African cities are diverse and thriving, but face many challenges. How to make them healthier

A new book called Urban Health in Africa explores how rapid urbanisation across the continent shapes public health and wellbeing. Drawing on diverse research and case studies, the book reframes African cities not just as sites of challenge, but as places of innovation, resilience and opportunity. We spoke to global health researcher Elaine Nsoesie and urbanisation and wellbeing sociologist Blessing Mberu, co-editors of the book, to explore why the stories of African cities matter, and what it will take to build inclusive, healthy urban futures. What’s one thing about urban life in Africa that you think more people should appreciate? African cities work, but not always like cities in other regions. In the book, we quote the following text by AbdouMaliq Simone, who works on issues of spatial composition in urban regions: In city after city, one can witness an incessant throbbing produced by the intense proximity of hundreds of activities: cooking, reciting, selling, loading and unloading, fighting, praying, relaxing, pounding, and buying, all side by side on stages too cramped, too deteriorated, too clogged with waste, history, and disparate energy, and sweat to sustain all of them. And yet they persist. That persistence matters. Too often, discussions about African cities focus only on their problems. These include inadequate infrastructure, rapid urbanisation and informal settlements. What gets lost is their remarkable functionality and their diversity. No single city can represent the entire continent. Lagos is not Nairobi; Accra is not Dakar. Each has its own history, governance structures and contemporary challenges. Treating them all the same flattens this complexity. Yes, these cities face serious challenges. But they’re also home to innovative urban experts, effective policy solutions and technological breakthroughs designed for their specific contexts. The question isn’t whether African cities work. It is whether we’re paying attention to how they work, documenting how they are addressing challenges related to health and learning from their solutions. Was there a story or example that really stayed with you? When we set out to write this book, we knew we had to start with history. You can’t understand health in African cities today without understanding how colonialism shaped the built environment and urban citizenship. We wanted readers to see how historical forces combined with rural-urban migration, population growth and policies created the urban landscapes affecting millions of lives today. Harare’s street traders create their own system to survive in the city

Our second goal was to map the social determinants of health – the conditions of the environments in which people are born, live, play, work and learn – shaping African cities. We focused on informal settlements and slums because they’ve become defining features of urban Africa. We examined how residents navigate daily struggles: inadequate housing, water and sanitation; air pollution; transportation; food insecurity. We didn’t want to present these as isolated problems. We wanted to show how they’re interconnected challenges that affect many communities. One of our favourite chapters is in this section. The chapter explores how transport affects health in African cities – both the risks and the benefits. For example, the availability of transportation increases access to hospitals and schools, while vehicles also cause traffic injuries and air pollution. The authors also discuss distinctive forms of public transport that African cities share that you won’t find in most other parts of the world. Motorcycle taxis, for example, have different names. They are called boda bodas in Kampala, okadas in Lagos. Commuter minibuses are referred to as poda-poda in Freetown, trotro in Accra, daladala in Dar es Salaam, matatu in Kenya, car rapides in Dakar, kamuny in Kampala, gbaka in Abidjan, esprit de mort in Kinshasa, candongueiros in Luanda, sotrama in Bamako, songa kidogo in Kigali. The chapter captures a major theme in the book; while these cities are different, policies that have been effective in one city can be adopted to address the needs of residents in another city. South Africa’s minibus taxi industry runs on social bonds – reform must accept this

In addition to the social determinants of health, we had another section that addressed Africa’s unique demographic reality: these cities are young. We dedicated sections to how urban environments shape young lives, particularly around sexual and reproductive health. We also highlighted the growing epidemic of chronic diseases like obesity, diabetes and hypertension. Studies have shown an association between the rate of urbanisation in Africa and an increase in chronic diseases because of issues such as adoption of unhealthy western diets, lack of spaces to exercise, and sedentary behaviours. To showcase how some cities are addressing the challenges related to the social determinants of health, we included case studies on air quality in Kampala, new mental health initiatives in Yaoundé, an approach to reducing school dropouts in Arusha, integrated planning transforming informal settlements in Nairobi, and digital health innovations. The case studies demonstrate that effective solutions incorporate community voices and the local context.
Your book outlines a future for urban health in Africa. What do you see? Our final chapters make explicit what we believe must happen next. We need public health professionals, urban planners, physicians, nurses, community health workers, policy advocates and water and waste managers working together. We need educational programmes focused specifically on urban health. Most critically, we need strong local, national and regional governance to turn plans into reality. Youth workers are spreading health messages on social media: how to support what they do in South Africa

But we also need to elevate youth voices, ideas and innovations across the continent. According to United Nations estimates, about 40% of Africans were under 15 in 2020, and nearly 60% were under 25 – the largest proportion of young people of any region worldwide. Young people are shaping African cities and they will live with the consequences of whatever decisions are made today. What motivated the publication of this book, and why now? When we started this project there weren’t any books on urban health in Africa written by Africans working to address the various challenges faced by urban residents. An estimated 46% of Africa’s 1.3 billion people live in urban areas. Africa is also the continent with the fastest urbanisation rate, with 50% to 65% of the population projected to live in urban areas by 2050. Despite having urban challenges similar to those in other regions, some of the issues that cities in Africa face are unique. We wanted to bring together researchers and practitioners with diverse expertise and deep knowledge of the challenges people face in cities. We wanted to look at these challenges, the policies that have been effective and recommendations about what must be done to improve the health of residents.

Elaine Nsoesie receives funding from the Gates Foundation to support a fellowship program for early career researchers in Africa. Blessing Mberu works for the APHRC, an organization that previously received funding for urbanization research, but not for the specific book on urban health in Africa, nor this submission to The Conversation Africa.