PUBLIC HEALTH

📝 Our assessment

Health inequities remain all over the world, with nearly half the global population lacking access to essential healthcare services. The COVID-19 pandemic highlighted not only inequities in accessing services, but the fundamental inequities between countries and within them, laying bare the importance of local and regional governments in ensuring access to essential health services, protecting communities, and reinforcing social safety nets. The growing climate emergency and the overlapping, interconnected crises that the world faces also call for a holistic approach to health in our cities and territories.

Key challenges include:

• Growing inequalities in accessing health services, stemming from marginalization and systemic barriers..

• The financialization and privatization of healthcare, which threaten affordability and universality and aggravate inequalities.

• Climate change and environmental degradation, exacerbating health risks through pollution, food insecurity, and extreme weather events.

• Technological shifts and digitalization require governance models prioritizing inclusivity, transparency, and equitable access to health innovations.

• The erosion of democratic governance, which undermines the value of decision-making in healthcare policies and the role of the public in developing health frameworks that prioritize communities.

Addressing these challenges requires rethinking health as part of the global commons, including health as a basic right and understanding access to clean air, water and sanitation as cornerstones in achieving healthy cities and territories. Health must be protected as a fundamental right, embedded within a universal public service framework that prioritizes equity, sustainability, and resilience.

🤝 Our commitment

Local and regional governments are uniquely positioned to transform universal and inclusive health coverage and promote health in our territories through a health-first approach. LRGs’ proximity to communities enables them to design and implement inclusive, people-centered health policies, and address health holistically within their territories. Through an understanding of health as a local public good, UCLG and its partners commit to transforming:

• Health as a Fundamental Right: Recognizing healthcare as an essential public good is the first necessary step toward its full realization as a human right. Embedding care at the core of health policies means prioritizing the needs of the most vulnerable and ensuring the dignity and value of health workers. Strengthening local health systems—and integrating them with public services such as education, sanitation, and social protection—is critical to advancing a holistic, rights-based approach to health that breaks with fragmented, siloed models.

• Localized and Participatory Health Governance: Empowering local and regional governments to co-create and implement health strategies rooted in community needs is a political imperative for building equitable health systems. Strengthening participatory decision-making ensures that communities are not passive recipients but active shapers of the healthcare services that affect their lives. Advancing decentralized governance that prioritizes primary healthcare, prevention, and the social determinants of health is essential to shifting power closer to the people and driving transformative public policy.

• Resilient and Climate-Sensitive Healthcare Systems: Resilient and climate-sensitive healthcare systems are a political and policy necessity in the face of escalating environmental and social challenges. Developing healthcare infrastructure around climate resilience must go hand in hand with bold investments in green public health policies, including sustainable urban planning, pollution control, and disaster preparedness. Strengthening health systems against future crises—be they pandemics, climate-related disasters, or those arising from social conflict—is critical to safeguarding lives, ensuring equity, and securing the future of public health.

• Protecting health in our cities: Protecting health in our cities requires a bold reimagining of urban development as a driver of equity and well-being. Ensuring equitable access to housing, education, and employment must be recognized as a foundation for healthy communities. Cities must be deliberately designed to promote health—through safe, affordable housing, accessible public transport, and inclusive green spaces. Expanding social safety nets, mental health support, and community-based healthcare is essential to addressing structural disparities and building urban environments that care for all residents, especially the most vulnerable.

📢 Our call

• Invest in Universal Health Coverage as a Public Good: Governments and global institutions must prioritize public investment in healthcare, ensuring sustainable funding models that reinforce equitable access to essential services. Public health should not be subject to market-driven logics but protected as a fundamental pillar of social justice.

• Strengthen Multi-Level Governance and Policy Coherence for a renewed social contract: A new approach to governance must place care and health at the center of economic and social policies, treating healthcare not as a privilege but as an essential right. Embedding UHC within broader public service frameworks will foster inclusive, resilient, and just societies, and involving local and regional governments in all health-related decisions, such as a global pandemic treaty, will ensure that responses to crises are equitable. National and international policies must align with local realities, integrating LRGs into decision-making processes to ensure effective implementation of UHC. Multi-level collaboration is essential for achieving equitable, people-centered health systems.

• Promote Urban Health and Well-Being: Cities must be designed to support health by improving air quality, expanding green and public spaces, ensuring access to education and mental health services, and creating spaces that address the externalities of health. Holistic urban policies create environments where all residents can thrive. Local and regional governments are ready to lead the transformation towards health for all, promoting equal access to healthcare services and valuing its workers, and transforming our cities and territories into healthy spaces. The local social covenant that UCLG and its partners are developing will aim to recognize health as a pillar of human dignity, social cohesion, and sustainable development.