In the last decade there has been growing interest in the impact of the urban planning on health. This has been fuelled by global trends in preventable chronic disease and their risk factors including increasing levels of physical inactivity, a global epidemic of obesity in adult and children and the debilitating impacts of stress and depression. Health concerns about urban planning and health are paralleled by concerns in other sectors related to rising fuel prices and global declines in the availability of cheap sources of energy. Well designed urban environments have the potential to facilitate healthy and sustainable living by encouraging walking, cycling and public transport use. Yet in an effort to provide ‘affordable housing’, low density housing poorly served shops, services and public transport is being built on the urban fringe of cities, as well as poorly designed high density housing in the inner city: both at the expense of pedestrian-friendly human scale developments that have the potential to optimise health outcomes. Increasing walking, cycling and public transport use must be prioritised to future proof cities and promote health. To ensure a healthy and sustainable future, we need to create cities that are healthy by design.