Innovation for

urban health
Policy brief
Innovation for urban health: policy brief

ISBN 978-92-4-009004-0 (electronic version)

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Photo credits: Cover: WHO / S. Farah: Community dialogue for promoting good health practices
in Somalia - November 2023; page iv: WHO / Tytaart: Field Epidemiology Training Program in
Mondulkiri Province. 2022; page 12: WHO / Muhd Ikmal Photography: Crisis Preparedness and
Response Centre (CPRC) Putrajaya, Malaysia. 2021; page 20: Unsplash / Victor: Building covered
in plants. Milan, Italy. 2019.

Design and Editing: Café Artes Visuel designed the brief, with input from James Crossley
(BYCS). Angela Burton edited the brief.
Innovation for urban health: policy brief

Acknowledgements
This brief was written by José Siri and Hugo Santa with strategic
guidance provided by Nathalie Roebbel and Tamitza Toroyan
(Department of Social Determinants of Health).

WHO gratefully acknowledges the contributions of many individuals

and organizations to developing this policy brief, in particular Daniel
Eppstein, Lucas Snaije, Daniela Gutierrez, and Alex Baum (BYCS,
Kingdom of the Netherlands). WHO also thanks the following external
experts who participated in a policy consultation on Innovation for
Urban Health from April 11-14, 2023: Luis Bettencourt (University of
Chicago, United States of America), Helen Elsey (University of York,
United Kingdom of Great Britain and Northern Ireland), Gabriella
Gomez-Mont (Experimentalista, Mexico), Susana Hausmann Muela
(Fondation Botnar, Switzerland), Jo Jewell (Novo Nordisk, Denmark),
Heba Allah Khalil (Cairo University, Egypt), Louise Vogel Kielgast (Gehl,
Denmark), Fabien Lanteri (City of Nice, France), Mark Nieuwenhuijsen
(ISGlobal, Spain), Marta Pahissa (DKV Insurance, Spain), David Rojas-
Rueda (Colorado State University, USA), Marc Sansom (SALUS Global
Knowledge Exchange, United Kingdom), Dimitrios Sarikizoglou
(Ministry of Health, Greece), Janene Tuniz (UNEP, Kenya), Nicholas
You (Guangzhou Institute for Urban Innovation, China). Emmanuel
Frimpong Boamah (University of Buffalo, USA) provided valuable
comments on a draft.

The following WHO staff members contributed important technical

feedback: Daniel Hunt, Hyung-Tae Kim, Monika Kosinska, Francisco
Obando, Susannah Robinson (Department of Social Determinants of
Health), Katia de Pinho Campos (Global NCD Platform), Jaimie Guerra
(Department of Communications), Trinette Lee (Department of Health
Promotion), and Matthias Braubach and Pierpaolo Mudu (WHO
Regional Office for Europe).

Funding
This policy brief was developed with funding support from
Bloomberg Philanthropies.

iii
Innovation for urban health: policy brief

Innovation
for urban health
Policy brief

This policy brief is part of a broad effort by the World Health Organization (WHO) to support
strategic reflection among urban health decision-makers in Member States. The brief is one
of four – each focusing on a cross-cutting theme: generating and working with evidence;
governance and financing; innovation; and partnerships and participation. Collectively, these
represent the essential “means of implementation” that set the stage for a strategic approach to
urban health. The series aims to inform national and subnational decision-makers and relevant
technical staff about actions that can foster such an approach.

Protecting and promoting people’s health in urban environments

is a pressing challenge for national and subnational governments
everywhere. In over two-thirds of countries, most people live in
cities, and even countries that have yet to reach this threshold are
rapidly urbanizing (1). Meanwhile, urban populations continue to
increase in absolute and relative terms worldwide – including in
slums (or other informal, unplanned, unregistered, or underserviced
neighbourhoods), which today are home to more than a billion people Innovation, as
(2). While cities typically offer health and economic benefits and a addressed in
favourable environment for urban health action, they also pose unique this brief, is
risks and challenges. In fact, while they have become healthier places the process
overall, many avoidable health risks, harms, and inequities persist in by which new
cities around the world. In part, this is because recent urban health ideas, methods,
practice has often focused on singular health outcomes, sectoral or technologies
interventions, or vulnerable groups, without incorporating actions are generated,
into an overarching, holistic approach. While focused initiatives can, evaluated,
and often do, secure real health gains, they risk missing important and applied
systemic effects arising from the complex nexus of diverse sectors, to existing
actors, and environments interacting in urban areas. This can give rise and emerging
to inefficiencies, unanticipated effects, diminishing returns, and other problems in
adverse outcomes. Only through a strategic, multi-sectoral approach, urban health.

