Invisible Fault Lines: Health Inequities and Resilience in Informal Urban Settlements

Rapid urbanization in Africa has outpaced the capacity of health systems to adapt, exacerbating health inequities and creating unique challenges in delivering equitable and resilient care [,]. Urban poor populations, especially those living in informal settlements, face disproportionate burdens of communicable and non-communicable diseases due to overcrowding, poor sanitation, limited access to essential services, and weak health infrastructure []. These vulnerabilities underscore the urgent need to reconfigure health systems to address the complex interplay between urban growth, poverty, and health. Building resilience within African health systems requires integrating lessons from fragile settings and recognizing urban contexts as critical determinants of population health []. Decentralization and community-based governance models are pivotal in strengthening equity, efficiency, and adaptive capacity, particularly in fast-growing cities []. Such approaches align with global commitments under the Sustainable Development Goals, especially universal health coverage (UHC) and the call for inclusive, people-centered systems []. This chapter critically examines the intersection of urbanization and health in Africa, highlighting pathways to build resilient health systems capable of addressing current challenges while preparing for future shocks. It draws on evidence from the Lancet Commission on the future of health in sub-Saharan Africa, which emphasizes innovation, governance reforms, and stronger partnerships as essential for achieving longer and healthier lives for all Africans by 2030 []. Ultimately, addressing urban health inequities through resilient systems is not only a technical necessity but also a moral imperative for sustainable development across the continent.