Urban geochemical alteration and transformation are complex processes that affect air, water, and soil, potentially posing serious health risks to the residents. Our health is determined by where we live now, and where we have previously lived and how long we have been there. This review explores patterns of urban environmental pollution and public health risks associated with potentially harmful elements. Academic databases including Scopus, Web of Science, and Google Scholar were used to find pertinent peer-reviewed papers, reports, and case studies. It discusses urban environmental and medical geochemistry, focusing on toxic heavy metals of public health concern and their urban sources. Case studies on geochemical anomalies in street dust, atmospheric, lithochemical, and hydrochemical contexts are critically examined. The review evaluates the effectiveness of geochemical indices in assessing pollution and health risk patterns in road dust, soil, air, and water, emphasizing the importance of geochemical background in urban geochemistry and medical geology. Strategies to reduce toxic heavy metal pollution in urban areas are also reviewed to protect public health. Finally, it offers conclusions and recommendations for future research. It is obvious that the environmental geochemistry of soil, street dust, water, and air contain a wealth of information about the state of urban environments. The outcomes of this study will help to raise public awareness of urban pollution and associated health risks, promoting environmental preservation and health protection in urban settings.