This study aimed to assess the state of health promotion within urban planning in Japan. A nationwide questionnaire revealed that municipalities with larger populations and higher aging ratios were more inclined to incorporate health and physical activity into their urban plans. Furthermore, it indicated that municipalities mentioning health as a guiding principle or challenge in their plans were more likely to develop facilities for physical activity. In contrast, municipalities with easier access to railroads were less likely to set quantitative targets related to physical activity and consider service facility proximity in terms of walking distance. These findings suggest a relationship between health awareness and facility development. Moreover, the presence of unfavorable urban structures is likely to incentivize the adoption of health-related initiatives.