The health, wellbeing and climate benefits of slum upgrading

Upgrading informal settlements can foster wellbeing while also building resilience to climate change, particularly when equitable, far-sighted strategies seek to partner closely with communities and address multiple health risks.

Article, 09 June 2022
Urban health equity
Multifaceted partnerships to promote the social, environmental and political determinants of urban health
A group of women gather round the entrance to a building.

A group of women gather round the entrance to a building following a slum upgrading in Zambia (Photo: Slum Dwellers International via Flickr, CC BY 2.0)

Informal settlements are home to up to 60% of city dwellers in many low- and middle-income countries. These areas vary widely, but often have low-quality shelter, minimal services and unsafe locations. 

At the same time, they can provide low-cost housing and often host a range of informal economic activities. 

By 2030, it is projected that almost one in seven people globally will live in informal settlements. As part of the 2030 Agenda, Sustainable Development Goal 11 on cities includes a target to 'ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums’.

When done well, slum upgrading can address multiple environmental determinants of health and deliver interrelated improvements in land tenure, housing, infrastructure, employment, health services and political and social inclusion. 

But upgrading initiatives have varied widely and may struggle to achieve these possible benefits. 

While some produce high-quality living conditions that greatly reduce illness, injury and premature death, other initiatives have offered few improvements and only continue to exclude residents. 

And although upgrading is widely recognised as a way to enhance shelter and promote economic development, few policymakers have recognised the initiatives’ significant potential to improve health equity. 

What IIED has done

There is scant research on the health benefits of upgrading informal settlements, as these initiatives are not viewed as a vital health-promotion strategy. David Satterthwaite wrote: “There are few measures with greater potential to transform wellbeing than a well-directed, participatory upgrading programme for ‘slums’ or informal settlements [but] this is not seen as a health intervention.”

Indeed, our review of slum upgrading evaluations from cities across Asia, Africa and Latin America found that few capture the multiple health benefits of upgrading. 

We recommended that policymakers adopt a ‘health in all policies’ framework to incorporate health in decision-making and ensure that upgrading initiatives can fulfil their multiple benefits for health and wellbeing. 

To highlight the importance of informal settlement upgrading for promoting both health and climate resilience, we contributed to research in Nairobi’s informal settlement of Mukuru

Discussing key interventions and lessons to help fulfil the potential of upgrading for health, climate resilience and inclusion, our report identifies ten priority upgrading interventions that can yield multiple social, economic, climate, health and environmental benefits. 

While the priority interventions are specific to Mukuru, they can also help to inform multifaceted upgrading efforts in other cities seeking to foster health and climate-resilient development.

Supporting community-led processes

Upgrading has often been driven by communities, and much of the innovation is found in partnerships between local governments and residents’ organisations, including slum/shack dweller federations.

Community-driven processes are often founded upon residents’ own data collection (such as mapping, settlement profiles and enumerations), while local governments can provide the connections to all-weather roads, water mains, sewers and storm drains that communities can connect to. 

IIED has helped to document and disseminate key lessons on community-led upgrading processes, including in Environment and Urbanization. We continue to work closely with Slum Dwellers International (SDI), the Asian Coalition for Housing Rights (ACHR) and other grassroots partners to advocate for equitable, multifaceted upgrading partnerships that can generate important benefits for health and resilience.

Associated resources 

The implications of informal settlement upgrading programs for access to water, sanitation, and public health, David Satterthwaite, Alice Sverdlik (2021) 

Realising the multiple benefits of climate resilience and inclusive development in informal settlements, C40 Cities Climate Leadership Group, UN-Habitat, ICLEI – Local Governments for Sustainability, Cities Alliance, IIED, Slum Dwellers International (2019) 

Slum upgrading and health equity, Jason Corburn, Alice Sverdlik (2017), Int. J. Environ. Res. Public Health 2017, 14(4): 342 

Why is urban health so poor even in many successful cities?, David Satterthwaite (2011), Environment and Urbanization, 23(1), 5-11


Anna Walnycki (, senior researcher, IIED's Human Settlements research group