Health, wellbeing and nutrition: Domain report

Working Paper 15

Cecilia Tacoli, Rachel Tolhurst, Paul Currie, Henry Bazira, Wiseman Chijere Chirwa, Lamech Malekano Chimphero, Ayagirwelarha Cishibanji, Katy Davis, Mary H Hodges, Muallem Kamara, Liliane Nabintu Kabagale, Regina Mamidy Yillah, Veronica Mwangi, Inviolata Njoroge, Bossisi Nkuba, Andrew Gerald Omoding, Lilian Otiso, Samuel Owuor, Nicola Rule, Gloria Seruwagi, Maria Ssematiko, Sia Tengbea and Hamid Turay

June 2024


The escalation of global political, economic and ecological crises and associated price surges has contributed to interdependent forms of malnutrition – undernutrition, overweight and obesity – with enduring societal consequences. This study investigates the factors influencing the adoption of healthy diets in five African cities – Bukavu, DRC, Freetown, Sierra Leone, Kampala, Uganda, Lilongwe, Malawi and Nairobi, Kenya. It explores the engagement of policymakers, consumers, private actors and further stakeholders in food and health systems. Across all cities, rising food insecurity and the prevalence of non-communicable diseases (NCDs) linked to unhealthy dietary patterns, notably around consumption of ultra-processed foods, are observed. Despite urban residents generally experiencing lower food insecurity than rural counterparts, people with low incomes, particularly those living in informal settlements, remain vulnerable. Additional axes of vulnerability that intersect with low incomes are gender, age, disability and migrant/refugee status.

Socioeconomic drivers that exacerbate food and nutrition insecurity include the high cost of nutritious diets, inadequate market, road, water and sanitation infrastructures, and the proliferation of unhealthy processed foods. Policy responses predominantly prioritise food quantity over quality, overlooking the importance of healthy diets. Additionally, profit-driven dynamics, within food and healthcare systems, and inconsistent resident knowledge of healthy, balanced diets, perpetuate the cycle of ill-health driven by poor nutrition, while informal food vendors, vital for low-income urbanites, face neglect or harassment.

However, city governments possess avenues for intervention, such as awareness campaigns, social security mechanisms, and social and technical infrastructure support for water and sanitation, markets and street vendors. Primary healthcare services and community health workers play crucial roles in addressing malnutrition, youth development and adolescent health. Multisectoral collaboration is advocated for broadening the impact of strategic interventions from neighbourhood to city level. Reform efforts necessitate broad coalitions, encompassing governments, civil society and the private sector.


Healthy diets, health, nutrition, food environment, urban poverty, urban food systems, health systems, wellbeing