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Cities urgently need systemic health checks. Without them, they keep fixing symptoms, wasting scarce budgets, while hidden risks grow. This proposed approach helps cities understand their true health and activate their self-healing capacity instead of constantly firefighting.
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Target audience
Urban planner; Mayors; International city networks; WHO Healthy Cities initiatives
The problem
Today, cities assess “urban health” mainly as the health of people living in cities. This ignores the city itself as a complex living system. As a result, cities may appear healthy while exporting pollution, resource depletion, and social costs beyond their borders. This blind spot weakens urban resilience and overlooks the city’s immunocompetence—its ability to adapt, self-organise, and recover from shocks—especially under tight public budgets.
What we did and why
We propose a systemic health check for cities. It identifies the city’s overall health condition before choosing actions. The method combines a rapid health check, a deeper systems analysis, and a capacity assessment. Together, these steps reveal whether a city should optimise existing systems or transform them—helping decision-makers invest wisely, avoid costly mistakes, and strengthen resilience under real financial constraints.
Our study’s contribution
The paper moves beyond outdated approaches that fix urban “pain points.” Instead, it builds on the new science of cities that understand cities as complex, adaptive systems. This reveals unused potential, hidden risks, and leverage points for change. Improving health by constant repairs is no longer affordable. Understanding and activating a city’s self-organising and self-healing capacity is a smarter, economically sound alternative.
Impacts for city policy and practice
Cities should team up with science and conduct regular systemic health checks. This enables evidence-based prioritisation, cross-sector coordination, and smarter use of limited budgets. Rather than reacting to crises, cities can build resilience proactively—strengthening governance, partnerships, and learning capacities. Systemic health checks help cities decide when to optimise and when to transform, safeguarding wellbeing for people and the planet.
Further information
Full research article:
A systemic health check for cities by Franz W. Gatzweiler, Gabriele Harrer-Puchner, Mark Nieuwenhuijsen, Graham Alabaster, Felix Fuders, Hany Ayad, Yonette Thomas, Saroj Jayasinghe, Nicolas You, Lin Jianyi, Mari Vaattovaara & Rumiana Jeleva.
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