Key insights

Cities require practical monitoring systems that prioritise meaningful indicators without increasing the reporting burden. A structured framework assists cities in selecting indicators that are scientifically robust, feasible, and locally relevant. Health co-benefits indicators demonstrate the advantages of climate mitigation and adaptation, supporting better decision-making. Furthermore, monitoring these co-benefits strengthens accountability, policy legitimacy, and public support for climate action.

Why this matters: the role of monitoring in climate action

Monitoring is essential for effective climate action, enabling local governments to track progress, inform decisions, and communicate results to interest-holders. Integrating health indicators makes the co-benefits of climate actions visible. As cities pursue integrated strategies, health indicators provide an evidence base for both mitigation and adaptation, helping to identify synergies and avoid unintended trade-offs. However, local authorities face challenges including fragmented indicator systems, lack of clear guidance, and constraints in data availability. This policy brief addresses these needs by presenting a practical framework for indicator selection and use.

The citiES 2030 case

The Pathfinder Initiative partnered with the citiES 2030 platform, Spain’s national platform supporting the EU Mission for Climate-Neutral and Smart Cities. This platform brings together 19 cities, universities, and civil society partners. Collaborative workshops and exchanges took place from January 2025 to July 2026 to identify health-related indicators that are robust and feasible for local implementation. The process focused on aligning existing metrics to improve usability and comparability without increasing reporting burdens.

Co-benefits indicator selection: key steps

Indicator selection was guided by pathways linking climate mitigation to health outcomes across four priority domains: air pollution, active travel, healthy and sustainable diets, and nature-based solutions. Indicators were identified from the NetZeroCities framework, peer-reviewed literature, and international databases such as Eurostat and the European Environment Agency. A traffic-light classification system evaluated indicators based on literature support, data availability, methodological maturity, and alignment with city practices.

Indicator mapping

The mapping process resulted in a shortlist of 15 indicators. These include PM2.5 and NO2 concentration levels, the 15-minute city metric, public transport satisfaction, and the 3-30-300 rule for green space access. Indicators were prioritised based on high levels of feasibility and readiness for implementation, while retaining strategically important metrics with potential for future development.

Understanding the context: scoping calls with Barcelona, Viladecans, and Zaragoza

Scoping calls with frontrunner cities confirmed that health provides a powerful rationale for climate action. Barcelona, with 1.7 million inhabitants, uses co-benefit indicators as strategic tools to justify policies and attract funding. Zaragoza, with over 700,000 inhabitants, views these indicators as a way to connect climate action to citizens’ everyday lives. Viladecans, a city of 67,000, uses indicators to defend climate measures, such as low-emission zones, against public resistance. A common finding was that the main challenge is not a lack of data, but transforming it into meaningful information for decision-making.

Indicator validation and prioritisation

Participatory workshops grouped indicators into three categories: ready-to-use (feasible with existing data), requiring common methodologies (standardisation needed), and to be reconsidered (difficult to operationalise). Cities agreed to incorporate four specific indicators into their latest Climate City Contracts. The process highlighted the importance of transparency and balancing comparability across cities with local adaptability.

A practical framework to integrate health into urban climate action

The framework involves a five-step process: identify the climate action domain; select indicators according to maturity (core, development, or contextual); monitor progress over time; evaluate progress and outcomes alongside implemented interventions; and communicate co-benefits to interest-holders. This tiered approach allows cities to start with feasible metrics while progressively strengthening their systems.

From monitoring to action: health co-benefits as a driver of urban climate policy

Health co-benefit indicators help cities prioritise actions that deliver multiple benefits, reflecting the Health in All Policies (HiAP) principle. Health is not just an outcome but a strategic entry point for designing and sustaining ambitious urban climate policies. Standardisation enables learning across cities, while flexibility ensures relevance to local data realities.

Operational implications and key messages

Cities are encouraged to embed health indicators into climate monitoring and invest in the capacity to integrate environmental and health data. Policymakers should ensure health is explicitly included in policy monitoring and support harmonised indicator frameworks. Researchers should co-develop practical tools with cities and advance methods that link environmental exposures with health outcomes under robust ethical standards.