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Innovation for urban health: policy brief

coordinated across national and local governments and rooted in the

values of health equity and justice, can decision-makers realize the full
potential of cities and secure urban health for all.

Innovation for urban health

In the complex, constantly evolving realm of cities, innovation is
a cornerstone of a strategic approach to urban health. Innovative
solutions are regularly needed to safeguard and promote health in
the face of evolving, emerging, or unforeseen challenges associated
with urban complexity. Moreover, innovation – technological,
sociocultural, and institutional – is essential for continuous
improvement in health and well-being for all.

WHO defines a health innovation as “a new or improved solution with

the transformative ability to accelerate positive health impact”.1 More
broadly, innovation, as addressed in this brief, is the process by which
new ideas, methods, or technologies are generated, evaluated, and
applied to existing and emerging problems in urban health.

Governments can strengthen innovation for urban health in many

ways2; for example, decision-makers can support the development of
specific innovations, foster the process of innovation, and focus innovation
on the most pressing urban health challenges and most vulnerable
groups. In some cases, the public sector can itself be a critical innovator,
but in many others, its role is to create the enabling conditions within
which healthy urban innovation by communities, civil society, and the
private sector can flourish. Although innovation often emerges during
crises, it can also be proactive, anticipating and even averting imminent
health challenges. It is also important for resilience and prosperity: an
innovative city, nation, or society has the capacity to plan strategically,
respond to shocks and take advantage of new conditions.

Innovation for urban health can take many forms, including public
capacity expansion, changes in norms or institutions, new commercial
ventures, scientific or technological advances, novel social groups or
processes, or tinkering (4) with existing urban features, among others.
For example, mobile phone e-health apps, modal transport shifts,
urban heat action plans, and participatory budgeting schemes can all

1 WHO (2024). Health Innovation for Impact (https://www.who.int/teams/digital-health-and-innovation/health-

innovation-for-impact)
2 See, e.g., WHO Regional Office for the Western Pacific (2024). Regional Health Innovation Strategy for the
Western Pacific (3)

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Innovation for urban health: policy brief

be important innovations in particular situations – whether because

they introduce a tried-and-true technology or intervention where it
hasn’t been used before, take advantage of novel implementation
processes or partners, or engage with or call attention to health in
original ways. Innovation can also act at different scales (5), from
micro-level change – e.g., the substitution of a more effective or
healthier technology in particular situations (e.g., exchanging stoves
that burn wood or coal for clean cookstoves) – to changes with
macro-level societal implications (e.g., the adoption of a Health-
in-all-Policies approach across national government). Innovations Although
necessarily interact with the existing fabric of urban life. “Softer” innovation often
management and policy interventions are often more immediately emerges during
feasible and affordable than the development and introduction of new crises, it can also
technologies, and much more so than significant infrastructural and be proactive,
design modifications—yet each of these can have significant benefits anticipating and
for health and other goals and should be part of a broader approach. even averting
Ultimately, strategic objectives and context determine both the range imminent health
of possibilities for innovation and what is considered innovative. challenges.

Managing innovation risks

Because innovation, by definition, involves novel processes, actions,
ideas, and/or technologies, it also entails uncertain outcomes and
sometimes risks. A familiar example is the rollout of new, lifesaving
medical treatments, which nevertheless requires processes to
detect and manage potential adverse effects. In the same way,
interventions to improve the urban built environment can modify
citizens’ behaviour or residential dynamics in ways that promote
or imperil health; new processes can lead to changes in labour
markets, with some stakeholders gaining and others requiring
support; institutional innovation can have unanticipated effects on
how government functions; and groundbreaking policies can score
political wins or losses – just a few of many potential impacts. In each
of these cases, the benefits can be transformative, but governments
should take action to anticipate and manage risks.

