Urban Waste Management, Air Quality, and Public Health: Assessing the Health Burden of Rapid Urbanization in Sub-Saharan Africa

Rapid urbanization in sub-Saharan Africa (SSA) is placing increasing pressure on waste management systems and urban air quality, with significant health implications.This study integrates cross-city analysis of waste systems, air quality, and health burdens in rapidly urbanizing SSA.It examines the links between waste practices, pollution, and health outcomes in fastgrowing SSA cities using international and national data sources.Inadequate collection, open dumping and burning, and poorly regulated landfills elevate pollutant concentrations, particularly PM 2.5 , frequently exceeding World Health Organization guidelines.Resulting exposures are associated with respiratory and cardiovascular diseases, childhood infections, and premature mortality, disproportionately affecting low-income settlements.These inequities reflect deficits in governance and infrastructure.The study highlights the cumulative health burden of urbanization and calls for strengthened waste systems, reduced open burning, improved monitoring, and integration of health considerations into urban planning to support sustainable African cities.A comparative analysis of waste management, air quality, and related health impacts is conducted across four rapidly urbanizing SSA cities.Rapid urbanization in Sub-Saharan Africa (SSA) is advancing without the institutional, infrastructural, and regulatory capacity required for effective management.Urban populations are projected to double by 2050, with cities such as Lagos, Nairobi, and Kinshasa expanding rapidly and intensifying pressures on governance, infrastructure, and socio-spatial equity (1-3).Limited financing and weak institutions contribute to the growth of informal settlements characterized by overcrowding, inadequate services, and heightened environmental and health risks (4-6).Increasing consumption and waste generation further reveal the inadequacy of prevailing urban development models (2-3,5).Waste management systems remain under-resourced, relying heavily on open dumping and poorly managed landfills, while modern treatment and recycling options remain limited (7-11).Informal waste pickers contribute significantly to recycling yet remain marginalized, and community or public-private initiatives have limited impact without integrated regulatory and behavioral strategies (12-13).Air quality is deteriorating due to emissions from vehicles, industry, open waste burning, and biomass fuel use, often exceeding World Health Organization (WHO) guidelines and resulting in substantial health impacts (14-17).Weak monitoring capacity creates persistent data gaps that undermine accountability and obscure the full economic and health costs (15,18).Vulnerable groups (including children, older adults, and low-income communities) experience disproportionate exposure (14,19).Poor waste management and air pollution jointly intensify public health risks, contributing to infectious, respiratory, and chronic diseases.Mismanaged waste contributes to outbreaks such as cholera and malaria, while air pollution increases the incidence of asthma, lung cancer, and cardiovascular disease (20-21).Urban health systems, particularly in informal settlements, struggle to respond effectively (11,(22)(23).These interconnected challenges increase healthcare costs, reduce productivity, and constrain national development.This study proposes an integrated, justice-focused framework to align environmental and health policies and strengthen equitable, resilient urban health systems (Figure 1).Rapid urbanization in SSA has intensified air pollution through open waste burning, traffic emissions, industrial activity, and biomass fuel use.In many cities, PM 2.5 concentrations exceed international guidelines, increasing the risk of respiratory and cardiovascular diseases and premature China CDC