The world’s cities are growing in both size and number in all regions but there is particularly rapid growth in the number and size of cities across Asia, Africa and South America. This growth has occurred and will continue to occur over a relatively short period. Currently over half (55 per cent) of the world’s population lives in cities and by 2050, 68 percent of the world’s population is projected to be urban. Global heath will increasingly be determined by cities. Every city should develop a comprehensive strategy and action plan to address these ‘Vital 5’. These ‘Vital 5’ are most concentrated in deprived areas and show the greatest increase in low and middle income countries. They are the five most important health risk factors tobacco use harmful alcohol use physical-inactivity, unhealthy diet and planetary health. Improving health in cities requires multiple actions, by multiple actors, at every level. Cities are a meta-system with population health dictated by multiple interactions and multidirectional feedback loops. The collective body of evidence identified in this review, built up over the last 130 years, has hitherto been poorly documented and characterised. City health departments are making an increasing contribution however the role of mayors appears to be limited. The results show that the majority of initiatives were targeted at non-communicable diseases. The search identified 42,137 original citations, yielding 1,614 papers across 227 cities meeting the inclusion criteria. The study was conducted in accordance with PRISMA and the protocol was registered with PROSPERO (CRD42020166210). We conducted a systematic search to identify literature on city-wide initiatives to improve health. This systematic scoping review has been conducted to understand what cities are doing to improve health and healthcare for their populations. Currently over half of the world’s population, over 4 billion people, live in cities. Global health will increasingly be determined by cities.
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