III health unleashed? Cities and municipal services in Ghana

Increasing urbanisation, wealth and ill health in cities necessitate careful study, especially in African cities whose development is widely regarded as rapid and chaotic. Using Ghanaian cities as a case study, this article analyses some of the important sources of ill health, identifies why they persist, and assesses how they impinge on economic growth, redistribution, and poverty reduction. It argues that, although there is considerable evidence that policy change is urgently needed, the tensions and contradictions between economic and social efficiency, intermeshed with vested political interests, are likely to impede significant changes to the status quo.