Fostering innovation generally requires novel government approaches,

for example, allowing or encouraging risk-taking within prescribed
boundaries; accelerated timeframes for institutional processes (e.g.,
expedited review procedures) and interventions; or exceptions or
changes to existing policies, regulations, or norms. It is essential that
innovation to improve the health and well-being of urban residents

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Innovation for urban health: policy brief

does not create new harms. In particular, it should always account

for vulnerable or excluded groups and avoid exacerbating existing
inequalities, for example, by offsetting any adverse impacts. Indeed,
general population improvements coupled with health equity and justice
must be at the core of innovation for urban health. This means that not
only should risks be outweighed by potential benefits, but safeguarding
mechanisms must be robust and allow for swift recognition of potential
harms and corrective responses. Moreover, anywhere public sector
funds are involved, the value-for-money of a novel intervention must
be compared with existing ways of working. National and subnational
governments that navigate these risks effectively are well-positioned to
reap the abundant rewards of innovation for urban health and a range
of other societal goals.

The purpose of this brief

This policy brief reflects and offers guidance on how national and
subnational governments3 can catalyse and capitalise on social,
technological, and institutional innovation for urban health, including
by maintaining a flexible, capable, and innovative public sector and
supporting other sectors and communities. It draws on existing
international guidelines, academic literature, and insights from a
participatory workshop involving experts in research, policy, and
practice. The brief is primarily intended for national and subnational
decision-makers and their technical staff.

The recommendations and associated supporting actions highlighted

below are intended to be complementary and iterative, in line with
an integrated, constantly evolving vision for improving urban health.
Given substantial variation in needs, capacities, opportunities, and
arrangements for fostering innovation within and across countries,
this guidance is not intended to be prescriptive, but rather to serve as
a starting point for adaptation to local city and country contexts. Not
all items will be immediately or fully implementable everywhere, and
sequencing will vary with local conditions. Additional resources that
readers may find useful for advancing some of these recommendations
in their work are available in the WHO Urban Health Repository.4

3 In this brief, “subnational governments” is used to represent a variety of governance arrangements at various
levels; it always includes local, municipal, and city governments, but the broader term is sometimes used to
improve clarity and readability.
4 WHO (2021). Urban Health Repository (https://urbanhealth-repository.who.int/home).

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Innovation for urban health: policy brief

Recommendations
1. Cultivate an innovation
ecosystem for urban health

Innovation benefits greatly from cross-fertilization of ideas and

mutual learning among diverse stakeholders. Together, the complex
system of actors, activities, resources, and relationships that allow
novel ideas to come to fruition constitute the innovation ecosystem.5
National and subnational decision-makers can cultivate an innovation
ecosystem for urban health by supporting and engaging many
kinds of stakeholders in a culture of innovation, removing barriers
and providing incentives, creating consistent and reasonable rules
(e.g., standards, regulation), and ensuring that resources and
opportunities are available.

To grow an innovation ecosystem:

• Adopt an urban innovation strategy • Identify and replace norms, standards,

consistent with broader urban health and regulations that are outdated,
plans,6 allowing for effective policy no longer fit for purpose, or that
integration. An urban innovation impose excessive bureaucratic or
strategy should articulate short- (e.g., logistical burdens (e.g., red tape) with
annual) and long-term goals, be a balance of flexible rules to support
explicitly linked to the institutional and experimentation and innovation and
logistical mechanisms that support more rigid rules to provide clarity,
urban health governance (e.g., protect health and other human rights,
legislation, funding), and be rooted in and guard against perverse incentives.
principles of human rights and health
equity (8,9).

5 Granstrand and Holgersson provide a more formal definition of innovation ecosystem as “the evolving set
of actors, activities, and artifacts, and the institutions and relations, including complementary and substitute
relations, that are important for the innovative performance of an actor or a population of actors.” (6)
6 These may take different forms, particularly at national versus local scales; for example, urban health plans can
be integrated in city-level master plans or national-level economic or development strategies, or in dedicated
national strategies for urban health. See, e.g., WHO (2023). Governance and Financing for Urban Health (7).

