5.E. Workshop: Salutogenic Cities: European experiences in Urban Health

Environmental sustainability, especially in an era of growth health inequality, is one of the most important challenges facing Public Health systems around the World. Environmental sustainability is responsibly interacting with the planet to maintain natural resources and not jeopardize the ability for future generations to meet their needs. The SDGs put environmental sustainability at the center of sustainable development. Environmental Health is the branch of Public Health concerning all aspects of the natural and built environment affecting human health. It is targeted towards preventing disease and creating health-supportive environments. It encompasses the assessment and control of those environmental factors that can potentially affect health, such as pollution, poverty and inadequate energy solutions. Urban Health is an intersectoral arena that links both the public health and the urban planning sectors, mainly captured by SDG3 (including Mental health) and SDG11. Both during the first waves of the Covid-19 pandemic period and in contemporary cities, urban environments were stressed; the resilience of our cities were tested, highlighting the strengths and weaknesses of the urban contexts, not always capable to pro-mote and protect the population health status. Urban Green Spaces (UGS) have proved essential role as “tools” to improve Urban Public and Mental Health. Unfortunately, the heterogeneous distribution of UGS inside the contemporary cities, together with the disparity in quality of such spaces, led to some exclusion phenomena. Evidence/experience-based research strongly demonstrated the positive effects on Public Health of the UGS, and for this reason, they are now becoming the strategic and challenging issue of many urban regeneration programs. The importance of UGS as a key infrastructure has generated the necessity of developing new health-centered design criteria able to conform to their new role in urban environments. The augmentation of UGS surface alone, does not necessarily make cities more livable. An increase in area and surfaces does not translate in ease of accessibility from all social groups or from all the cities’ neighborhoods, or not does it give data on the qualities of such areas, like potential for social engagement or Physical Activity. Aim of the Workshop - organized by the three EUPHA Section URB+MEN+ENV - it would like to be to build the capacity and knowledge between participants about the main topics and urban features capable to have relevant Urban Public, Mental and Environmental Health outcomes. Additional scope is to collected case studies and research experiences considered virtuous at the international level, analyzed in detail to highlight the main urban and architectural features of those healthy experiences and the related health outcomes, such as sedentary lifestyle reduction, increase of the attractiveness of places, reduction of air and noise pollution. Key messages • Promotion of healthy places - with particular reference to the green spaces - that enhance the experience and Mental Health needs to be part of green and inclusive recovery at all levels. • Policy Makers, Public Health experts, civil societies & citizens are driving forces to implement the development equation, allowing cities to become greener, inclusive, safer, resilient & sustainable.

According to the “Urban Health Rome Declaration” at European meeting “G7 Health” that defines the strategic aspects and actions to improve Urban, Environmental and Public Mental Health into the cities, and referring to the Agenda 2030 in which the 11th SDG argue about “Sustainable Cities and Communities. Make cities and human settlements inclusive, safe, resilient and sustainable”, one of the most expressive syntheses of the challenging relationship between urban planning and Public Health is stated by WHO (2016): “Health is the precondition of urban sustainable development and the first priority for urban planners”. Referring to the Healthy Cities & Urban Health definitions, we can consider Public Health not merely an aspect of individual health protection and promotion, but a collective condition, strongly influenced by the environmental context and by the strategies implemented by local Governments. The “Health in All Policies” strategy, clearly underlines how health depend by the quality of outdoor and indoor living environments. In this scenario, healthy living and the requirements for healthy places, infrastructure for the public good and Public Health, cycling, walking, disintegrating the role of polluting traffic from the urban environments, social vulnerability and equality are just a few aspects in complex puzzle when designing the urban spaces for healthy, active, walkable cities. The lockdown due to the pandemic has prevented travels, forcing many people to work at home and reducing the possibility of accessing services in the territory. This condition has further highlighted the importance of urban living areas capable of satisfying basic needs within a reasonably easy range of accessibility. The concept of the “15 minutes city” is a useful vision to represent the city of proximity, where it is possible to meet the needs for sustainable, fair, quality, and healthy living. This dimension of proximity can be central to formulating strategies to improve the quality of urban life. A place of proximity, therefore not only defined based on the physical characteristics and people's uses, but also based on the data collected from a public health perspective in which it is also possible to try to test different types of information and build the conditions to suggest suitable policies and projects. Aim of the Workshop - organized by the two EUPHA Section URB+ENV - it would like to be to build the capacity and knowledge between participants about the main topics and urban features capable to have relevant Urban Public and Environmental Health outcomes. Additional scope is to collected case studies and research experiences considered virtuous at the international level, analyzed in detail to highlight the main urban and architectural features of those healthy experiences and the related health outcomes, such as sedentary lifestyle reduction, increase of the attractiveness of places, reduction of air and noise pollution. Key messages • Cities for people, promoting Urban Public Health, Environmental Health and active mobility, require optimization of public spaces for citizens and their activities. • Case studies and research experiences to highlight the main urban and architectural features of those healthy experiences and the related health outcomes, such as sedentary lifestyle reduction.

