Effective strategies to build a national approach to the integration of health and urban planning at all levels of government is essential if the health problems of urban Australians, such as obesity and respiratory illnesses, are to improve. This paper examines some policies and initiatives that could facilitate intergovernment cooperation on health and sustainability within the constraints of Australia’s federal government system. These include recommendations for an Australian Sustainability Commission and Charter of Sustainability, evaluations of the Better Cities Program of the 1990s, and current proposals for improving urban governance to enable the implementation of a healthy and sustainable cities agenda.