It is expected that by 2030, more than 60% of the world’s population will be living within an urban area. To inform future urban health system governance in expanding urban areas, we propose the Urban Health System Governance Framework that identifies health policy co-benefits between SDG 3 (Good Health and Well-being) and SDG 11 (Sustainable Cities and Communities). We utilize two case studies to supplement our framework. Our first case study describes the Youth at a Healthy Weight (Jongeren op Gezond Gewicht – JOGG) intervention in the Netherlands. Our second case study describes the Barcelona Superblocks, which consist of amalgamations of blocks throughout the city to improve the habitability of public spaces, sustainable mobility, urban green, and promote residents’ participation and co-responsibility. Two important themes necessary to understand co-benefits between the two SDGs emerged. First, achieving SDG 11, that is making cities healthy, sustainability, inclusivity, resilience, are prerequisites to achieving good health and wellbeing. Second, addressing health inequities should be a strong priority to ensure urban growth is sustainable, inclusive, and resilient, and to promote equity, the health system and other urban governance structures must work together to create strong intersectoral collaboration.

The Chapter describes health system governance as the aggregation of principles and normative values within the political system in which a health system functions. There is increasing appreciation of the central role of governance in influencing all elements of the health system. The five key governance principles or elements in health are strategic vision, participation, accountability, transparency, and rule of law. These, and other, governance principles have an influence strategic planning and decisionmaking, regulation, partnerships, and insurance in health. Multisectoral governance in health involves government and non-government agencies to address multidimensional challenges of differing levels of complexity across multiple sectors. Ministries of health need to assume new responsibilities in the 21st century and adopt roles that include – de jure governance processes, preparation for and response to change in context, relationship management, and values management. More work is needed to delineate the scope and influence on all health system functions, assessment tools and monitoring indicators, and to develop interventions for improving governance of the health system.