Author: Urban Hub Team at Save the Children International

Pollution, heat stress, hunger and poverty are increasing in rapidly urbanising cities and towns in low-and middle-income countries, posing severe health risks to millions of children, particularly those living in slums and informal settlements. This blog identifies 11 actions that governments and other relevant stakeholders can take to promote healthy cities for all children. 

According to UN-Habitat, 56% of children globally live in cities. By 2050, every 7 of 10 children will be urban dwellers. 90% of urban growth will occur in Asia and Africa, where rapid and unequal urbanisation has already resulted in 350 to 500 million children living in slums and informal settlements. This figure is set to triple by 2050 if transformative action to improve slums and informal settlements is not taken. 

Challenges to children’s health and wellbeing in cities and towns 

On average, children living in urban areas are considered to have better wellbeing indicators than their rural counterparts. However, large urban centres mask massive, complex and deep-rooted inequalities. Recent reports by UNICEF reveal children living in urban slums and informal settlements face worse health and wellbeing outcomes than rural children.  

Children in urban slums face multiple deprivations that pose threats to their health, survival and wellbeing. Deprivations like lack of access to clean water, sanitation, nutritious food, safe and secure housing and poor waste management make slums hotspots for malnutrition, diarrhoea, pneumonia, malaria and a range of skin and eye ailments.  

Overcrowding and lack of access to services can cause infectious diseases, like COVID-19 and the Ebola Virus Disease, to spread rapidly in slums with devastating health, economic and social impacts. Further, increasing air, water and soil pollution, poor road safety and lack of access to green spaces pose serious health and survival risks to children growing up in fast urbanising areas.  

Slums and informal settlements, often situated in urban heat islands, hillsides or flood zones, are on the frontline of climate change impacts. Flooding and heatwaves in urban slums, which are occurring more frequently and with more intensity, only deepen poverty and inequality. They not only cause traumatic injury and death, destroy meagre assets and livelihoods and displace people. But also increase water- and vector-borne diseases, exacerbates existing health risks and increase social tensions. 

So, what can be done to reduce urban child health inequalities and make cities healthier for all children? 

11 key actions to promote healthy cities for all children, with links to actionable examples. 

 1. Prioritise and accelerate slum and informal settlement transformation in global, national and local agendas

The 2024 SDG Report shows the proportion of people living in urban slums increased between 2020 and 2022, a reversal from decreasing trends between 2010 and 2020.  

 Source:  2024 SDG Report 

Sub-Saharan Africa, according to this 2018 report, the world’s fastest urbanising region and projected to add 65 million urban dwellers annually, shows the highest increase in the growth of slum populations. East and SE Asia are other regions showing an increase.

Without transformative action which improves living conditions in slums at scale, child health inequalities will continue to increase, putting at risk millions more children in years to come and chip away at developmental gains made in previous years. Read our blog on a call to action for slum transformation for more information 

2. Invest in localised and disaggregated data on child health and environmental inequalities

Several publications in the Global Alliance’s Cities for Children and Youth research series show a dearth of localised and disaggregated data on issues affecting urban children, like air pollution, road traffic incidents, childhood injuries and food insecurity. Investing in geo-located and disaggregated data on child health and environmental inequalities can identify high-need locations and populations and support targeted and impactful action.   

3. Ensure safe and affordable housing for all

Poor quality and cramped housing exposes children to several health hazards. Exposure to smoke, pests, contaminated water, toxins from building materials, overcrowding, and domestic violence have severe negative physical and mental health impacts on children. Read our blog on slum upgrading solutions that can save children’s lives for ideas on implementing child-safe housing. Equally important is the application of health impact assessment (HIA) and the adoption of urban health in all policies (HiAP) frameworks in slum upgrading and redevelopment efforts to improve health equity. 

4. Ensure access to climate-responsive and resilient water, sanitation and hygiene services

Climate change, air pollution, heat stress, flooding and decreasing clean water supplies in urban slums exacerbate child health inequalities. Multistakeholder and cross-sectoral approaches are needed to test, innovate, and scale access to affordable, quality, and reliable water and sanitation services in slums and informal settlements while taking into consideration the needs of children and caregivers.  

A promising example is the RISE program in informal settlements in Indonesia and Fiji, which works with communities, governments, local leaders and partner institutions to co-design and implement climate resilient water and sanitation solutions to improve the health and wellbeing of residents, particularly children under five years of age. 

5. Promote inclusive, healthy and affordable food systems

Child malnutrition and obesity rates are growing in urban slums, increasing the double burden of malnutrition. Studies in slums in India and South Africa show high costs of living, time-poor caregivers, lack of easy access to nutritious food, unhygienic living conditions and lack of access to affordable and quality childcare all contribute to growing obesity rates, especially among women, and wasting and stunting in under-five children.  

