Consequences of a city's actions can extend far beyond its limits. The impact of urban development on the environment is a significant concern. Scores from the Municipal Performance Index 2020 reveal shortcomings in key areas, with health being the lowest rated.

Sanitation and waste management also received low scores, indicating a need for improvement. The presence of contaminants in sewage is a major issue, with many treatment plants unable to handle them.

Further information on the effects of urbanization and city governance can be found through the Municipal Performance Index 2020. Details on the scores and the impact of urban development are available from the source.