What a healthy city needs beyond hospitals

When people talk about health in a city, they usually talk about hospitals. How many are there? Are they modern? Do they have enough doctors and equipment?

Hospitals matter — a lot. But by the time someone arrives at a hospital, many of the causes of their illness have already happened: the polluted air they breathed for years, the unsafe water they drank, the road accident on a street with no sidewalk, the lack of safe places to exercise, the stress of noise and heat, the cheap fried food that was the only option near work.

Health is made — or lost — on streets, in markets, in homes and in neighbourhoods.

What does a healthy city need beyond hospitals — and how can African cities build health into everyday life?

Cities are growing fast

Africa is urbanising rapidly. UN-Habitat and the UN's World Urbanization Prospects project that Africa's urban population will roughly double over the coming decades. Cities like Lagos, Kinshasa, Dar es Salaam, Luanda and Abidjan are among the fastest-growing in the world — and smaller cities like Cotonou, Porto-Novo and Abomey-Calavi (Grand Nokoué) are growing too.

This growth brings opportunities: jobs, education, services. But without planning, it also brings health risks: pollution, crowded housing, traffic, flooding and poor sanitation.

Africa's urban population is projected to nearly double by 2050. (UN DESA, World Urbanization Prospects; UN-Habitat) How cities are designed now will shape the health of hundreds of millions of people.

1. Clean air

WHO estimates that almost the entire global population (99%) breathes air that exceeds WHO air quality guideline limits. Air pollution is linked to heart disease, stroke, lung cancer, asthma and pneumonia.

In African cities, sources include:

• Old vehicles and motorbikes with poor fuel.
• Burning rubbish.
• Cooking with charcoal and wood.
• Dust from unpaved roads.
• Industry and generators.

Healthier air needs: cleaner transport, waste collection (so people don't burn rubbish), cleaner cooking fuels, paved roads and air quality monitoring. Low-cost air sensors are now helping some African cities measure pollution for the first time — see Why local action needs good information.

Joke break: A Cotonou resident said he doesn't need a weather app: "If I cough after 10 minutes on the moto, it's a pollution day. If I cough after 2 minutes, it's Monday morning traffic."

2. Safe water and sanitation

Clean water and toilets are among the most powerful health tools ever invented. They prevent cholera, typhoid, diarrhoea and many other diseases. Many African cities still have neighbourhoods without piped water or safe sanitation.

A healthy city invests in:

• Water networks and kiosks.
• Sewers and safe on-site sanitation (septic tanks, emptying services).
• Drainage to prevent flooding and stagnant water (which breeds mosquitoes).

Read Clean water and the choices communities make.

3. Streets designed for people

Road traffic injuries are a major cause of death, especially for young people. WHO's Global Status Report on Road Safety shows the African Region has some of the highest road traffic death rates in the world relative to population. Pedestrians, cyclists and motorcyclists are the most at risk.

Healthy streets include:

• Sidewalks that are continuous and not blocked.
• Safe crossings and speed control.
• Street lighting.
• Helmets for moto riders and passengers.
• Public transport that's safe and affordable.

Walkable streets also encourage physical activity — which prevents heart disease, diabetes and obesity.

4. Green spaces and shade

Parks, trees and green spaces:

• Cool the city (reducing the "urban heat island" effect).
• Clean the air.
• Reduce flooding by absorbing rain.
• Provide places to exercise, play and relax.
• Improve mental health.

As African cities get hotter with climate change, trees and shade become health infrastructure. Some cities are launching tree-planting programmes and protecting wetlands and lagoons.

"The best time to plant a tree was 20 years ago. The second best time is now." — proverb (often described as Chinese)

5. Healthy food environments

What people eat depends a lot on what's available and affordable near them. Many African cities are seeing rising rates of obesity, diabetes and high blood pressure — linked to more processed food, sugary drinks and less physical activity.

A healthy city supports:

• Markets selling fresh fruits, vegetables and fish.
• Urban and peri-urban farming.
• Safe street food (clean water, hygiene, safe oil).
• Limits on marketing sugary drinks and junk food to children.

