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It has become evident that our planetary ecosystem is changing rapidly in response to human activities. This has led scientists to recognize the present-day era as a new geological epoch, the Anthropocene, in recognition of the substantial effect of man on the Earth’s systems. Human health is better today than at any other time in history. Yet the flourishing of civilization has come at the cost of an unsustainable exploitation of nature’s resources. As we look toward the future, it has become clear that we now face substantial health risks from the degradation of the natural life support systems which is critical for human survival. Global environmental change, including climatic change, ocean acidification, land degradation, water scarcity, overexploitation of fisheries, and biodiversity loss, poses serious challenges to the global health gains of the past several decades.

Extreme events, both natural and anthropogenic, increasingly affect cities in terms of economic losses and impacts on health and well-being. Most people now live in cities, and Asian cities, in particular, are experiencing growth on unprecedented scales. Meanwhile, the economic and health consequences of climate-related events are worsening, a trend projected to continue. Urbanization, climate change and other geophysical and social forces interact with urban systems in ways that give rise to complex and in many cases synergistic relationships. Such effects may be mediated by location, scale, density, or connectivity, and also involve feedbacks and cascading outcomes. In this context, traditional, siloed, reductionist approaches to understanding and dealing with extreme events are unlikely to be adequate. Systems approaches to mitigation, management and response for extreme events offer a more effective way forward. Well-managed urban systems can decrease risk and increase resilience in the face of such events.