According to the “Urban Health Rome Declaration” at European meeting “G7 Health” that defines the strategic aspects and actions to improve Urban, Environmental and Public Mental Health into the cities, and referring to the Agenda 2030 in which the 11th SDG argue about “Sustainable Cities and Communities. Make cities and human settlements inclusive, safe, resilient and sustainable”, one of the most expressive syntheses of the challenging relationship between urban planning and Public Health is stated by WHO (2016): “Health is the precondition of urban sustainable development and the first priority for urban planners”. Referring to the Healthy Cities & Urban Health definitions, we can consider Public Health not merely an aspect of individual health protection and promotion, but a collective condition, strongly influenced by the environmental context and by the strategies implemented by local Governments. The “Health in All Policies” strategy, clearly underlines how health depend by the quality of outdoor and indoor living environments. In this scenario, the on-going COVID-19 pandemic is a strong reminder that urbanization has changed the way individuals and communities live, work, and interact, and that it's urgent to make the urban systems and local communities resilient, to prevent the spread of infectious diseases today and tomorrow. Certainly, the on-going urbanization is achieving an increasing attractiveness/appeal, considering that the urban population is expected to rise to the forecasted 70% by 2050 as stated by the UN Population Division Department. The increase in building density will be one of the main global trends, with significant impacts on Public Health and the increase in risk factors affecting the contemporary city, creating a gap between built and green environments, in terms of alarming living conditions. The COVID-19 pandemic is also an accelerator, revelator and amplifier of the on-going urban emergencies in terms of environmental sustainability and Urban Health, with particular reference to the social, environmental and digital issues. Aim of the skills building seminar titled “(re)FORMING CITIES DUE TO THE COVID CHALLENGE”, organized by the three EUPHA Section URB+MEN+ENV, it would like to be to build the capacity and knowledge between participants about the main topics and urban features capable to have relevant Public and Mental Health outcomes, with a specific focus about the COVID-19 pandemic period. For this purpose, after the three presentations, 30 minutes will be used to create a discussion with the audience, using digital systems (like MENTIMETER, SOCRATIVE, etc.) to collect opinions and create a live discussion about a specific set of questions and topics. The qualitative approach of the second part of this skills building seminar is opposed to the first part, in which the three presentations will share scientific-evidences and data; both approaches can be further summarized in the drafting of a Position Paper. Key messages The WP would build the capacity and knowledge between the audience about the main topics and urban features capable to have relevant ENV, URB & MEN outcomes, focusing the COVID-19 pandemic period. The COVID-19 pandemic accelerated the on-going urban emergencies in terms of sustainability, Urban and Public Mental Health, with particular reference to social, environmental and digital issues.