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Innovation for urban health: policy brief

• Support innovation-generating (11). Ensure that all segments of society

domains (e.g., science, social (e.g., young and older people, women,
entrepreneurship), providing, as excluded groups of all kinds) are linked to
needed, hard and soft infrastructure opportunities to contribute to innovation.
(e.g., ICT, venues for interaction),
financial support, skills development,
• Engage urban health stakeholders
in devising collective solutions for
and technological and knowledge
urban health challenges by: creating
resources (10).
opportunities (e.g., meetings,
• Promote a culture of innovation that networks, platforms) for dialogue and
engages all urban health stakeholders exchange of ideas and information
(including, among others, national between stakeholders within cities and
and local governments, practitioners between cities themselves; promoting
and professional associations, private reciprocal feedback across sectors
enterprises, academics, communities, and scales; providing opportunities
and civil society). Conduct targeted for mutual learning; and encouraging
and collective outreach to stimulate collaboration (11). Involving those
innovation, mapping the priorities with lived experience of urban health
and capacities of distinct groups challenges in such discourses can be
and recognizing the varied roles and especially valuable.
creative potential of all stakeholders

HIGHLIGHT

The city of Utrecht, The Kingdom of the Netherlands has adopted “healthy
urban living for all” citizens as an overarching, long-term goal. Embodied in the
Utrecht Spatial Strategy 2040,7 its vision encompasses a wide-range of urban
health-promoting interventions on themes as varied as green and blue space,
transport, housing, mixed-use development, sustainable energy, an inclusive
social environment, and others. Innovation is deeply embedded in the city’s
urban health planning – Utrecht has an explicit innovation strategy focused
on engaging and building connections among urban stakeholders, building
capacities, and developing resources to support innovation (e.g., urban data,
funding) (12) . Efforts like the Social Impact Factory, aimed at strengthening
the innovation ecosystem by building cooperation among social entrepreneurs
and increasing their visibility, the use of the city’s considerable procurement
budget to leverage innovative solutions for sustainability, and the development
of an open data platform to foster new ideas and approaches, are among
many that speak to Utrecht’s commitment to innovation for urban health (13).

7 Gemeente Utrecht. Our vision for Utrecht in 2040 (https://healthyurbanliving.utrecht.nl/our-vision-for-utrecht-

in-2040/)

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Innovation for urban health: policy brief

2. Create or designate dedicated spaces

for urban health experimentation

Experimentation is vital to innovation; it allows novel ideas and

interventions to be tested and compared; supplies valuable
information on the practical challenges of implementing new
solutions in specific contexts and on their impacts; and supports the
refinement of existing approaches. Experimentation can highlight
actual or perceived risks and show how they can be mitigated,
operating as a risk management tool and helping overcome
resistance to change. Experiments can also be powerful drivers
for generating hypotheses and original ideas. The accumulation
of insights from experimentation, their implementation, and their
testing in real world situations provide an important stimulus
for ongoing innovation while improving outcomes and building
capacities - and thus accelerating development.

Dedicated spaces where experimentation is allowed, encouraged,

and supported can advance both targeted (i.e., geared toward the
development or advancement of a specific solution or the resolution
of a specific problem) and ad hoc (i.e., supporting innovative
processes more generally) innovation. An “experimentation space”
in this context can be a physical space, such as an innovation hub
that gathers innovators together under one roof, or a geographic
domain, like a neighbourhood formally designated as an innovation
district (or existing informally as a nexus for innovation, as in many
slum communities). It may also involve short- or long-term “action
spaces” relating to a specific sector or for a specific issue, such as a
hackathon or innovation challenge to resolve an identified problem.
Such spaces can support activity by a wide range of stakeholders,
including communities, social value-oriented businesses, civil society
organizations, and academia.

