Healthy and resilient cities for future pandemics: a systematic review

This study identifies key lessons from COVID-19 to inform next-generation healthy cities. Following PRISMA and ENTREQ guidelines, a systematic review was conducted across Scopus, PubMed, and Web of Science (up to October 2025), focusing on English-language, peer-reviewed articles analyzing city-level pandemic responses. Registered with PROSPERO (CRD42024421530), the review employed thematic synthesis (Thomas & Harden) and included 55 studies (32 qualitative, 16 quantitative, and 8 mixed-methods), revealing seven major themes: urban greenery (enhancing mental and physical health); population density (smart city approaches enabling control in high-density areas); inequality and inequity (highlighting the need for environmental and social justice); sustainability and resiliency (well-designed compact neighborhoods fostering resilience); smart cities (supporting data-driven health responses); co-benefit urban models (linking public health with the SDGs); and security and safety (strengthening trust and participation). While Global North cities can leverage smart technologies and green infrastructure to enhance resilience, they must address equity gaps. In contrast, Global South cities require urgent investment in basic services, housing, and community-led solutions to build foundational resilience. The study advocates integrating Nature-Based Solutions with health equity policies, expanding digital infrastructure, and aligning urban planning with the SDGs to enhance pandemic preparedness, reduce inequalities, and advance climate and environmental justice globally.