The 17 Sustainable Development Goals (SDGs) are a complex system comprising 169 targets and about 230 indicators. Urban Health could be considered a complex system since it deals with 15 out of 17 SDGs, excluding the two related to life below water and life on land. According to the World Health Organization, to achieve the SDGs, countries have committed to organize Urban Health initiatives to improve the social, economic, and physical environments promoting health and sustainability globally. Cities will become more inclusive, safer and more sustainable, which are important driving forces to implement the development equation. To set up a framework to point out that Urban Health is a complex system oriented to the achievement of the SDGs. It has been conducted an extensive literature review on databases (PubMed, Embase, Web of Science and Scopus) using keywords in 3 strings combined with Boolean operators: SDGs and Urban Health, Urban Health as Complex System and Urban Health, Environmental Health and Public Health as Complex Systems. In addition, a grey literature review has been carried out. Out of 1005 publications, 21 were eventually included: 14 publications relate to the interdependent relationships between SDGs and Urban Health, with regard to the association between Urban Health and complex system, 3 publication studied the effects and implications of such correlation, 4 focused on Environmental Health and Public Health in relation with the complex system. The selected publications suggested methodologies aimed at setting up an urban health framework to achieve SDGs. There is an initial orientation focused on the study of Urban Health problems aimed at achieving SDGs from the perspective of complex systems. We highlight the need to conduct further studies on a more detailed framework in order to address this type of approach.

Tourism cooperation is increasingly recognized as a key driver of regional economic development, playing a crucial role in facilitating internal circulation and enhancing urban public health. This study examines the relationship between tourism cooperation and urban public health development, with a focus on China. Using data from 284 Chinese cities over the period 2011-2022, this research measures both the degree of tourism cooperation and the level of urban public health development. Empirical analysis is conducted to assess the impact of tourism cooperation on urban public health outcomes. The study employs robustness tests to ensure the validity of its findings. The findings indicate that tourism cooperation significantly promotes urban public health development. After conducting robustness tests, this result remains consistent. Furthermore, heterogeneity analysis reveals that the "core hinterland" type of tourism cooperation model has a stronger impact on urban public health development compared to the adjacent city type. Among different city cooperation models, tourism cooperation between central cities has the greatest empowering effect, followed by cooperation between central and non-central cities, while cooperation between non-central cities has the smallest effect. The research suggests that tourism cooperation can effectively address regional economic disparities and the imbalanced development of urban public health in China. The findings have important implications for policy-making, particularly in promoting sustainable urban health development and narrowing regional gaps in economic and health outcomes.

The Workshop titled “Healthy Buildings: interdisciplinary perspectives” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), policy/decision makers and buildings’ users, to establish a multidisciplinary approach for understanding together how to create and manage healthy living indoor environments (both housing and complex constructions/public buildings). The Workshops mainly address both the “Climate emergency / Environment and health / Urban health” and the “Mental health” EPH23 conference topics. The Workshops purpose is to explore the relationship between housing conditions, Indoor Environmental Quality, and Mental Health implications on human well-being. In fact, time spent at home and in the indoor environment increased due to the recent COVID-19 lockdown period, and social-sanitary emergencies are expected to grow due to the urbanization phenomenon. Thus, the role of the physical environment in which we live, study, and work, has become of crucial importance, as the literature has recently highlighted. The Workshops program include inputs which they argue current experiences, emerging practices and scientific outcomes related to the Urban Health discipline. From Sustainable Development Goals framework, in “Urban environment, unhealthy buildings as a root of inequalities and importance of SDGs”, to Indoor Environmental Quality implications, in “Can housing conditions and features affect well-being? A review through Indoor Environmental Quality aspects and Mental Health implications”. From experience-based works related to specific functions, in “Can the built environment impact on the health and well-being of people with dementia? Evidence from Literature and Stakeholders Involvement”, to Indoor Air Quality emerging issue, in “Buildings, air quality and mental health conditions: a review of intervention studies”. Key messages • Explore the relationship between housing conditions, Indoor Environmental Quality, and Mental Health implications on users well-being. • Establish a multidisciplinary approach for understanding together how to create and manage healthy living indoor environments (both housing and complex constructions/public buildings).