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Innovation for urban health: policy brief

To foster experimentation for urban health:

• Assign relevant authorities8 the adopting responsive management

task of establishing and managing approaches (e.g., budgets that can
experimentation spaces for urban be flexibly allocated to emerging
health. This includes identifying needs). Resources should be
promising circumstances (e.g., physical allocated to minimize bottlenecks
or social contexts where innovation and administrative delays. This may
is already happening or where it be especially beneficial in contexts
could be productively encouraged, where barriers to participation are
or challenges that are potentially more prominent, as in many informal
responsive to experimentation); settlements and developing country
defining rules (e.g., specialized contexts and for excluded or otherwise
regulatory or monitoring processes for vulnerable groups.
innovation challenges) and boundaries
(e.g., the limits of innovation districts);
• Ensure that experimentation spaces are
subject to rigorous, timely monitoring
catalysing cooperation among
and oversight and compliant with local
multisectoral actors; and monitoring
and international ethical standards9 to
and evaluating progress.
avoid unintended health risks or harms.
• Ensure that experimentation spaces
respond to societal (or local, as
• Design experimentation spaces to
foster (and take advantage of) co-
relevant) needs, not merely market
creation and cross-fertilization across
signals or commercial interests,
sectors, domains, and scales, where
and that they reflect local diversity
feasible, enlisting existing collaborative
and conditions to ensure that novel
networks and civil society structures
solutions are relevant (14). Authorities
(10), as well as a wide range of
should clearly articulate the high-level
stakeholders with different experiences
goals that such spaces are intended to
and viewpoints.
achieve and how this would address
urban health priorities. • Document and disseminate
opportunities and experiences relating
• Make it easy to participate in
to experimentation spaces transparently
innovation, reducing regulatory,
to promote widespread, inclusive
operational, and other barriers
participation and broad acceptance.
(e.g., rigid hierarchies, red tape)
within experimentation spaces and

8 At subnational or national scales, such authorities may reside in the health or planning sectors or in
other dedicated institutions in accordance with local governance and overarching urban health strategies.
Regardless of the specific location, experimentation spaces should avoid siloed approaches, examining a wide
range of problems and potential solutions through a health lens.
9 See, e.g., WHO (2024). Global Health Ethics (https://www.who.int/health-topics/ethics-and-health)

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Innovation for urban health: policy brief

HIGHLIGHT

Over recent decades, the city of Monterrey, Mexico faced a set of

paradigmatic urban challenges: car-centric development leading to urban
sprawl, congestion, and air pollution, and growing drug and violence
problems, as in many regional cities. Starting in 2013, a university-led
revitalization effort resulted in the creation of DistritoTec, a globally
recognized urban regeneration and innovation zone (15). Binding together
24 neighbourhoods into a cohesive district and recruiting stakeholders from
a range of domains – including business, communities, arts, and science –
DistritoTec has led to city-wide transformations that affect health, including
“Increased access to public space and green space, walking and cycling,
business activity, and social cohesion through cultural and community
programming and participatory governance” (15). A key element in its
success was its recognition by the municipality as a “special development
zone under Mexican law”, opening the door to experimentation and
innovative redesign of the urban fabric (15). As of 2023, the second phase
of DistritoTec is underway, including the creation of a multidisciplinary
innovation space which will bring together academia, industry, and society to
“[generate] scientific and technology-based knowledge to provide solutions
to the challenges facing humanity” (16); a physical and virtual platform
for the promotion of innovation in water, sanitation and solid waste in
Latin America and the Caribbean,” supported in part by the InterAmerican
Development Bank 10; and a greater focus on the role of art in unleashing
scientific creativity and discovery. (17)

10 IDB (2023). Innovation Facility in water, sanitation and waste: support for the development of innovative
solutions (https://www.iadb.org/en/whats-our-impact/ME-T1517)

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Innovation for urban health: policy brief

3. Develop processes to identify and

scale up promising, novel solutions
Providing a clear pathway for scaling up promising solutions for
urban health (i.e., solutions that have demonstrated positive health
impacts and the potential for significant health and economic
value at scale) promotes stakeholder investment and cooperation,
reduces wasted effort and resources, and speeds implementation.
“Solutions” in this context may refer to specific, replicable policies,
interventions, or technologies or to the processes that gave rise to
their conceptualization, implementation, and adoption, from which
others can learn. Effective, sustainable scaling requires mechanisms to:

• Evaluate the impacts – intended and • Mitigate or overcome implementation

unintended, positive and negative – of challenges, including logistical/
innovative solutions and their potential technical barriers and stakeholder
value at scale; resistance (14);

• Tailor solutions to new situations • Monitor impacts transparently, ensure

(e.g., different-sized cities, novel sets accountability, and make adjustments
of stakeholders, or new cultural or as needed;
environmental contexts);
• Navigate policy, political, and
• Expand the coverage or utilization of bureaucratic environments (e.g.,
solutions efficiently (including by taking rules and regulations, lobbies for
advantage of economies of scale); existing practices or competing
solutions, red tape);

Governments may play a significant role in scaling up urban

health solutions, yet the private sector, civil society, and
communities themselves are usually also involved, at times through
multistakeholder partnerships. In some contexts, and given
appropriate incentives, commercialization can be an effective,
efficient way to scale up health-promoting innovations; nevertheless,
where commercial interests are involved, due diligence is essential to
identify conflicts of interest and safeguard the health and well-being
of end users and to ensure the appropriate use of public funds.

Decisions around what innovations to scale should be evidence-

based, drawing on health impact assessment, cost analysis, and other
tools as needed. They should also consider equity, weighing absolute
numbers versus high need among specific groups, where relevant.

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Innovation for urban health: policy brief

This is particularly important in resource-limited contexts, where

trade-offs among different interventions must be considered, or
where innovations are likely to have differential impacts. Parameters
for decision-making in such contexts are critical.

To facilitate scaling of promising innovations:

• Define formal processes to access • Emphasize the importance of

resources (e.g., funding, technical, considering the potential for scaling in
logistical, or social support) for scaling demonstration and pilot projects. Such
up urban health solutions. Ideally, projects can provide evidence of small-
support should be made available for scale impacts or unintended effects,
different types of innovation, whether identify essential features for success,
primarily social, technological, or and raise awareness and social buy-in.
institutional in nature. Likewise, the Involving urban health authorities in
public and private sectors, civil society, oversight can facilitate the integration
and communities each have unique of scaled-up solutions into governance
needs and capacities, and thus require structures and budgets.
different resources and often distinct
mechanisms to foster scaling.
• Learn from successes and failures
by documenting efforts to scale
• Base criteria for accessing public up solutions. Ideally, monitoring
resources for scaling on the potential and evaluation of scaling efforts
value of solutions for urban health should assess not only the details of
(relying on verified impacts), the interventions and implementation
demonstrated capabilities of processes but also the form and
implementers, cost-effectiveness, and efficacy of governmental support or
feasibility (18). Assessment of feasibility incentives (e.g., innovation grants).
should consider local context (e.g., Insights about implementation and
population health, policy and political how best to support it should be
environments, socioeconomic and synthesized and widely shared.
cultural factors, etc.).
• Use communications campaigns and
• Require proposals for accessing engagement processes (e.g., events,
resources for scaling to assess the networks) to increase awareness of
costs, risks, impacts, and implications promising innovations and resources
of scaled-up solutions. A clear, realistic available for scaling among social
understanding of the degree and and policy entrepreneurs, private
nature of change required to support enterprises, and urban health
new solutions is important for setting champions. Special effort should be
expectations, allocating resources, made to communicate opportunities
and ensuring that scaling is sensible to stakeholders in marginalized and
and sustainable. informal communities and engage their
voices in innovation for urban health.

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Innovation for urban health: policy brief

HIGHLIGHT

Grand Challenges Canada is an innovation-focused not-for-profit funding

organization created and funded by the Canadian government with other
partners. It seeks to support innovative ideas that integrate science and
technology, social, and business innovation, with a significant focus on
global health. Its Transition to Scale program supports innovators in low- and
middle-income countries, offering direct investment while brokering “smart
partnerships that mobilize private capital and domestic public resources to
generate scalable and sustainable solutions that deliver measurable social
impact.” Urban health figures prominently among the thematic areas supported,
which include urban sanitation and hygiene, community health worker models,
and digital health, among others. The program’s integrative approach to
markets and partnerships has led to significant successes: $189 million CAD
invested in 237 projects in 55 countries has leveraged over $399 million CAD in
additional funding, and Grand Challenges Canada estimates that these projects
will save up to 1.78 million lives and improve up to 64 million by 2030.11

