Africa’s rapid urbanization often exceeds the capacity of governments to provide essential services and infrastructure, exacerbating structural inequalities and exposing vulnerable populations to serious health risks. This paper examines the case of Douala, Cameroon, to demonstrate that health inequities in African cities are not simply the result of urban growth but are shaped by spatial inequities, historical legacies, and systemic exclusion. Disadvantaged neighborhoods are particularly impacted, becoming epicenters of health crises. Using a mixed-methods approach combining spatial analysis, household surveys and interviews, the study identifies three key findings: (1) Healthcare services in Douala are unevenly distributed and dominated by private providers, which limits access for low-income residents. (2) Inadequate infrastructure and environmental risks in informal settlements lead to a higher disease burden and an overflow of demand into better-equipped districts, which overwhelms public health centers across the city. (3) This structural mismatch fuels widespread reliance on informal and unregulated care practices. This study positions Douala as a microcosm of broader public health challenges in rapidly urbanizing African cities. It highlights the need for integrated urban planning and health system reforms that address spatial inequalities, strengthen public health infrastructure, and prioritize equity—key principles for achieving the third Sustainable Development Goal (ensuring good health and well-being for all residents) in sub-Saharan Africa.

The Gambia’s coastline, known for its unique ecosystems and vital role in the country’s economy through fisheries, tourism, and agriculture, is becoming increasingly vulnerable as a result of the combined effects of climate change and human activity. This coastline sustains an important portion of the population by providing livelihoods and contributing to food security, as well as housing critical infrastructure including ports, urban areas, and tourism hubs. However, as climate change intensifies pre-existing vulnerabilities, such as increased sea-level rise, coastal erosion, and extreme weather events, these socio-economic assets are becoming more and more vulnerable. As a result, this study focused on investigating the physical vulnerability of the coastline in the context of climate change. The vulnerability assessment was conducted using the coastal vulnerability index approach, utilising a combination of oceanographic data, remote sensing, and field observations. The research outcomes supported the identification of key areas at risk and examined the contributing factors such as tidal ranges, storm surges, and human activities. The findings highlight the immediate and long-term threats to coastal communities, infrastructure, and natural habitats. Due to the vulnerability provided by geological and geomorphological factors, the average Coastal Vulnerability Index (CVI) score of 29 indicates a high level of exposure to coastal hazards from Buniadu Point to Barra. From Banjul to Cape Point, the average coastline dynamic rate is positive at 0.21 m/year, indicating some accretion. Despite this, the CVI score of 22 indicates significant vulnerability to coastal hazards from Bald Cape to Salifor Point. The study also explored potential mitigation and adaptation strategies to enhance coastal resilience to sea-level rise, coastal erosion, and flooding. Integrated and sustainable strategies were outlined to support policy-making and community-based initiatives towards safeguarding coastal regions of The Gambia against the backdrop of climate change.