ZusammenfassungNeue Ansätze in der Stadtentwicklung werden gefordert, um Städte in nachhaltige Orte zu transformieren. Das erfordert u. a. eine Verdichtung der Städte, die kaum denkbar ist ohne eine Zunahme der Geräuschentwicklung – meist in Form von Lärm. Um eine Akzeptanz für die Verdichtung zu erreichen, sind qualitätsvolle, gesundheitsförderliche akustische städtische Räume erforderlich. Hierfür bedarf es Ansätze, die über reine Lärmminderungsmaßnahmen hinausgehen. Ausgehend von der Frage: „Was hält gesund?“, ist eine Perspektive, die auf eine gesundheitsförderliche städtische Klangqualität bzw. auf eine positiv bewertete akustische Umgebung zielt, erforderlich. Geräusche können als gestaltbare Qualität in urbanen Räumen als eine wichtige Ressource für eine gesundheitsförderliche Stadt verstanden werden. Hierfür werden über die schallpegelbasierten Indizes hinaus weitere Metriken benötigt, die eine gute urbane Klangqualität indizieren können. Wissen, Forschung und Anwendung zu urbaner akustischer Qualität, insbesondere mit Blick auf Gesundheit, befinden sich noch in den Anfängen. Für Urban Public Health schlagen wir eine Perspektiverweiterung durch die Verknüpfung und systematische Anwendung von zwei verschiedenen Soundscape-Ansätzen vor. Der vorliegende Beitrag gibt einen kurzen Überblick zu den Begriffen „Lärm“ und „Geräusche“, stellt zwei Ansätze der Soundscape-Forschung vor und legt anschließend Ziele und Methodik des Pilotprojektes SALVE („akustische Qualität und Gesundheit in urbanen Räumen“) zum Thema akustische Qualität in urbanen Räumen dar. Insgesamt wird ein Einblick in das neue Forschungs- und Praxisfeld von urbaner Klangqualität, Soundscapes und Stadtgesundheit gegeben.

Issue/Description Partnerships between academic institutions and public health practice are instrumental in addressing public health, particularly health in cities, but often difficult to achieve. Despite commitments to urban health, academic institutions often mired in research and teaching and lack grounding in PH practice, while public health organizations and local health departments are forced to focus on the day-to-day practice of public health and less able to invest time and human resources to longer-term public health solutions. Results In 2019, the Dornsife School of Public Health (DSPH), through its Urban Health Collaborative (UHC), established a strategic partnership with the Big Cities Health Coalition (BCHC), the forum for the leaders of America's largest metropolitan health departments who collectively serve one in 5 Americans. This partnership supports the Coalition's vision of healthy, more equitable cities through big city innovation and leadership. For the UHC, the partnership is an opportunity to advance its commitment to urban health research, training, and policy translation locally and globally. The UHC and BCHC have partnered on variety of projects funded by both the BCHC and their partnering organizations, providing a replicable framework for partnership between academia and public health practice. Projects include the Big Cities Data Inventory (BCHI), an equity focused cross-city data platform providing a baseline of health in urban communities, health-equity based program and policy evaluations, advocacy on key US public health policy issues, and a recent focus on cross-city climate work focused on data, research and practice. Lessons The UHC/BCHC partnership is a replicable model of collaboration between academia and public health practice, leveraging the expertise and lived experience of local health departments with the technical expertise of academia to improve public health. Key messages • Urban public health practice benefits from urban health research and policy frameworks. • Academic public health is strengthened by the real-world practice of public health.

Building a Healthy Urban Design Index (HUDI): how to promote health and sustainability in European cities.

Urban public health is an important global issue, and receives extensive attention. It is necessary to compare urban public health status among different cities, so that each city can define its own health patterns and limiting factors. The following assessment indicators were established to evaluate urban public health status: living conditions, physical health, education and culture, environmental quality, and social security. A weighted-sum model was used in combination with these indicators to compare the urban public health status in four cities—Beijing, New York, London, and Tokyo—using data for 2000–2009. Although the urban public health level of Beijing was lower than that of the other cities, it showed the greatest increase in this level over the study period. Different patterns of urban public health were identified: London had the most balanced, steady pattern (almost all factors performed well and developed stably); New York and Tokyo showed balanced, but unsteady patterns (most factors remained high, though social security and environmental quality fluctuated); Beijing had the most unbalanced, unsteady pattern (the different factors were at different levels, and education and culture and social security fluctuated). For enhanced urban public health status, environmental quality and education and culture clearly need to be improved in Beijing. This study demonstrates that a comparison of different cities is helpful in identifying limiting factors for urban public health and providing an orientation for future urban development.

