The New York-based Rockefeller Foundation has released a roadmap to help cities around the world plan for and respond to the global health emergency caused by climate change. With more than half of the world’s population living in urban areas, the Foundation’s report, Urban Climate-Health Action: A New Approach to Protecting Health in the Era of Climate Change, identifies the gaps in city-level responses to climate-induced health threats. The Foundation is investing more than $1 million to support the plan’s implementation through grants, including to C40 Cities and Resilient Cities Network.

By 2050, nearly 70% of the world’s population is expected to live in a city, each facing health risks caused by climate change. The features that define cities—dense populations, concrete landscapes, limited greenspace, and proximity to water— intensify heat, increase pollution, and spread disease. Cities like New Delhi and Ouagadougou, Burkina Faso are experiencing unprecedented heatwaves, while Dhaka, Miami, and Dubai face more frequent and severe flooding. Rio de Janeiro and Ho Chi Minh City have seen increased cases of dengue fever due to expanding mosquito habitats.

The Foundation’s report was informed by data collected and analysed by the Yale School of Public Health together with the Resilient Cities Network.

The Rockefeller Foundation argues for three key actions:

• Connect health and meteorological agencies to translate climate risks into forecasts that show the impact on the health of vulnerable populations.
• Build multisectoral teams that include leaders and experts across climate, health, urban planning, transportation, education, and civil society who will use climate insights to develop local prevention and response plans.
• Budget for future climate-related health threats by positioning resources where they are needed most and ensuring timely, effective communications reach those most at risk. 

The Foundation’s roadmap for cities also includes seven case studies demonstrating successful programmes across three continents, including:

• Rio de Janeiro, Brazil, a multidisciplinary team including Rio’s Municipal Health Secretariat under the Health Surveillance Superintendence, set up the Dengue Emergency Operations Center to forecast dengue hotspots and predict spikes in early 2024.
  By bringing together the Operations and Resilience Center and other local partners to predict a spike two months earlier than forecasted by traditional epidemiological models, Rio improved timely notifications and deployment of resources enough to ensure the lowest death rate among the last four dengue epidemics.
• Dhaka, Bangladesh, the Red Crescent Society engaged a multisectoral team to develop an Early Action Protocol to minimise health risks during intense heatwaves.
  By using heat forecasting and street-by-street vulnerability data, response partners in Dhaka have alerted a million people of their increased risk and deployed live-saving resources like safe drinking water and umbrellas at critical locations.
  If scaled to 57 countries, this sort of warning system could save almost 100,000 lives a year, according to the World Health Organisation and World Meteorological Organisation.
• Lusaka, Zambia, the El Niño climate phenomenon has led to severe drought and water insecurity, increasing the incidence and severity of cholera outbreaks.
  A risk communication and community engagement response led by the Collective Service has improved localised understanding of health-seeking behaviours and key concerns, propelling a 100% uptake of the cholera vaccine and increased uptake of oral rehydration salts, stemming the outbreak and preventing deaths.

“From New York to Nairobi, Bogotá to Bangalore, cities worldwide are facing rising health risks and increased stress from climate change,” said Elizabeth Yee, Executive Vice President of Programs at The Rockefeller Foundation. “This report highlights immediate, actionable steps mayors, health officials, and residents can take to protect lives and improve well-being.”

“Cities are flying blind to the impact climate change is having on human health, and people are needlessly suffering as a result,” said Dr. Naveen Rao, Senior Vice President of Health at The Rockefeller Foundation. “Integration across sectors is vital to respond to the unfolding climate-health crises.”

To put this roadmap into action, The Rockefeller Foundation is supporting C40 Cities and Resilient Cities Network in separate grants to implement recommendations laid out in this report. A grant to the Resilient Cities Network, made up of over 100 cities advancing urban resilience globally, will support the Urban Pulse: Climate, Health, and Equity in Action programme by creating a city-led Community of Practice and integrating health priorities into climate adaptation and mitigation efforts. Another grant to C40 Cities, a network of nearly 100 mayors of the world’s leading cities working to confront the climate crisis, will support heat-health pilot initiatives to assist city officials and other stakeholders to better respond to health impacts on vulnerable communities during extreme heat events. These investments are part of the Foundation’s $100 million commitment to test and scale climate and health solutions, announced at the inaugural COP28 Health Day in December 2023.