By 2050, antimicrobial resistance (AMR) is predicted to have caused 40 million deaths globally. In the same timeframe, almost 70% of the global population has been projected to be living in urban areas. 90% of this urbanisation will occur in Africa and Asia, regions most burdened by AMR. Urbanisation is linked to an abundance of pathogens in soil, drains, and water. Yet, research and action on the convergence of AMR and rapid, often informal, urbanisation are scarce.
Urban informal settlements often house large numbers of cities’ residents in self-organising and self-governing communities because of structural and systemic neglect. Residents in urban informal settlements face problems, such as insecure tenure and land rights; poor urban planning; inadequate water, sanitation, and hygiene; and disproportionate exposure to waste, pollution, animal disease, and extreme weather events, creating conditions that drive AMR. This inequitable distribution of harms constitutes an environmental justice issue, wherein marginalised communities in urban informal settlements face high exposure to, and burden of, antimicrobial-resistant microbes. Poor access to health care and precarious livelihoods without sick pay drive reliance on trusted, informal health-care providers as a survival tool for immediate health and economic needs.
This paper calls for visibility for urban marginalised populations by identifying and addressing the context-specific disparities driving transmission; bottom-up evidence generation and AMR governance approaches that support accountability for those at greatest risk; and embedding AMR as a priority into slum upgrading and urban development strategies for effective and equitable AMR responses.
Full citation
Rosie Steege, Anne Ngunjiri, Sabina Rashid, Adam P Roberts, Katy Davis, Kate Hawkins, Ralalicia Limato, Joseph Kimani, Clarissa Magdalena, Russell Dacombe, Sally Theobald, Invisible nexus of antimicrobial resistance and urban informal settlements, The Lancet Global Health, 2026, 103952, ISSN 2214-109X, https://doi.org/10.1016/j.langlo.2026.103952.