11 Grand Challenges Canada. Transitions to Scale (https://www.grandchallenges.ca/programs/transition-to-

scale/)

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Innovation for urban health: policy brief

4. Build a flexible, innovative public

sector capable of meeting present and
future needs
Innovation cannot thrive without a flexible, innovative public sector
capable of both internal rebalancing and effective partnership with
other sectors. Indeed, the complex, cross-sectoral nature of urban
health demands agile responsiveness across government, while
accelerating global challenges such as climate change, resource
depletion, globalization, and others increase the need for resilience
and innovation from public actors in general.

Yet, many factors reduce government capacity to promote

innovation across society at large, and to recognize, scale,
and sustain promising solutions – e.g., excessive bureaucracy,
sectoral siloes, communication deficits, competing interests, poor
quality partnerships, limited opportunities for multistakeholder
engagement, and others. In many contexts, regular change in
political administrations – although it serves an important role in
public accountability – can also constrain public sector innovation and
lead to risk aversion, short-termism, and a lack of policy learning.

An innovative public sector should recognize and address medium-

and long-term needs and initiate action that future administrations
can learn from, build on, and evolve to meet changing conditions.
Likewise, urban health innovation itself should be anchored in legal
and policy frameworks that ensure it continues to grow beyond a
given administration. This creates an opportunity for embedded,
ongoing systemic transformation and reform that can meet the
needs of the present and the future.

To build a flexible, forward-looking public sector:

• Promote engagement, mutual learning, (e.g., siloed organizational structures)

reciprocal feedback (including upward and by developing and enforcing rules
feedback), and joint action across levels and mechanisms (e.g., consultation
of government and among ministries, and reporting requirements, cost-
departments, or agencies in different sharing opportunities, multisectoral
sectors, both by removing barriers coordination frameworks) to support

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Innovation for urban health: policy brief

communication and collaboration (9). are given appropriate resources and

authority, and that relationships with
• Encourage collaborative partnerships
existing structures are clear. Where
between public sector staff and external
feasible, incorporating stakeholders
specialists in diverse urban health-related
from longstanding innovation
fields to improve public management
communities with experiences and
of innovation. Where relevant, this may
practices transcending political regimes
include consultation with international
can help foster and sustain innovation.
nongovernmental organizations, city
networks, and other global actors and • Design to transcend political turnover,
purpose-driven engagement with the responding to medium- and long-
private and civic sectors. Care should be term needs and reducing constraints
taken that such partnerships serve to arising from short-term political
build internal capacities and not only to pressures. These may include broad,
outsource project work (8). flexible terms of reference for
urban health authorities, binding
• Promote a culture of creativity and
policy commitments (e.g., MOUs,
considered risk-taking by ensuring that
contracts, treaties), mechanisms for
rules (e.g., performance indicators)
adaptive policy (e.g., automatic policy
and managerial strategies empower
adjustment) and institutional reform,
civil servants (8). Involve public sector
multistakeholder or participatory
staff in innovation processes (e.g.,
processes that decentralize decision-
experimentation spaces and scaling of
making (e.g., participatory budgeting),
novel solutions, as highlighted above)
or others (19).
and disseminate case studies to promote
familiarity with implementing new ideas. • Illustrate the value of innovation and
Avoid unnecessarily stringent budget and innovation support to public sector staff,
accountability processes that lead to risk- e.g., by instituting robust, highly visible
averse, reactive decision making rather processes of monitoring and evaluation.
than proactive, innovative choices (8). Measure and communicate across
government the likely impacts and
• Where needed, create new governance
cost-benefit of support for innovation
units, processes, or positions to
in relation to alternative scenarios,
address specific challenges that require
including do-nothing scenarios.
cross-sectoral innovation (e.g., for
coordinated action on the multiple
impacts of extreme temperatures). Care
must be taken to ensure that such staff

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Innovation for urban health: policy brief

