With more than 80% of the European population expected to live in urban areas by 2030, cities play a pivotal role in steering the transition towards a low-carbon society as well as in promoting and protecting health and wellbeing, and preventing and mitigating socioeconomic inequalities among urban dwellers. This publication reviews the key drivers for change in the European urban environment, highlights the burden of disease in European cities, and discusses opportunities and barriers to action. Taking into account the responsibilities of cities in relation to several policy areas that have a direct impact on health and the environment, it also proposes possible ways forward to strengthen support for cities that are committed to addressing environment and health challenges in their communities. Such support will be channelled through the development of new partnerships, facilitating the dialogue and exchange of knowledge between subnational and local authorities, national governments and international actors, while building on existing strategic partnerships and initiatives at all levels of governanc