Experiences from countries in the WHO European Region show that planning for healthy, sustainable cities can be achieved locally but that this requires political will and leadership, a coherent vision, targeted financing, sustainable commitments at all levels of government and citizen engagement. An integrated approach, including collaboration between urban developers and environmental and health professionals, is necessary to address the current and future challenges to urban health and sustainability posed by environmental trends. “Boundary spanners” to connect different groups and expertise are key. This brief summarizes messages and lessons learnt on how local authorities across Europe can establish effective policies and interventions to provide healthy, sustainable environments for their citizens. It addresses the design and implementation of health-promoting urban policies that have been effective at local level, including both the challenges to be overcome and the enablers that should be maximized. The target readers of this brief are national, regional and local decision-makers and practitioners working in urban planning, environmental management and health promotion.