HIGHLIGHT

As of 2014, the city of Bologna, Italy, faced a concerning lack of civic

engagement. Faced with excessive bureaucratic and regulatory constraints
and restrictions on participation, citizens were opting out civic life, and even
simple improvements to the urban fabric were challenging to implement.
To remedy the situation, “the city council passed the “regulation on public
collaboration between citizens and the city for the care and regeneration of
urban commons,” which allowed citizens and private organizations to sign
collaboration pacts with the city in order to improve public space, green areas,
and abandoned buildings” (20) – thus reducing red tape and simplifying the
process of public engagement. It also established, in coordination with the
University of Bologna, an Office of Civic Imagination,12 which manages six
innovation laboratories across the city, where city hall staff work directly
with residents on local initiatives – including health-promoting projects like
community gardens (21), public and green spaces, childcare centres, and
others.13 Since 2017, the district labs also manage a participatory budgeting
process which is widely accessible to citizens, including from groups like
youth whose voices are often excluded (20). This combination of efforts has
transformed the city’s relationship with citizens, improving information flows,
making the public sector much more flexible and responsive to needs, and
fostering a spirit of co-creation and innovation. Bologna’s example has inspired
over 100 other Italian cities to adopt similar regulations (20).

12 Fondazione Innovazione Urbana (2020). Activation of participatory and co-production paths (https://www.
fondazioneinnovazioneurbana.it/en/civic-imagination)
13 Cities of Service (2024). Engaged Cities Award: Bologna, Italy: Winner (https://engagedcities.jhu.edu/bologna-
italy-finalist/)

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Innovation for urban health: policy brief

A strategic approach
to urban health
The recommendations given here for fostering innovation are
intended to be consistent with a strategic approach to urban health,
which should be:

01 Integrative
encompassing, involving, and empowering all stakeholders
whose actions contribute to urban health; raising collective
awareness of risks and opportunities; creating a shared vision
prioritizing collaboration toward unified goals; supporting
intersectoral connections and joint work; fostering coherence in
action, diversity in ideas, and grass roots ownership.

02 Contextualized
tailoring solutions to local conditions, culture, and values;
recognizing that social, environmental, economic, and
commercial determinants of health vary widely, as do
stakeholders and their needs, priorities, capabilities, norms,
and resources; using place-based mechanisms to involve local
actors in urban health planning, policy, and practice.

03 Complexity-informed
acknowledging the dynamic complexity of cities and their
relationships to broader interdependent systems (e.g.,
climate, global trade); recognizing feedbacks among social,
environmental, economic, and commercial determinants
of health and health outcomes; avoiding unintended
consequences, managing systemic conflicts, and capitalizing on
synergies.

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Innovation for urban health: policy brief

04 Equity-oriented
recognizing that populations in situations of vulnerability face
heightened health risks, that exclusion exacerbates health
inequities, and that these are intersectional and compounding;
devoting the effort and resources to rectify injustice and counter
the self-perpetuating nature of inequities; leveraging urban health
decision-making to prevent and reduce inequities among cities,
citizens, neighbourhoods, and population subgroups.

05 Continuously improving
regularly updating situational awareness through formal and
informal mapping, assessment, monitoring, and evaluation;
always seeking a higher level of health based on best information
about present conditions and likely futures; swiftly reacting
to changing circumstances; constantly learning from local
experience, accumulated evidence, and engagement with peers
and other stakeholders.

06 Efficient
taking advantage of cross-sector and cross-scale synergies and
avoiding incoherence; pursuing integrated decision-making
where appropriate; repurposing existing assets, resources, and
mechanisms to mitigate the administrative and financial costs
of new policies or structures; improving return-on-investment
where feasible.

07 Sufficient
developing and assigning the financial and human resources
needed to effectively anticipate, plan for, respond to, and
overcome urban health challenges; allocating resources
according to needs; investing in capacity building to meet
current and future requirements.

08 Forward-looking
ensuring that short- and medium-term actions address immediate
needs, yield tangible results, and demonstrate progress, while
emphasizing long-term planning to lay strong foundations
and sustainable mechanisms for healthy futures; recognizing
the impact of current actions on future options (e.g., via path
dependency and lock-in).

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Innovation for urban health: policy brief

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