In recent decades it has become clear that increasingly accelerated urbanization globally, combined with increased consumption of natural resources and pollution, dramatically alter the ecological context where cities are struggling to provide long-term social, economic and environmental sustainability. Given that urban areas are densely populated and are among the most polluted ecological environments, it can be concluded that the highest percentage of diseases caused by environmental risks is recorded in urban areas. Among the major challenges in urban areas is public health, which is one of the most important demographic and social parameters. The urban population, despite facing increasingly greater social and economic inequality, also faces daily exposure to health risks, becoming victims of significantly worsened living conditions that directly affect their health, mortality and productivity. Urbanization is often accompanied by an increase in air pollution, which causes a significant mortality rate due to cardiovascular and respiratory diseases. The consequences of these diseases are particularly present among disadvantaged groups, economically weak countries and developing countries. Nearly 80% of current deaths from these diseases occur in low- and middle-income countries or where environmental regulation is weak or nonexistent. The implementation of national and local policies for sustainable urban development in order to create sustainable cities becomes a priority throughout the world. The international community increasingly emphasizes that addressing environmental sustainability issues should not happen exclusively at the international level, on the contrary, these political decisions should be... half of the paper... of the city. Skopje has the potential to transform from a capital of social divisions and enormous pollution into a center of ancient and modern culture of innovation and new ideas aimed at sustainability. One of the main tasks of local authorities is to generate environmental services on which all citizens depend equally, especially taking into account their health and access to resources. A strong argument is that greater community participation, as well as greater accountability and transparency on the part of planners and authorities, are needed to cultivate the city's available potential to achieve the various sustainable development goals set by Rio +20 .Works CitedKemp, R. , Parto, S. and Gibson, R.B. (2005) “Governance for sustainable development: moving from theory to practice”, Int. J. Sustainable Development, vol. 8, nos. 1/2, pp.12–30.