Is the Mayor the Most Important Doctor in a City?

Is the Mayor the Most Important Doctor in a City? By Nora Van Cauwenbergh

At the recent World Economic Forum’s Urban Transformation Summit, one question stood out: Is the mayor the most important doctors in a city? This provocative idea reflects the power of urban design to influence public health outcomes, prevent illness, and build resilience against climate challenges. The discussions that followed highlighted that when city leaders prioritize healthy, resilient environments, they address not only housing and infrastructure needs but also set the foundation for improved health and well-being.

Gathering leaders across sectors—climate, nature, health, transport, housing, and finance—the summit facilitated a rich exchange of ideas. Below, I share insights from discussions on affordable housing, climate resilience, and health-centered urban planning, including reflections from panels on nature-positive cities, health infrastructure, and urban congestion.

Transitioning Toward Resilient, Health-Focused Cities

The summit opened with a call for a cultural shift in urban planning, emphasizing that cities can no longer approach housing, infrastructure, and environmental issues in silos. Leaders discussed how cities must confront the dual threats of flooding and extreme heat while simultaneously addressing affordable housing and generating positive health impacts through smart design.

A survey of Chief Resilience Officers across cities revealed that flooding and extreme heat rank as top concerns. These climate-related shocks are compounded by stressors like housing insecurity and the absence of integrated climate-health plans; in fact, fewer than 30% of cities have strategies that address both climate and health impacts. The session underscored the need for predictive tools and community engagement to effectively manage these interconnected risks.

Local Action, Global Challenge: The Case for Nature-Positive Solutions

The Nature-Positive Cities session focused on actionable, community-centered solutions. Here, the emphasis was on nature as core infrastructure—not just as an environmental asset but as a key component of public health. Cities that invest in green roofs, rain gardens, and urban forests can mitigate flooding and heat impacts while fostering mental health benefits and social cohesion. However, to scale these solutions, we need to (1) understand the distribution of risk and benefits to allow for high-impact place-making and (2) leverage the value of nature beyond what is currently acknowledged in economic models and featured on the balance sheets of municipalities and corporations.

Our work at BitaGreen has demonstrated that nature-based solutions (NBS) can be highly cost-effective, especially when accounting for co-benefits like climate resilience and improved community well-being. However, implementing NBS requires trust between cities and communities, as well as innovative financial models to capture the value created. Catalytic capital and public securities can play a key role in de-risking NBS for private investors. Community and impact bonds further bridge the gap between benefits generated and financial returns. Projects like our ongoing collaboration with the city of Leuven highlight the importance of distributed risk understanding and blended investment approaches, where public-private partnerships bring the needed flexibility and community support.

Health-Centered Design Beyond Traditional Infrastructure

One of the summit’s key takeaways was the understanding that health infrastructure goes far beyond hospitals and clinics. In fact, in the healthy cities’ session, the need for more or better doctors or hospitals was not mentioned even once. Instead, speakers highlighted models like the 15-minute city, where residents can access essential services within a short walk. This design approach encourages physical activity, reduces air pollution, and fosters social connections, all of which improve public health and lower long-term healthcare costs.

Japan’s approach to “walk, talk, eat” infrastructure, for example, has led to measurable health improvements by motivating people to stay active and connected within their communities. A representative noted that incentivizing mobility and social interaction has reduced healthcare costs, as active lifestyles prevent illness. AI and predictive analytics, meanwhile, are enabling cities to move from reactive to preventive health approaches, demonstrating significant benefits within the first year of implementation.

With congestion and transportation as major concerns for urban dwellers and policymakers, they present a massive opportunity to increase resilience and well-being. The solution to congestion is not to build more individual transport infrastructure but to create a cultural shift toward shared and active forms of mobility. This approach not only reduces congestion, it frees up space for more nature and affordable housing and in doing so it reduces stress, productivity loss, and the overall health burden on urban residents.

The session underscored the importance of trust and community buy-in, particularly in transportation changes and nature-based solutions. By involving local voices in planning, cities can create policies and environments that reflect community values, encouraging residents to see these projects as their own.

Moving from “BANANA” to Trust: Building Cultural Support for Change

Cultural and economic barriers to change were recurring themes throughout the summit. Acronyms like BANANA (Build Absolutely Nothing Anywhere Near Anyone), NIMTO (Not In My Term of Office), and TSP (Ten Same People) were referenced as symbols of the resistance urban planners encounter. Transitioning to a resilient, nature-positive city model requires new metrics and economic incentives that value the “free” services provided by nature, such as clean air and cooler urban temperatures. And while we work on fixing our economic models, this shift also requires political courage and private sector leadership to begin the transition.

As mentioned during the opening session—if Einstein had 1 hour to solve a problem, he’d spend 59 minutes understanding it. We all agreed: the 59 minutes are over. It’s time to act. 

Reflecting on this urgency, a San Francisco urban leader addressing sea-level rise said, “When people ask me how it feels to be on the climate edge, I say—like being on the edge. It’s uncomfortable, but we shouldn’t avoid discomfort. Instead, acting, sharing, and learning will help us through.”

Conclusion: Empowering Urban Leaders as “City Doctors”

The summit reinforced that effective urban leaders can serve as “doctors” for their cities—designing environments that prevent illness, encourage healthy lifestyles, and withstand climate stresses. Achieving resilient, health-centered cities requires collaboration between communities, the private sector, and innovative financing solutions. While traditional economic models have often overlooked the intrinsic value of nature, this paradigm is shifting as cities recognize the long-term benefits of integrating health, climate, and community resilience.

As cities face the challenges of today and tomorrow, urban planners and leaders play a crucial role. The question is no longer if we need change but how we can empower city leaders to “prescribe” sustainable solutions that foster health and resilience for future generations.