The African continent is predicted to be home to over half of the expected global population growth between 2015 and 2050, highlighting the importance of addressing population health in Africa for improving public health globally. By 2050, nearly 60% of the population of the continent is expected to be living in urban areas and 35–40% of children and adolescents globally are projected to be living in Africa. Urgent attention is therefore required to respond to this population growth - particularly in the context of an increasingly urban and young population. To this end, the Research Initiative for Cities Health and Equity in Africa (RICHE Africa) Network aims to support the development of evidence to inform policy and programming to improve urban health across the continent. This paper highlights the importance of action in the African continent for achieving global public health targets. Specifically, we argue that a focus on urban health in Africa is urgently required in order to support progress on the Sustainable Development Goals (SDGs) and other global and regional public health targets, including Universal Health Coverage (UHC), the new Urban Agenda, and the African Union’s Agenda 2063. Action on urban public health in Africa is critical for achieving global public health targets. Four key research and training priorities for improving urban health in Africa, are outlined: (1) increase intersectoral urban health literacy; (2) apply a healthy urban governance and systems approach; (3) develop a participatory and collaborative urban health planning process; and, (4) produce a new generation of urban health scholars and practitioners. We argue that acting on key priorities in urban health is critical for improving health for all and ensuring that we ‘leave no-one behind’ when working to achieve these regional and global agendas to improve health and wellbeing.

Vol. 114, No. 1 AnnouncementsOpen AccessHandbook of Urban Health: Populations, Methods, and Practice Tord Kjellstrom Tord Kjellstrom Search for more papers by this author Published:1 January 2006https://doi.org/10.1289/ehp.114-a64aAboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Edited by Sandro Galea and David VlahovNew York:Springer, 2005. 599 pp. ISBN- 0-387-23994-4, $89.95The world is undergoing major urbanization. Within 25 years, more than half the world’s population will be living in urban areas, and in this period approximately 1 million people will be added to city populations each week. Urban health is thus significant for population health, and this handbook provides a timely review of the issues involved.This book takes a broad view of urban health, emphasizing urban social factors important to population health. The editors successfully bridge urban health inquiry and public health practice by combining descriptions of issues in urban health, methods used in urban health studies, and examples from practitioners. The authors of the 29 chapters come from different professional backgrounds, primarily in North America, but those from developing countries add a global flavor.Part 1, “Populations,” includes 11 chapters on health aspects of different socioeconomic groups in cities and different age groups, describing time trends and geographic differences. Special issues for minority groups are reviewed, and each chapter provides a wealth of up-to-date research references.In Part 2, “Methods,” 10 chapters present methods in anthropology, epidemiology, demography, sociology, environmental health, and economic analysis. Each chapter provides relatively detailed descriptions, some including detailed mathematical formulas for analyzing data. Although this handbook can present only part of the knowledge required to be fully conversant with any of the methods, these chapters give a good overview of methods available in urban health. One limitation lies in the examples used to describe the methods. For example, the environmental health chapter deals almost exclusively with urban air pollution while other important urban health hazards, such as community noise, are barely mentioned.Part 3, “Practice,” includes excellent examples of the broad approach to urban health used in the Healthy Cities movement as well as more focused examples from a local health department level. Legal issues and suggestions for teaching urban health are also presented. The editors note that success in interventions that target proximal determinants of health depends on more upstream laws and regulations. Promoting health in cities requires an appreciation of the multiple levels of determinants that shape population health, and this handbook is a good starting point for such appreciation.In handbooks that cover a multitude of fields and examples, some issues are not given the space that they may deserve. Here, apart from the limited range of environmental health issues presented, the book rarely mentions injuries and their more proximal determinants. Living and working in cities almost invariably require daily transport, and the risks involved are surely urban health issues. Neither is much attention given to workplace factors and health, even though cities serve as magnets for both people and different types of modern workplaces. A variety of occupational health hazards, including psychosocial factors as well as traditional chemical and physical hazards, are prominent determinants of population health in urban areas.Nevertheless, the editors intended the handbook to form one step toward the systematic study of urban health. They have succeeded by giving readers a thorough view of the social factors involved. The handbook is an excellent resource for students, researchers, teachers, and practitioners in urban health. The aspects of urban health given less prominence in this volume may be a suitable focus of a companion volume at a later stage. Further study of urban health situations and determinants is required to meet the challenges of global urbanization during this century. This handbook is a valuable contribution.FiguresReferencesRelatedDetails Vol. 114, No. 1 January 2006Metrics About Article Metrics Publication History Originally published1 January 2006Published in print1 January 2006 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

