<![CDATA[Rapid urbanization and persistent air pollution are increasing pressure on public health systems by intensifying healthcare demand, environmental exposure, and institutional vulnerability. This study aimed to examine how urbanization pressures and air pollution influence public health system resilience and to identify institutional capacities associated with stronger performance. A mixed-methods cross-sectional design was applied across four urban areas, involving 420 respondents and 30 key informants. Quantitative data were collected through a resilience questionnaire and secondary environmental indicators, while qualitative data were obtained through semi-structured interviews. The overall resilience score was moderate at 3.39 ± 0.61. Higher PM2.5 concentrations and population density were negatively associated with resilience, whereas intersectoral coordination, environmental surveillance, and resource flexibility showed significant positive associations. Multivariable regression explained 48% of the variance in resilience, with intersectoral coordination emerging as the strongest positive predictor. Qualitative findings confirmed that integrated surveillance, flexible resource allocation, and timely information exchange supported stronger institutional responses. These findings highlight resilience as a dynamic governance capacity. Public health resilience in rapidly urbanizing and polluted settings depends on more than healthcare infrastructure alone. Strengthening cross-sector governance, adaptive capacity, environmental surveillance, and equitable community engagement is essential for sustaining health services and reducing long-term urban health vulnerability.]]>
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