The growing number of global cities present a new paradigm for domestic public health practice which requires thinking
at scale and pace within an international context of population belief patterns and a looming threat of global risk transmission
along economic and recreational transport corridors. This expert opinion piece reflects on this emerging paradigm through the
perspective of the director of public health at Birmingham, England’s second city.
I. Public health is a discipline dedicated to protecting and improve the health and wellbeing of populations.
II. Cities present unique challenges to public health in terms of scale and the multiple operational levels of individual, families,
communities and layering of place.
III. Global cities present additional challenges to public health because of the duality of narratives experienced by citizens that
drive beliefs and behaviors as well as increased complexities of migration and trade.
IV. Responding to these challenges presents a new paradigm for public health which requires triangulation of global, regional
and local factors and upstream action at a system level to achieve sustainable change at scale.
V. This new paradigm requires a public health leadership workforce that is fluent in global cultural and political contexts of
health promotion and is supported by more global networks to support action as well as shared learning.
Keywords: Public Health; Cities; Globalization; Active transport; Food Systems; Birmingham; Ethnic minority health