factors in building resilience that are critical for a full and speedy recovery, including long-term investment in critical infrastructure, transforming the economic model to rely more on sustainable and green industries, and control over development pressure.