BACKGROUND:
Rapid urbanisation in East and Southern Africa (ESA) is intensifying inequities in health through substandard living, working and social conditions and unhealthy food systems. Inequalities in wellbeing are exacerbated by climate shocks and economic marginalisation. While cities contribute to climate emissions and inequality, they also bring resources and innovations to equity-oriented responses(1,2).

METHODS:
Between 2023-2025, EQUINET has synthesized evidence and learning from the regional urban health community of practice in ESA, through literature review, national and regional dialogues, and 24 case studies. Using grounded thematic meta-analyses, the study identified cross-cutting patterns linking urban systems, climate adaptation and circular economy approaches.

RESULTS:
Evidence from ESA shows how increased urban waste and ambient air pollution, poor diets, working and living standards, and social and climate stress heavily impact on low-income urban communities. It also shows many urban examples of climate-adapted urban food, waste management, energy and green urban systems within holistic, circular economy approaches and using local technology innovations. They bring multi-sector, multi-actor collaborative planning and social participation to urban planning processes, and reduce the emissions, flooding, and economic insecurity that exacerbate climate change impacts on health. However, lack of support of local initiatives and technology development from higher levels, including from climate financing; legal barriers to urban agriculture; lack of disaggregated mapping of urban health and climate impacts and weak inclusion of informal workers and residents in urban planning weaken the scale up of these climate-adapted innovations(3).

CONCLUSIONS:
Urban communities are actively generating solutions for equitable and climate resilient cities. We present from regional dialogue on the practices and their enablers in and challenges for implementation 10 recommendations to build, enable and scale up these innovations, and show how applying these recommendations in ESA can generate climate, economic and health equity co-benefit in urban areas(4).