November 12, 2025

In a recent paper in Nature Medicine, Co-Directors of the Urban Health Collaborative, Ana Diez Roux, MD, PhD, MPH, and Usama Bilal, MD, PhD, MPH, provided a detailed examination of the future of urban health research, highlighting the necessary steps to improve health equity in a rapidly urbanizing world.

Over half of the world’s population lives in cities, and that number is only poised to grow to at least two-thirds of the world’s population by 2050, particularly in low- and middle-income countries. This phenomenon provides for both opportunities and caution, though, for improving health equity.

Rapid, unmanaged growth can exacerbate public health burdens – like non-communicable diseases, infections, and injuries – and deepen social and environmental inequities. However, cities are also uniquely positioned to act via multisectoral policies to improve health, reduce health inequities, and contribute to environmental sustainability. Diez Roux and Bilal outline 4 research priorities for achieving this:

1. Sharper descriptive work to expose within- and between-city health gaps and to track trends to spur action.
2. Stronger causal studies – using longitudinal data, quasi-experiments, and systems modeling – that can clarify how urban factors impact health across diverse settings.
3. Rigorous evaluations and simulations of the effects of transportation, housing, fiscal, and climate adaptation or mitigation policies to quantify co-benefits for health, equity, and sustainability, and guide multi-sector action.
4. Meaningful engagement with communities and policy makers, from agenda setting through to dissemination, to ensure that evidence is locally relevant and politically usable.

There are already clear policies that cities can implement to promote health equity: encouraging active transportation, improving access to healthy food and affordable housing, ensuring quality education, safe jobs, and healthcare, cutting fossil fuel use and pollution, and addressing income inequality and structural racism. However, and as Diez Roux and Bilal emphasize, “doing so requires political will, robust evidence, and multisectoral collaboration to build healthier, more equitable, and more sustainable urban futures.”

Urban health research can provide motivation for these policies and can help identify new policies that might be useful. The big challenge is addressing the barriers to implementing effective policies and supporting social movements that seek these changes. Well-managed urbanization can create a virtuous cycle that improves health and sustainability for all, even outside of cities.

Read The Article