Currently, half of the world’s population lives in cities, and by 2050, that number will grow by 2.5 billion more people—and close to 90 percent of that increase is occurring in Asia and Africa.  

The transition to urban life has also tracked with the shift in the global burden of disease. With progress on reducing infectious diseases, people are living longer, and infant mortality rates are at historic lows. At the same time, rates of noncommunicable diseases such as cancers, diabetes, and heart and lung disease have risen rapidly. Premature deaths from these noncommunicable diseases disproportionately affect low- and middle-income countries.  

It can be easy to look at these issues and think that urbanization exacerbates the problems. But really, the solution will rely on cities.  

Repeatedly, cities are proving their potential to drive large-scale innovations in public health. We have helped mayors and other local leaders pioneer smoke-free laws protecting people from working in restaurants and offices filled with smoke and inspiring people to quit. We’ve helped them keep sugary drinks and junk food out of schools where teachers were once paid to promote them. We have worked with city leadership where road crashes are the leading cause of death among young adults to redesign intersections, promote seat-belts and helmets, and reduce drink driving. In all of these initiatives, progress has been carefully proven and documented to be modeled elsewhere. 

At Vital Strategies, we believe that the world’s healthiest future will be urban, dense and green. We have led work with 54 global cities that signed on to the Partnership for Healthy Cities, an initiative that enables each city to deliver a smart, proven intervention of its own choice to address noncommunicable diseases and injuries. We’ve seen how cities can pilot programs that are eventually adopted by national governments. And conversely, we’ve seen how essential cities are to implementing national programs and policies.  

Cities will not be able to solve issues as complex and large-scale as climate change or tobacco use on their own, but they will increasingly be looked to as the incubators for ideas that governments might be hesitant to take on, whether it’s a policy to ban smoking in public places or bold innovations in public transportation. More and more, cities are going to be looked upon to take the lead and to prove the potential for real change, because they must and because they can. The examples laid out in this report demonstrate how urban centers have taken up the charge, and how Vital Strategies has supported these efforts through the expertise and partnership for which we’ve become known.