By Sebastiana A. Etzo, SAGaPS Co-funder and Urban Health Expert
BLast month, I attended the first Africa Urban Forum convened by the African Union (AU) in Addis Ababa, Ethiopia (4-6 September 2024). The event provided a platform for governments to collaborate on shaping sustainable and thriving urban environments across the continent.
Africa is experiencing rapid urbanisation. In the past 20 years, cities across the continent have grown at an annual rate of 3.5%, with projections anticipating that this trend will continue, with all economic, social, cultural and political implications for regions and countries.
The Forum, attended by government representatives, the private sector, academia, and civil society, provided three days of in-depth discussions on the opportunities and challenges of urban growth. The Harmonised Regional Framework for Implementing the New Urban Agenda in Africa set the stage for the main theme, Sustainable Urbanization for Africa’s Transformation, aligning with the goals of the Africa Union’s Agenda 2063. Two key sub-themes guided the discussions: Financing Urbanization for Socio-economic Transformation and Sustainable and Resilient Urban Development in Africa.
Key issues discussed at the Forum included urbanisation as a driver of economic growth, addressing infrastructure deficits, housing shortages, social inequalities, and integrating climate resilience into urban planning. Climate change, recognised as a catalyst for conflict and migration, including internal displacement, was a major concern, along with the need for innovative financial strategies to fund urban projects. Inclusive governance, capacity building, and the involvement of marginalised groups in urban planning were also critical topics. These discussions are reflected in the final Addis Ababa Declaration, which outlines a strategic roadmap for AU member states.
The issues that emerged in the talks and round-tables resonated deeply with my work as a global health consultant with an interest in healthy cities. While the Forum successfully addressed numerous critical aspects of urban development, it revealed an important gap: despite health being intrinsically linked to urban wellbeing, it wasn’t explicitly central to the dialogue. Yet, as I listened to countries sharing their experiences, the health implications of their urban challenges became increasingly apparent. This observation shaped some reflections:
Urbanisation trends tell only part of the story
While statistics highlight the rapid growth of African cities, they don’t fully capture the complexities of urban living and the associated health disparities. Attending the Forum provided valuable insights into these nuances. For example, a representative from Eswatini government noted that rapid urbanisation is occurring even in rural areas challenging municipalities’ capacity to keep up with the population growth. This often leads to inadequate housing, insufficient infrastructure, and limited access to essential services—all of which have direct implications for public health. The World Health Organisation (WHO) refers to the “triple threat” of urban health issues, i.e. infectious diseases, noncommunicable diseases, and injuries (including road traffic accidents) and interpersonal violence.
Understanding these complexities enables policymakers and urban planners to design targeted health interventions that address both the symptoms and root causes of health challenges in urban and urbanising settings.
Investing in infrastructure: a pathway to healthier, more equitable cities
A major concern highlighted at the Forum was the need for infrastructural investment to address housing shortages and improve urban living conditions. Local governments in Africa have exceptionally low budgets and limited fiscal revenue. Finding alternatives and sustainable financing mechanisms for housing and other urban infrastructure remains a significant challenge, especially for cities more prone to climate change-induced events due to their geographical location.
Prioritising people in urban planning can lead solutions and partnerships that tackle multiple crisis simultaneously. Strengthening multi-level and multi-sectoral governance can ensure that health considerations are integrated across different levels of government and sectors. For instance, urban planning should consider health impacts by providing access to green spaces to promote physical activity and mental wellbeing. Improving public transport and infrastructure for active mobility can reduce pollution, alleviate road congestion, and promote healthier lifestyles. Cities like Addis Ababa are already taking steps in this direction by building green corridors that encourage active mobility, as well as improving transport infrastructure.
Embracing urban informalities as a catalyst for health and development
African cities are often characterised by a significant presence of informal settlements and economies. Recent debates suggest that informality should not be viewed merely as a problem to be eradicated but rather as an intrinsic part of urban life that offers both challenges and opportunities. The Forum echoed this view, highlighting the need to rethink the approach to urban informality.
Rather than perceiving informal settlements as areas lacking legitimacy, there is a growing recognition of their role in providing affordable housing and employment opportunities to millions of urban residents. These communities are hubs of innovation and resilience, often compensating for gaps left by formal systems.
From a health standpoint, informal settlements face unique challenges, including limited access to healthcare services, inadequate sanitation, and higher exposure to environmental hazards. However, they also possess strong social networks that can be leveraged for community-based health initiatives. For example, local organisations within these settlements often lead successful health education campaigns and mobilise resources during public health emergencies.
Embracing informality involves integrating these communities into urban planning processes without disrupting their social fabric. Policies should focus on upgrading infrastructure, improving access to basic services, and securing land rights to prevent forced evictions. This aligns with the United Nations’ New Urban Agenda, which advocates for inclusive urbanisation that leaves no one behind.
By acknowledging and integrating the informal sector, cities can enhance public health outcomes.
Health as a cornerstone of sustainable urban development
Reflecting on the Forum, it’s clear that health is a fundamental component of sustainable urban development. While not always explicitly highlighted, it underpins many of the challenges and opportunities discussed. By adopting a holistic approach that places health – and therefore people – at the centre of urban policies and practices, African cities can become healthier, more equitable, and more resilient and thriving places for all.
My experience at the African Urban Forum has reinforced my belief that addressing urban health challenges requires collaborative efforts across sectors and governance levels. It also highlighted the importance of considering the unique experiences and know-how of African cities, embracing their diversity.arcelona, 08/10/2024
