A new study is challenging one of the most persistent assumptions in urban research: that the greatest living-condition problems are concentrated in the world’s largest and most visibly crowded cities. According to research published in Nature Cities, small and medium-sized cities can contain substantial deficits in housing, infrastructure and everyday services that remain largely invisible in national statistics and global urban rankings. These places may not produce the dramatic skylines, congestion or informal settlements that attract international attention, yet many residents can face living conditions comparable to, or in some cases worse than, those found in much larger metropolitan areas.
The finding matters because urban policy is often guided by broad averages. A country may appear to have made strong progress in housing, sanitation or access to services when conditions are measured at the national level, while serious shortages persist in particular cities and neighborhoods. Large cities also tend to dominate global datasets, academic research and development funding. Their problems are more frequently mapped, surveyed and reported, creating a feedback loop in which visibility attracts resources and lack of visibility allows deficits to continue. The new research places smaller urban centers at the center of that blind spot.
Living conditions are not a single variable. Researchers commonly evaluate them through combinations of indicators, including the quality and durability of housing, access to clean water and sanitation, electricity, roads, schools, health facilities and reliable transportation. Such measures can be combined into composite indices, but the result depends heavily on the scale at which data are collected. When information is averaged across an entire city or administrative region, severe problems in specific districts can disappear inside an apparently acceptable citywide score. This statistical smoothing is one of the mechanisms that can make deprivation “hidden.”
The problem is intensified by the way cities are defined. An urban area may be divided among municipal boundaries, census districts and informal settlements that do not correspond neatly with one another. A small city surrounded by rural communities may be classified differently from a dense suburb attached to a major metropolitan area, even when residents experience similar infrastructure shortages. Comparisons can therefore be distorted by inconsistent definitions, incomplete population registers and surveys that sample too few households. The study’s central message is not simply that smaller cities are poorer, but that conventional systems for observing urban inequality can fail to detect their most vulnerable populations.
Technical advances are beginning to expose these gaps. Researchers can now combine household surveys with satellite imagery, geospatial databases, census information and other forms of remotely sensed evidence. Satellite observations may reveal roof materials, settlement density, road connectivity, vegetation loss or the expansion of built-up areas. Nighttime-light data can provide indirect information about electrification and economic activity, although such signals are imperfect and can miss households with unstable or expensive power access. Geographic information systems allow these datasets to be overlaid, making it possible to compare infrastructure and environmental conditions at much finer spatial resolutions than a national average.
Yet more data do not automatically produce a more accurate picture. Remote sensing can identify the physical appearance of settlements but cannot reliably determine whether a household has safe drinking water, affordable transport or dependable access to medical care. A brightly lit neighborhood may still experience overcrowding, insecure tenure or polluted water. Likewise, a road visible from space may be unusable during the rainy season, while a formally planned district may have services that are too expensive for many residents to access. The most credible assessments therefore require technical models to be checked against local knowledge and household-level evidence.
The study also has implications for theories of urban development. For decades, researchers have examined whether cities become more productive and better serviced as they grow. Larger urban areas can benefit from economies of scale: infrastructure networks may serve more people at lower average cost, while concentrated populations can support specialized schools, hospitals and public transport. But those advantages are not automatic. They depend on effective governance, investment and the capacity to extend services across neighborhoods. Conversely, smaller cities may lack the tax base, administrative resources and political influence needed to maintain infrastructure, even when their populations are growing rapidly.
This creates a potentially dangerous policy mismatch. Governments may prioritize megacities because they contain more people in absolute terms, while development agencies may target places that are easiest to compare internationally. Small and medium-sized cities can fall between institutional responsibilities: too urban to qualify for rural programs, but not large enough to receive the attention directed toward major metropolitan regions. If planners rely only on population size or citywide averages, investment may arrive after deficits have become entrenched. Early identification could instead allow authorities to improve water systems, sanitation, housing quality, transport links and public facilities before shortages escalate.
The consequences extend beyond individual households. Poor infrastructure can amplify exposure to heat, flooding, air pollution and infectious disease. Inadequate drainage increases the risk that heavy rainfall will contaminate water supplies, while weak housing materials can make heat waves more dangerous. Limited access to transport can prevent residents from reaching hospitals, schools and jobs, effectively turning distance into a form of inequality. These pressures may be especially severe in rapidly expanding cities where construction outpaces formal planning. Because climate hazards and urban growth are both accelerating, the cost of overlooking smaller cities could rise quickly.
The researchers’ broader warning is that urban progress should be judged by distribution, not appearance. A city does not become resilient merely because it is growing, attracting investment or adding modern buildings. Nor does a national improvement in average living conditions guarantee that residents in every urban center are benefiting. More consistent definitions, higher-resolution data, transparent indicators and sustained local surveys will be needed to reveal where deficits are concentrated and which interventions work. By drawing attention to overlooked urban populations, the study turns a familiar question—how cities grow—into a more urgent one: who is still being left unseen as they do?
Subject of Research: Hidden living-condition deficits in small and medium-sized cities
Article Title: Hidden living-condition deficits in small and medium-sized cities
Article References: Veeravalli, S.G., Blei, A.M., Friesen, J. et al. Hidden living-condition deficits in small and medium-sized cities. Nat Cities (2026). https://doi.org/10.1038/s44284-026-00498-w
Image Credits: AI Generated
DOI: https://doi.org/10.1038/s44284-026-00498-w
Keywords: urban inequality, small cities, medium-sized cities, living conditions, housing, infrastructure, urban development, spatial data, public services, hidden deprivation
Tags: access to basic services in mid-sized citieschallenges in small and medium-sized urban developmentcity size and urban quality-of-life gapsdisparities in urban living conditionsglobal urban rankings and local living conditionshidden quality-of-life disparitieshousing shortages in smaller urban areasinfrastructure deficits in medium-sized citiesresource allocation for small citiesunderreported urban issues in smaller citiesUrban inequality in small and mid-sized citiesurban policy blind spots
