Rapid urbanization and escalating climate crises place cities at the critical juncture of environmental and public health action. Urban areas are home to more than half of the global population, contributing ~ 75% of global greenhouse gas emissions. Structured surveys were completed by 191 leaders in city governments and civil society from 118 cities in 52 countries (February-April 2024). Data aggregated to report one response per city. The survey utilized framework and indicators established by The 2023 Lancet Countdown on Health and Climate Change. (1) Health hazards, exposures, impacts: two-thirds of cities identify extreme heat, flooding, and air pollution of "high concern," with health impacts for residents. (2) Adaptation, planning, resilience for health: Although 60% of cities have climate resilience plans, only 22.9% of cities have plans that concurrently address climate and health. Essential resources, municipal systems, and cross-sector collaborations are limited. (3) Mitigation actions and health co-benefits: 90% of cities reported air pollution from multiple sources
only 38% monitor air quality. Energy, food, and transportation systems are sub-optimal to mitigate climate concerns. (4) Economics and finance: 92% of cities report climate change-related economic losses
they plan to increase investments though resources remain constrained. (5) Public and political engagement: City leaders report minimal knowledge sharing among media, national/local government, scientific community, business community, and residents. Results underscore urgency for action and highlight solutions, providing a roadmap for cities to enhance resilience, safeguard public health, and promote social equity.