BACKGROUND:
Urban environments play a critical role in shaping population health, yet many cities remain inaccessible to people with disabilities and aging populations, contributing to health inequities through barriers in housing, transportation, and public space design.¹–³ Although the World Health Organization (WHO) Healthy Cities Initiative promotes equity, participation, and sustainable urban development, the extent to which accessibility and universal design are embedded within its strategic frameworks remains unclear.⁴–⁶ This study examines how accessibility is explicitly and implicitly addressed within WHO Healthy Cities documentation and evaluates the presence and application of universal design principles in global urban health governance.⁴,⁶,⁷

METHODS:
A qualitative document analysis was conducted using WHO Healthy Cities policy and strategy documents published between 1986 and 2025.⁴–⁶ Documents were identified through a structured search of the WHO online repository and screened using predefined inclusion criteria. Documents were reviewed using thematic content analysis in ATLAS.ti, with a coding framework informed by the United Nations Convention on the Rights of Persons with Disabilities, the Sustainable Development Goals, and universal design principles.⁷–⁹

RESULTS:
Accessibility was referenced more frequently in later Healthy Cities phases, particularly through concepts such as inclusive governance, functional ability, and age-friendly environments.⁵,⁶ However, explicit references to persons with disabilities and universal design principles remained limited and inconsistently applied across documents.⁴,⁶ Universal design was primarily implicit and rarely operationalized through standardized indicators or planning tools.⁸,⁹

CONCLUSIONS:
While the WHO Healthy Cities Initiative demonstrates a growing rhetorical commitment to inclusion, accessibility and universal design remain insufficiently institutionalized within its planning and evaluation frameworks.⁴–⁶ Embedding clear accessibility standards, universal design frameworks, and participatory accountability mechanisms is essential to advancing equitable, healthy, and inclusive cities globally, in alignment with international human rights and sustainable development commitments.⁷–⁹