An increasing interest has been present in scientific literature and policy making for the links between urban environments and health, as also learnt from the COVID-19 pandemic. Collaboration between urban planning and public health is therefore critical for enhancing the capabilities of a city to promote the well-being of its people. However, what leverage potential for urban health can be found in existing plans, policies, and strategies that address urban health? Starting from the relationship between urban systems and health issues, the purpose of this contribution is to broaden the systemic knowledge of urban systems and health so as to try to figure out the impact potential of local urban governance on public health. Considering the systemic nature of health issues, as defined by the World Health Organisation, this is done through a systems thinking epistemological approach. Urban health proposals are studied and assessed in four European cities (Copenhagen, London, Berlin, and Vienna). Current criticalities are found, starting from the guiding goal of such proposals, yet a systemic approach is suggested aimed at supporting and evaluating lasting and healthy urban planning and management strategies.

BackgroundAs the world becomes increasingly urbanised, there is recognition that public and planetary health relies upon a ubiquitous transition to sustainable cities. Disentanglement of the complex pathways of urban design, environmental exposures, and health, and the magnitude of these associations, remains a challenge. A state-of-the-art account of large-scale urban health studies is required to shape future research priorities and equity- and evidence-informed policies. ObjectivesThe purpose of this review was to synthesise evidence from large-scale urban studies focused on the interaction between urban form, transport, environmental exposures, and health. This review sought to determine common methodologies applied, limitations, and future opportunities for improved research practice. MethodsBased on a literature search, 2958 articles were reviewed that covered three themes of: urban form; urban environmental health; and urban indicators. Studies were prioritised for inclusion that analysed at least 90 cities to ensure broad geographic representation and generalisability. Of the initially identified studies, following expert consultation and exclusion criteria, 66 were included. ResultsThe complexity of the urban ecosystem on health was evidenced from the context dependent effects of urban form variables on environmental exposures and health. Compact city designs were generally advantageous for reducing harmful environmental exposure and promoting health, with some exceptions. Methodological heterogeneity was indicative of key urban research challenges; notable limitations included exposure and health data at varied spatial scales and resolutions, limited availability of local-level sociodemographic data, and the lack of consensus on robust methodologies that encompass best research practice. ConclusionFuture urban environmental health research for evidence-informed urban planning and policies requires a multi-faceted approach. Advances in geospatial and AI-driven techniques and urban indicators offer promising developments; however, there remains a wider call for increased data availability at local-levels, transparent and robust methodologies of large-scale urban studies, and greater exploration of urban health vulnerabilities and inequities.

The Global South has some of the world's largest cities, where rapid, ad hoc development of urban centres and 'megacities' has fuelled major socio-economic, environmental, and public health concerns. These urban environments can generate feelings of loneliness, with multiple barriers for access and participation in socio-cultural infrastructures. An inclusive future agenda for global creative health must, therefore, consider how urbanisation impacts social public health, what creative health approaches can do to alleviate this, and what the barriers are to access. This article explores barriers and facilitators to accessing socio-cultural urban infrastructures in two case-study cities: Salvador in Brazil and Cochabamba in Bolivia. Data were collected as part of a survey examining access to, and engagement in, arts and cultural activities undertaken between 25 January and 1 May 2023. This article focuses on two questions: What helps you to access artistic and cultural events in your city? and What barriers do you face in accessing artistic and cultural events in your city? 239 open responses from adults, in Portuguese and Spanish, were analysed using descriptive thematic analysis. Findings highlight how emergent issues around existing economic inequality, safety, and accessibility can limit residents' capacity to engage in creative health activities. While preliminary in scope, this raises wider public health implications for how creative health approaches may be leveraged within urban, Global South contexts. Findings highlight how greater dialogue is needed between the urban development, public health, and creative health sectors. Given the emerging evidence of the role of creative engagement to alleviate loneliness, integrating creative health approaches within urban public health may further strengthen connections with the most vulnerable communities, and help to build healthier cities. The article ends by outlining an approach that incorporates both local and city-wide creative encounters, highlighting how future interventions could be appropriately designed that gradually scale these types of interventions from tailored local offerings to larger, city-wide activities.