Rapidly growing cities represent unique challenges and opportunities. Unplanned growth often outpaces infrastructure development and occurs at the expense of a city’s ecological foundations, undermining residents’ wellbeing and the city’s sustainability.

The SEI Initiative on City Health and Well-being uses novel approaches to investigate how evolving cities are affecting the well-being of residents and how this interacts with the overall health of city systems: What makes a city healthy for its residents? Could citizens be actively engaged in monitoring the health of their city? These are some of the central questions informing our initiative case study activities in Asia and Africa.

Novel methods of data generation and collection have been employed across four interconnected activities in two case study locations (Nakuru in Kenya and Udon Thani in Thailand). These activities are:

  1. Understanding the impact of urban forms’ impact on health and wellbeing
  2. Co-designing urban citizen science monitoring
  3. Urban metabolism and participatory modelling
  4. Governance for greater urban equity and inclusion

The research is contributing to a rethink of urban development practices. The knowledge generated through this action research and boundary partner engagement will inform sustainable and participatory planning for urban environments.

The new evidence we generate will be aimed at guiding policy recommendations to equitably maximize the well-being of urban populations while minimizing resource consumption and without undermining their resilience.

Environmental monitoring with citizen science in Nakuru, Kenya

Can citizen-led monitoring help local governments manage cities better and improve services to people? This was the question CHeW investigated through environmental monitoring using citizen science techniques.

SEI supported environmental leaders from a community in Nakuru, Kenya using a data collection app called Epicollect to map out environmental challenges facing their local area. EpiCollect enables questionnaires to be created which are then accessible on mobile phones. User responses to questions are linked to their locations using the phone’s GPS.

Between April and June 2019, a group of 15 Environment Champions surveyed their neighbourhood (called Free Area) taking pictures of problem areas and documenting the status of them over the time-period. The SEI team helped co-organize information collection activities and afterwards shared findings back to the community and local government representatives including public health officers, County Government and County Assembly, Nakuru Water and Sewerage Company (NAWASCO), ward administrators, garbage collectors and the Area Chief, during a workshop held in mid-2019.

The survey brought a focus on the dominant issues which were related to waste (open dumping) and water and drainage (leaking/broken water and sewer pipes, and open or unsafe manholes). The data from the survey was also mapped so that users are able to identify where the problems were and to help the relevant authorities resolve them.

Nakuru, Kenya is a town of about 500,000 people, northwest of Nairobi on the shores of Lake Nakuru. The image above shows a snapshot of the environmental monitoring by the people of Free Area neighborhood. Click on the image to open an interactive visualization (on a separate webpage).

This is one example of how, through the CheW initiative, SEI is striving to catalyze citizen-led activities within rapidly growing cities and to embed them into improved urban governance practices.

Fluorosis and emerging water pollutants in East Africa


Fluorosis is a widespread disease caused by excess Fluoride intake. The World Health Organization considers Fluoride as one of 10 chemicals of major public health concern. Fluorosis impairs dental and skeletal health, child development, and has other health consequences.Excess Fluoride in drinking water is the most common cause. 

Fluoride occurs naturally in certain mineral geologic formations around the worldThe East African Rift Valley is one of the global hotspots and in Nakuru county (Kenya), effects of Fluorosis were found in over 75% of people tested at 2 health facilities.

In addition, emerging contaminants, including pharmaceuticals in water bodies, are increasingly impacting environmental and human health. Exposure and impacts of these are less clearly understood. 

Exploratory workshop for South-South Cooperation

A workshop was held on 18th June 2021, with participants drawn from Kenya (Nakuru), India, UK and USA.  Funded by the University of York (UK), and organized by SEI, the workshop brought together international and local experts, practitioners and Nakuru city stakeholders with the aims of: 

  1. Reviewing the state of knowledge and practice on Fluoride and other water contaminants in the Rift Valley, with a focus on Nakuru town and county. 
  2. Expanding knowledge on differential exposure of city residents to excess Fluoride from different water sources. 
  3. Compiling information and insights on local and regional solutions.

A summary workshop report will be available in Autumn 2021.

Pilot study

The workshop followed research undertaken during the earlier phase of the City Health and Well-being Initiative. A pilot survey was conducted by SEI (with support from Umande Trust) whereby water samples were taken from different neighborhoods in Nakuru to establish the levels of fluoride and other contaminants present. 

Read about the study in the following feature.

What does a healthy and liveable city look like? The residents of the Northern Thailand city of Udon Thani provide their perspectives.

Presentation by Heidi Tuhkanen for Climate Exp0.

A series of mini presentations on digital participatory tools made at the Nature of Cities Festival 2021

Fluorosis, caused by excess fluoride intake, affects millions of people around the world. SEI is working with local communities and Indian doctors on managing Fluorosis risk in Nakuru, Kenya. A combination of water supply management and community sampling is helping better understand the scale of the problem, and its solution. Part 1 – describes the work undertaken by doctors from Ramaiah Medical Centre (India) transforming the health of school children in the village of Kaiwara . They explain how they identified that fluorosis was a serious health issue and how they succeeded in providing safe water to the village. Presenter: Vishal K. Mehta – SEI Interviewees: Arjunan Isaac, Nanda Kumar – Ramaiah Medical Centre, Bengalaru, India Video Production: Aditi Rajeev

Read more about the work being undertaken.

Part 2 – describes the transfer of knowledge from doctors from Ramaiah Medical Centre (India) to the city of Nakuru, Kenya. Initial research carried out using citizen science to look at water quality identified high levels of Fluoride in groundwater. The doctors explain how lessons learnt from their reducing fluorosis in their village can be introduced and scaled-up in Nakuru. Presenter: Vishal K. Mehta Interviewees: Cassilde Muhoza, Romanus Opiyo – SEI; Arjunan Isaac, Nanda Kumar – Ramaiah Medical Centre, Bengalaru, India Video Production: Aditi Rajeev

Ontological frameworks applied to Smart City research and policy

As part of the City Health And Wellbeing (CHEW) initiative, Dr. Arkalgud Ramprasad was invited to present his work on ontological frameworks applied to research, policy, and practice. CHeW is particularly interested in how such a framework can be applied to sustainable cities.

Dr. Ramprasad is Professor Emeritus in Information and Decision Science at the University of Illinois, Chicago, and the Director of the Ramaiah Public Policy Centre in Bangalore, India.  His talk, entitled “Systematic Policymaking Using Ontologies: How to Make the ‘Elephant’ Dance”was hosted in Davis, California by SEI’s Vishal Mehta. A shortened version of his presentation, focusing on Smart Cities, is available here.

Participatory mapping activities – before data collection in Nakuru (left) and an example completed map for one neighbourhood (right). Photo: Steve Cinderby / SEI

Climate Exp0 poster

Urban Greenspace Wellbeing Benefits in Low and Middle Income Countries
By: Heidi Tuhkanen, Steve Cinderby and Annemarieke de Bruin

Climate Expo0 poster – Click for PDF version

Presentation at the ClimateExp0 conference for researchers showcasing recent international research relevant to decisions being made at COP26 in November 2021.

Heidi Tuhkanen presents an overview of the City Health and Wellbeing project for ClimateExp0 , May 2021.