Vegetable market in India © John Haslam

As part of the ‘Roof Over Our Heads’ global campaign, women leaders and networks in slums across Asia and Africa prioritised ‘greens in their meals’ as one of 5 priorities for action. A whole-of-government and whole-of-society approach is needed to improve living conditions, make healthy and nutritious food easily accessible and affordable to urban poor residents and impose taxes on the more readily available processed and high-sugar foods. Our blog on urban greening covers a range of initiatives that promote community gardens and urban farming in informal settlements. 

6. Promote safe and active mobility to school and in neighbourhoods

Road traffic injuries are the leading cause of death for children and young people aged 5 to 29. We must reimagine, reprioritise and rebuild urban streets for people, not cars. Recent publications from Alliance members on safe school streets, designing streets for kids, and cycling for young children and caregivers present tools and actionable examples for making streets safer and healthier for children. You can also get ideas from our blogs on designing safer school zones, open streets and child-friendly street transformations. 

7. Protect and increase children’s access to green and inclusive public and common spaces

Children playing in a child-led and community built green common space in an urban slum in Dhaka, Bangladesh © Archnet

Playing and socialising outdoors and in green spaces is essential for children’s health and development. Being active outdoors reduces the risk of myopia, obesity and cognitive and behavioural disorders. Think big. Put in place inclusive city-wide policies, programs and actions like the Paris Oasis Schoolyards programme to increase children’s access to safe, green and outdoor spaces. For more ideas, read our blogs in the public space for children series and our member publications on solutions for nature-based play and reclaiming play in cities.  

8. Reduce harmful pollution

Waste and air pollution degrade ecosystems and pose severe health risks, particularly to children under five. Poor waste management and increasing hazardous waste in cities are also increasing children’s exposure to toxic and heavy metal poisonings.

Many of the drivers of air pollution (i.e., combustion of fossil fuels) are also sources of greenhouse gas emissions. Policies to reduce air pollution, such as using clean cookstoves or fuel-efficient vehicles, therefore, offer a win-win strategy for both climate and health, lowering the burden of disease attributable to air pollution and contributing to the near- and long-term mitigation of climate change.  

Governments and other stakeholders must invest in monitoring and measuring pollution levels in low-income neighbourhoods, schools, and health centres and put stringent policies and actions in place to reduce harmful pollution levels. Nation-wide clean air programs,  clean cookstove initiatives in slums, clean air programs in kindergartens, youth-led campaigns, and advocacy to reduce air pollution and improve waste management in cities are some ideas for action.  

9. Improve access to affordable and quality healthcare and strengthen health systems

Children and caregivers in slums face several barriers to accessing quality healthcare, including high costs and poor quality. Further climate disasters like floods wash out roads, interrupt electricity to health centres and disrupt transportation services, impeding access to health and emergency services where and when they are most needed. 

National and local governments must invest in improving sustainable health systems to reach the most in need at the last mile and engage in multistakeholder approaches to leverage innovation and technology to drive scalable and equitable healthcare solutions. The International Society for Urban Health’s Active-Learning Resource Center offers a simple and actionable toolkit and project examples from around the world to drive greater health equity in cities. 

10. Innovate for quality and affordable childcare in low-income neighbourhoods

© Hanna Adcock / Save the Children

Affordable and quality childcare is sorely lacking in urban areas where caregivers have little time to balance caregiving and workplace demands. Providing nurturing care, which includes good health, adequate nutrition, safety and security, responsive caregiving, and opportunities for learning for young children, assures a healthy start in life with life-long benefits and supports women’s capacity to contribute to household incomes. Read our blog on innovative approaches to childcare in slums for more ideas.  

11. Advocate for and implement child-responsive urban planning

According to a 2014 report, 75% of infrastructure for areas that will be urban by 2050 has yet to be built. Child-responsive urban planning can go a long way in accommodating growing urban populations in healthy and liveable places. The Van Leer Foundation’s Urban95 initiative and Proximity for Care Design Guide, UNICEF’s Shaping Urbanization for Children, and Arup’s Designing for Urban Childhoods guide all showcase tools, guidelines and actionable examples for planning and designing child-friendly cities. 

Children playing in the reclaimed and redesigned street spaces © GDCI

Apart from these actions, the World Health Organization’s Healthy Cities Initiative in Southeast Asia and Europe and Bloomberg Philanthropies’ Partnership for Healthy Cities have several tools and actions that promote health in cities.  Key to implementing these actions are innovative financing models, leveraging technology and innovation for inclusive development, building and sustaining multistakeholder partnership platforms for advocacy and action, and working with faith-based organisations, grassroots networks and community-based organisations in slums and informal settlements to recognise and respect local priorities and co-develop and implement locally relevant solutions. 

About the Author 

This blog was written by the Urban Hub Team at Save the Children International. Many thanks to Sheridan Bartlett, Lani Crane and Hayalnesh Tarekegn for reviewing earlier versions of this blog and for their insightful comments, which significantly strengthened the blog. 

The Ideas for Action Series showcases ideas for action, innovation, programmes, policies and practices that make public spaces child-friendly. Read more of our blogs here. 

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