BACKGROUND:
Cities at the climate change–health nexus face escalating risks from extreme weather events, environmental degradation, and deepening social inequities.1 In South Africa, coastal cities are particularly vulnerable to climate shocks that disproportionately affect low-income communities and strain already overburdened health systems.2 This paper presents the development of the Climate Resilient Development Strategy and Action Plan for Nelson Mandela Bay, situating climate resilience as a determinant of population health, wellbeing, and social justice.3

METHODS:
The CRD strategy was developed using a participatory, multi-sectoral methodology that integrated climate risk analysis, policy review and stakeholder engagement. Methods included desktop analysis of climate projections and socio-economic data; mapping of climate-sensitive health and social vulnerabilities; and facilitated engagements with municipal departments, civil society, community-based organisations, and technical experts. A systems-thinking approach was applied to identify cross-sectoral pathways linking climate hazards, service delivery, livelihoods, and public health outcomes.

RESULTS:
The strategy identifies priority climate risks including heat stress, flooding, drought, food insecurity, and ecosystem degradation with their direct and indirect impacts on physical and mental health, livelihoods, and access to basic services. Key outcomes include a shared vision for climate-resilient development strategy; a set of integrated strategic objectives; and a prioritised action plan emphasising health co-benefits, inclusive governance, and community participation. The strategy strengthens alignment between climate adaptation, disaster risk reduction, and public health planning, while highlighting the role of local knowledge and social infrastructure in building resilience.

CONCLUSIONS:
The Nelson Mandela Bay CRD Strategy and Action Plan demonstrates how climate-resilient development planning can be leveraged as a public health intervention. Embedding health equity, participation, and accountability within climate governance offers a pathway to reduce vulnerability, strengthen urban health systems, and advance just and resilient cities in the face of climate change.