Healthy cities as catalysts for sustainable development: A systematic review of co-benefits, trade-offs, and solutions to the SDGs

In 2015, the United Nations (UN) introduced the Sustainable Development Goals (SDGs) as a comprehensive global framework to address interconnected challenges related to public health, social inequalities, climate change, environmental sustainability, and urban governance. In parallel, for several decades, the Healthy Cities paradigm has evolved as a holistic and context-sensitive approach to enhancing urban health and quality of life (QOL) through integrated planning, participatory governance, and cross-sectoral action. This study conducts a PRISMA-guided systematic review of the co-benefits and trade-offs associated with the dimensions and solutions of healthy cities in relation to the SDGs. In this process, 91 peer-reviewed articles published between 2016 and 2025 were retrieved from major international databases and analysed using a structured qualitative content analysis to identify dominant patterns, co-benefits, and trade-offs. The findings indicate that existing research primarily focuses on SDGs 3 and 11, while also revealing meaningful linkages with SDGs 2, 6, 9, 13, 16, and 17. Healthy city interventions, including green and blue infrastructure, active mobility systems, inclusive governance mechanisms, and evidence-informed policymaking, demonstrate substantial potential to generate co-benefits across environmental, socio-spatial, and institutional dimensions. Nevertheless, the literature highlights persistent challenges and trade-offs, such as digital exclusion, institutional fragmentation, and spatial and social inequalities in access to health-enabling environments, which continue to hinder progress toward these goals. The results show that the identified co-benefits and trade-offs are strongly place-dependent. Local culture and social norms, urban morphology and density patterns, urban microclimate conditions, mobility and accessibility structures, and institutional and financial capacities play a decisive role in shaping how healthy city strategies interact with the SDGs across different regions and cities worldwide. Accordingly, the effective integration of the Healthy Cities paradigm within the SDG framework requires translating global objectives into locally implementable planning actions and designing neighbourhood-scale, context-sensitive monitoring indicators. To achieve sustainable and equitable outcomes, urban policies should prioritise reducing socio-spatial inequalities, strengthening inclusive civic participation, and mainstreaming health considerations across all dimensions of urban development. The study underscores the need to advance place-based empirical research, context-responsive innovations, and interdisciplinary collaboration to fully realise the potential of healthy cities in shaping sustainable, resilient, and health-oriented urban futures.