Mindsets and actions: Shifts in equitable and sustainable development in U.S. cities

Cities face interconnected challenges for health equity, including structural racism, inadequate housing, and climate change. Due to past failures to achieve positive development outcomes for low-income and marginalized communities, many U.S. cities now emphasize equitable planning and community engagement. However, practitioners often lack the tools to implement just, equitable, and health-promoting policies effectively. Through semi-structured interviews with 23 professionals in sectors like community development, planning, transportation, and housing—primarily in local government and nonprofits—we observed a shift toward more equitable practices, explicitly naming the role of racism in urban planning and the adoption of new strategies and frameworks for equitable planning that support health. We document approaches used to overcome opposition to healthy, equitable, and sustainable development, including building trust and employing strategic communication framing. Community-led initiatives emerged as powerful drivers of equity and sustainability, though greater public sector support for these potentially transformational efforts is needed. Further progress could benefit from a deeper understanding of cultural mindsets that hinder equitable transformation.