Cliché says that you are what you eat; but it would be more accurate to say you are where you live. According to the World Health Organization, the conditions in which we are born, live, and work account for between 30 and 55 percent of health outcomes. Pollution levels, physical activity, green space, and access to healthcare are just a few factors that can vary widely based on what country you live in, and what region—even down to the individual street. Given over half of the world’s population lives in cities, a figure predicted to rise to 70 per cent by 2050, cities are more than an urban design challenge. They’re increasingly a global health problem.

Aging populations and the rise of non-communicable diseases are also adding pressure to already strained health systems. Climate change, now widely regarded as one of the greatest threats to human health, is exacerbating these challenges. C40 Cities—the global network of mayors working together to tackle the climate crisis—estimates that if emissions reduction targets are not reached, over 1.6 billion city residents will face extreme heat by 2050; 800 million will face increased risk of flooding; and 650 million will be dealing with water shortages.

But with challenges come opportunities. There is a clear opportunity to embrace the benefits of shifting healthcare from simply responding to ill-health to actually preventing it. Prevention, both primary and secondary, have the potential to help people live longer, healthier, happier lives whilst also improving the health of our planet by reducing the burden of modern healthcare delivery on our environment.

Bupa is committed to help addressing health- and climate-related challenges and making the most of the opportunities presented by preventative healthcare. In November, as part of its Healthy Cities campaign, the healthcare company released the second edition of its Healthy And Climate Resilient Cities Report. Bupa understands that to drive change in the fight against climate change, collaboration with organizations both within and outside of healthcare is critical. This is why Bupa has developed this report in partnership with C40 Cities, and the Norman Foster Foundation, which helps new generations of architects, designers, and urbanists to anticipate the future. It details how the next generation of city leaders and urban designers can rethink the way we plan and run cities. And this starts by treating public health and climate action as connected issues.

The relationship is closer than you might think. Take public transportation: 5.1 million excess deaths worldwide are attributed to air pollution from fossil fuel use every year. Bike lanes and pedestrianization can reduce reliance on fuel-guzzling vehicles, while increasing the public’s opportunities for exercise. It is estimated that Beijing’s Low Emissions Zone saves 43 lives every year. In Los Angeles, phasing out coal plants has been associated with a decrease in the proportion of preterm births. And in London, cleaner air created by the introduction of the Low Emissions Zone (LEZ) contributed to an 8 percent decrease in respiratory issues like asthma and bronchitis. (The city’s Low and Ultra-Low Emissions Zone schemes also generated cost savings of £963 million per year.)

Bupa’s report highlights innovative ways that cities around the world are fighting climate change, while introducing healthy reforms. New Delhi, India, for example, has some of the most polluted air in the world, with particulate matter multiple times higher than WHO safety levels. A study by the Lung Care Foundation (LFC) found that the prevalsence of children with an indicator of severe asthma in the region could be as high as 29.4 percent. To tackle this problem, the LFC and Doctors for Clean Air and Climate Action are providing training programs for teachers and staff, conducting screenings in schools, and raising awareness about the health impact of air pollution.

In Bogota, Colombia, the Urban95 program set out to reimagine the design, planning, and management of cities by consulting with children and their caregivers, to ask: “If you could experience the city from an elevation of 95cm—the height of a three-year-old—what would you change?” The result—drawing on dozens of city departments, urban-planners, designers, and local NGOs—was dramatic, ranging from new play equipment and social spaces to traffic calming-interventions for safe walks to school (in doing so, cutting emissions), and creating safer public spaces. There were lifestyle improvements, too: the city introduced new street furniture suitable for caregiving and saw a reduction of garbage on sidewalks. By cutting emissions, the city has built the foundations for a healthier and happier place to live.

Taking what Bupa calls a “Health and Climate-Resilience” approach can prompt political leaders to deploy more holistic actions. Reforms that prioritize electric cars, for example, can cut emissions, but will still perpetuate car-centric cities; in contrast, public-transport-first policies can simultaneously promote better physical and mental health. As the report found, “Neighborhoods with green spaces experience smaller heat and flooding impacts, but also provide space for activity and socializing, which contribute to better mental health.” In other words, the benefits are manifold.

Furthermore, as an international healthcare company itself, Bupa understands that the healthcare systems that are designed to protect people from ill-health are also major contributors to global greenhouse gas (GHG) emissions. This means that the sector is part of the growing problem that everyone is trying to solve. An important part of the solution to overcome the emissions challenge is the digital transformation of healthcare, with innovations such as genomics and AI ushering in a new era of healthcare delivery that is more preventative, personalized, predictive, and participatory.

Recently, Bupa became the first private healthcare provider in the UK and Spain to offer whole genome sequencing for more than 3,500 customers. The program aims to identify risk of disease across 14,000 conditions, including 10 cancers, with customers accessing personalized recommendations and tailored health plans to prevent illness and promote early detection of disease

Also, more than 6.4 million people already use Bupa’s digital healthcare service, Blua, across more than 200 countries. By offering remote consultations and services including symptom-monitoring, online health classes, and medication delivery, Blua reduces the need for patients to travel to hospitals or other physical infrastructure, lowering carbon emissions. In 2023, Sanitas, Bupa’s Spanish business, helped prevent over 11,500 tons of CO₂e emissions by offering digital services.

In terms of Bupa’s wider Healthy Cities initiative, it is creating a movement to make cities healthier places for occupants to live. To do so, it is challenging people to do things that keep them and the planet healthy, like being active. In return, it works with local community partners and NGOs to invest in urban nature regeneration projects. In 2024, the Healthy Cities program was delivered across 24 countries, including over 62,000 people taking part in the step challenge. These participants walked a total of 16 billion steps, which resulted in Bupa investing over £2.8 million in nature projects.

The campaign is also pushing leaders to accelerate sustainable interventions and adaptation efforts that supports the health of people in their cities—while also prioritizing health as a driver of climate action. Bupa is supporting academics and researchers who need better data and support to study the impacts of these kinds of climate-health interventions. The goal? To see health as one of the foundations of equitable and just climate-resilient city planning.

Bupa also recently launched a documentary called Healthy Cities, which explores the intricate links between climate, health, and urban living, while showcasing what’s possible when we work together to drive change. The documentary is essentially a call to action, an invitation to all of us to unite and take meaningful steps toward healthier, more sustainable communities.

There’s also little time to get together and take these steps. 2024 has been the hottest year in recorded history, with an increasing frequency of fires, droughts, heat waves, and urban floods. And yet, despite these dire signals, GHG emissions continued to rise in 2023.

Even so, treating climate change and health as interconnected problems could help overcome many challenges and create opportunities: Cities occupy only 3 percent of the world’s landmass but generate 70 per cent of energy-related greenhouse gas emissions, but organizations like C40 Cities and programs like the Norman Foster Institute for Sustainable Cities are spreading best practices, and innovative solutions are popping up everywhere. In Barcelona, where heatwaves are a regular occurrence, the city has created a network of over 200 safe public climate shelters accessible to those who do not have cooling in their homes. In Paris, the city has planted 100 hectares of vegetation on walls and roofs, to make the city more resilient and liveable. In Mexico City, the Move on Bikes program has resulted in 20,000 users getting more than an hour of additional exercise every week.

These kinds of interventions, Bupa suggests, show that cities can be climate-resilient, and healthier places to live.