Building a healthy city is intentional, not haphazard. It always occurs in a human context which defines and is mutually defined by a wide range of cultural, societal and individual human factors. Building and managing a healthy city involves choosing between a range of options in order to achieve numerous objectives some of which may not give a high priority to health and quality of life. This keynote address argues that it is necessary to reconsider the construction of cities and urban development in a broad environmental, economic, social and political context that explicitly accounts for health and well-being. It begins with a presentation of some key concepts, definitions and interpretations of health and cities. Then it presents the eleven key principles that the World Health Organization has presented as being the main constituents of healthy cities. It also discusses those prerequisites that are necessary in order to apply these principles in professional practice to achieve the goal of constructing healthy cities. A review of common approaches during the 20th century clearly shows that it is not an easy feat to apply the eleven principles in practice. Prior to the conclusion, the author suggests and illustrates a few innovative approaches that have been applied successfully in theWHO Healthy Cities project since 1987. Hopefully, these kinds of contributions will serve as a catalyst for many more innovative projects in the near future.