While there is a wealth of literature on the impact of urban design on health, our understanding of the factors that influence integration of health into urban design is limited. With the growing recognition of cities playing a leading role in enhancing health equity and population health outcomes, it becomes crucial to examine the perspectives and experiences of municipal actors concerning health and equity. To address this gap, we interviewed 30 stakeholders engaged with urban design policy- and decision-making at the City of Regina in Saskatchewan, Canada. Our research uncovered a lack of shared understanding of health among municipal actors. From our findings, we identified several factors that serve as either facilitators or barriers to integrating health and equity in urban design policies. This case study enhances our understanding of these factors and provide recommendations for developing healthy urban design policies. Our findings underscore the importance of adopting an integrated and holistic approach for healthy and equitable urban design. As urbanisation continues to bring a greater share of the world population into urban areas, it becomes imperative to deepen our understanding of how municipal governance can be leveraged to create environments conducive to the well-being of their residents.

The authors have declared no competing interest.

This work was supported by the Saskatchewan Health Research Foundation [grant number 6470, 2023]

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics approval for this research was received from the University of Regina Research Ethics Board (project ID: 2023-109).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors.