Ahead of the next GCHU Public Seminar in January 2026, this blog explores how a more deliberative (or citizen-led) approach to urban health adaptation planning can help create cities that are healthier and more responsive and resilient to climate change.
Despite the climate emergency there is still a marked absence of adaptation strategies in many cities across the world. Recent research, for example, has shown that half of European cities still do not have an adaptation plan in place, setting out how to adjust to the current and future impacts of climate change to reduce vulnerability and build resilience. Even where there is a plan in place, the climate-related measures are often inconsistent because their climate risk assessments, policy goals, adaptation measures and monitoring programmes are not aligned. The threat of the climate emergency, is creating hotter temperatures more frequently in many of the world’s biggest cities. A lack of action therefore is surprising and concerning, particularly as climate change can impact people negatively in many ways, through heat-related illness and the physical and mental impacts of flooding, for example.
Photo: Alastair Johnstone (Agency: Climate Visuals)
To add to this deficiency, very few city authorities explicitly consider the tangible benefits of health-related adaptation. Urban public health authorities are often not engaged in the climate emergency agenda, and previous research has highlighted what is known as a ‘health adaptation gap’ not only at national and international level but also at subregional levels. Much more could be done therefore to integrate health and adaptation planning in cities, especially at the level of citizen engagement and participation in decision-making.
But how can this be achieved so that we can create cities which are not only healthy, but resilient and adaptive to climate change as well? In a recent C40 Cities journal article, we discussed the potential role of deliberative democracy, which includes mini publics, such as citizens’ assemblies and citizens’ juries, in enhancing civic engagement and direct participation, to influence local climate policies. In this way, citizens’ deliberations about adaptation and health actions can highlight the varying impacts on vulnerable communities faced with climate change.
At a city level in the UK, our review found that the most effective deliberative democratic processes complemented existing political systems rather than replaced them. Using Carbon Disclosure Project (CDP) data, we found that up to 2024, there had been 60 citizen assemblies and juries at the subnational level in the UK with about 90% of those focusing on climate change, but only two cities, Bristol and Manchester, had used such processes to examine the public health-climate change interface.
We also highlighted how Marmot Places (named after Professor Sir Michael Marmot’s seminal report, ‘Fair Society, Healthy Lives’ (2010)) can provide a strong focus for helping tackle health inequalities in UK cities and other areas in the context of climate change. There are more than 50 local areas currently signed up, including Oxfordshire. Essentially these places recognise that health and health inequalities are significantly impacted by the social determinants of health (SDH), or the conditions in which people are born, grow, live, work and age, and so the onus is on local authorities in partnership with other agencies to take joint action to improve people’s health and reduce health inequalities. Climate change is also a direct concern for Marmot Places because it creates both direct health impacts (such as heat stress, flooding) and indirect impacts (such as food and energy prices) that can worsen existing socio-economic inequalities between higher income and more vulnerable lower income populations.
Despite this, adaptation planning and public health in cities in the UK and internationally remains disconnected and often involves a fragmented deployment of multiple agencies. Therefore, there is an advantage, it must be said, for pivoting towards a policy landscape and research agenda which links public health, climate change adaptation, and urban planning much more strongly than is currently the case. This can surely only help the case for action within our towns and cities because public health is a critical concern, and climate change is affecting both public health and the urban adaptation planning responses. Of course, using deliberative democracy takes time and resources, and our review highlighted costs of anything between £30,000 and over £100,000 for this sort of exercise. It’s also vital to (i) ensure representative participation from local people (through the process of ‘sortition’); and (ii) to create mechanisms for ensuring local authorities really do respond to the groups involved.
Joining up multiple actions and creating a new policy focus, or what we call ‘Deliberative Urban Health Adaptation Planning’ (DUHAP), is essential if city authorities are to tackle the climate and public health crises. In our view, deliberative democracy offers city authorities an opportunity to help build consensus and increase trust in planning and decision-making at the interface between public health and climate change.
Read more information about the paper on which this blog is based on.
There will also be a GCHU Public Seminar on 21 January 2026 at Kellogg college, exploring themes from the paper and this blog.
Click here to register GCHU: Can community-led planning make cities more adaptive and healthier? Tickets, Wed, Jan 21, 2026 at 5:30 PM | Eventbrite
Authors of the blog
Timothy J. Dixon is an emeritus professor at the University of Reading (School of the Built Environment), a research associate at the Global Centre for Healthcare and Urbanisation, and a visiting fellow at Kellogg College.
Juliet Carpenter is the director of research at the Global Centre on Healthcare and Urbanisation at the University of Oxford.
Katherine Maxwell is a research associate at the Global Centre on Healthcare and Urbanisation at Kellogg College, University of Oxford. She is also an Associate—Climate and Sustainability at Arup.