Climate change prompts increased urbanization and vulnerability to natural hazards. Urbanization processes are relevant to a right to health analysis of natural hazards because they can exacerbate pre-disaster inequalities that create vulnerability. The 2010 earthquake in Port-au-Prince and the 2005 hurricane in New Orleans provide vivid illustrations of the relationship between spatial inequality and the threats associated with natural hazards. The link between urbanization processes, spatial inequality, and vulnerability to natural hazards is important in terms of an analysis of the right to health; in particular, it provides a basis for arguing that states should prioritize equitable land use and development as a matter of human rights. This article draws on work by geographers, disaster specialists, and international legal scholars to argue that inequitable urbanization processes violate the obligations to respect, protect, and fulfill the human right to health in disaster-prone regions.