Acting on the environmental, socio-economic and behavioural determinants of health is key to reducing incidence, prevalence and impact of both communicable and non-communicable diseases (NCDs).

Increasing prevalence of NCDs (e.g. cardiovascular disease, cancer, diabetes, mental ill-health) is associated with urbanisation which drives differing risk factors among urban men and women (e.g. in many contexts higher tobacco use among poor men, higher obesity among poor women).

While the urban middle-classes are contending with increased prevalence of NCDs, the urban poor are affected by both communicable diseases and NCDs. The impacts of poor water and sanitation are evident in high levels of gastro-intestinal disease and childhood stunting. Vector-borne diseases are a growing threat to urban life. Huge growth in construction in booming mega-cities has created perfect mosquito breading grounds fuelling Zika, dengue and chikungunya. Understanding such vector-borne disease is challenging due to limited surveillance data.

This double burden of communicable diseases and NCDs requires new approaches within the health system that: address both the structures and functions of health systems as well as the attitudes and norms of those working within the systems; pay attention to gender, disability and other social differences and identities; increase accessibility to quality public and private primary health care; provide new drugs and equipment; update reporting systems; and create feasible referral systems.