6. Waste management

Uncollected rubbish blocks drains, causes flooding, attracts rats and mosquitoes and gets burned — creating toxic smoke. The UNEP Africa Waste Management Outlook found that a large share of waste in Africa ends up in uncontrolled dumpsites.

Cotonou's waste management agency, SGDS, and community pre-collection services are examples of efforts to improve collection. See The ideas helping African cities reduce waste and The people making African cities easier to live in.

7. Safe, affordable housing

Crowded, poorly ventilated housing spreads diseases like tuberculosis. Houses in flood zones put families at risk. Healthy cities need:

• Affordable housing with ventilation and light.
• Protection from floods.
• Secure tenure, so people can invest in their homes.
• Upgrading of informal settlements with water, sanitation and roads.

8. Mental well-being in the city

Cities can be stressful: noise, crowds, traffic, insecurity, loneliness. A healthy city supports mental well-being with:

• Safe public spaces where people can meet.
• Cultural spaces: libraries, museums, music venues. (See Why cultural spaces need young visitors.)
• Green spaces for rest.
• Community groups and sports.
• Access to mental health services.

The WHO Healthy Cities idea

In 1986, WHO launched the Healthy Cities movement. The idea: health isn't just the job of the health ministry. Every city department — transport, housing, water, education, environment — shapes health. The movement encourages cities to put health in all policies and to involve citizens.

This "health in all policies" approach is especially important for African cities, where resources are limited and prevention is much cheaper than treatment.

What citizens can do

You don't need to be a mayor to make your city healthier:

• Join or organise clean-ups. See What it takes to keep a street clean together.
• Plant and protect trees on your street.
• Don't burn rubbish.
• Wear a helmet and drive carefully.
• Walk or cycle short distances when safe.
• Support local fresh food markets.
• Speak up at local meetings about sidewalks, drains, lighting and parks. See How young people can join local decisions.
• Report problems (broken lights, blocked drains) to local authorities.

What city leaders can do

• Plan cities with sidewalks, green spaces and public transport.
• Invest in water, sanitation, drainage and waste collection.
• Monitor air quality and publish data.
• Enforce road safety rules.
• Upgrade informal settlements with residents, not against them.
• Involve health experts in urban planning.
• Listen to communities.

An illustrative "health walk" through a neighbourhood

Try this exercise with a school class or community group. Walk around your neighbourhood for one hour and note:

• Where is the air smoky or dusty?
• Where do people walk on the road because there's no sidewalk?
• Where does water collect after rain?
• Where is rubbish piled or burned?
• Where is there shade? Where is there none?
• Where can children safely play?
• Where can you buy fresh fruit and vegetables?

Mark everything on a simple map. You'll quickly see which parts of your neighbourhood support health — and which parts need change. That map can become the start of a real project. See How teachers bring real problems into lessons.

Heat: the growing health threat

As the climate changes, African cities are getting hotter. Heatwaves are dangerous, especially for babies, older people, outdoor workers and people with chronic diseases. Heat also affects sleep, concentration and mental health.

Cities can respond by:

• Planting trees and protecting green spaces.
• Using lighter-coloured roofs and better ventilation in buildings.
• Providing shaded public spaces and drinking water points.
• Adjusting school and work hours during extreme heat.
• Warning people before heatwaves.

Heat isn't just uncomfortable. It's a public health issue that will grow in importance over the coming decades.

Hospitals are the last line, not the first

A healthy city keeps people out of hospital. It does this with clean air, safe water, safe streets, trees, good food, clean neighbourhoods, decent homes and places to rest and connect.

Hospitals will always be needed. But the healthiest cities are those where health starts at the doorstep.

Keep reading: How community health workers reach families, Simple steps towards safer public spaces, and our Health & Well-being section.

Questions

What makes a city healthy?

Clean air, safe water and sanitation, safe streets, green spaces, healthy food, good waste management, decent housing and support for mental well-being — along with good health services.

How does air pollution affect health?

It's linked to heart disease, stroke, lung cancer, asthma and respiratory infections. WHO estimates 99% of people breathe air above its guideline limits.

What is the WHO Healthy Cities movement?

A global initiative launched in 1986 encouraging cities to put health at the centre of all policies and planning.