This should be a city resilience planning goal: healthy citizens in healthy cities.

Climate change can be considered an upcoming threat that further adds to the complex factors affecting health. In the urban context, this becomes even more complex.

The health of an individual or a community is an outcome of complex interactions between the internal and external environments, factors influencing these environments (exposure) and the preparedness of public - private systems and society (adaptive capacity).

Urban health is a new arena and climate change and resilience are an even newer arena in rapidly urbanising, developing nations. Within this context, it is the right time to initiate the process of understanding urban health and climate resilience.

The Urban Health and Climate Resilience Centre (UHCRC) of Surat organised a series of workshops for the process to understand urban health and climate resilience and to compile collective wisdom about health inclusive climate resilience needs, scope, and indicators, for evidence based planning and policy.

In 11 multi stakeholder workshops organised in different cities, 285 multi stakeholder participants from health, urban planning, social science backgrounds, public and private sectors, and NGOs working in the urban field, all actively participated. 

Impact factor scoring exercise:

Good governance and finance are overarching crucial influencers of urban health inclusive resilience. The first three highly scored factors influencing public health were integrated urban planning, urban infrastructure, community participation, and intersectoral convergence.

The scores also indicate that, although the effect of climate and disasters on health is important, coping capacity will be a significant saviour.

This exercise reflects that health focussed urban resilience comprises not only clinics, medicines, vaccines, health surveillance and health education, but is lot more dependent on the capacity of individuals, families, public and private service systems, environment and climate trends.

Documented statements by practitioners were:

• The entire urbanisation process has human development, economy, comfort and happiness dimensions.
• Though a visible goal of urban development is prosperity, ultimately it boils down to human survival, health and happiness.
• City resilience needs an integrated vision and approach.
• Public health requires approaches beyond the health sector.
• In the case of extreme events, public health is the first concern. 
• Investing in public health is an action building towards sustainable resilience.  
• Routine system strengthening and upscale forms a base for emergency management.
• Advocacy to nurture political will need evidence with a local focus
• An equity inclusive approach is a path to success.
• Joint training of urban practitioners can facilitate intersectoral understanding and convergence.
• Health inclusive resilience planning is more important for developing countries because disease and under nutrition apply burdens and stresses to the health system which aggravate the impact of exposure (environment, climate, disaster) on human survival, productivity and comfort. Within financial and programmatic limitations, it is crucial to identify climate and health synergy and prioritise interventions.

Strategic approach:

Urban practitioners worked on the strategic approach and suggested a ‘W3 strategy’ (watch, warn, work). Highlighting integrated routine surveillance, developing early warning system and design evidence based SOPs for intervention.

For which every city will need:

• Rapid assessment tools to work out local priorities and strategies for timely action (research organisations can facilitate the same by developing rapid self assessment tools for local self government).
• Integrated routine monitoring systems (technology used to improve efficiency and quality).
• A plan to focus on health inclusive resilience planning by all departments.
• A plan to highlight an early warning system within local self government departments and also within the community.
• Set standard operating procedures with proven success, modified to local circumstances.
• Informative to formative to transformative education with promotion of culture integration.

A resilient city is a city that accepts the need for sustainable development and resilience building, that learns from its experience, and plans long term and short term strategies based on local evidence, with holistic skills and approach, involving all in planning, and building a vulnerability sensitive approach.