Getting news of an occasional sick or deceased citizen is a normal part of your work as a Cities: Skylines mayor. But when a large number of your citizens start getting ill and dying at the same time, it sets off a few alarm bells.
So just to help you whittle down this problem, your citizens could be getting sick for any of the following reasons:
- Sewage backing up
- Contaminated water
- Ground pollution
- No access to healthcare
In this guide we’ll explain how to address these problems & get your city’s health back on track.
Cause #1: Sewage Backing Up
Sewage backing up is one way for a large number of your citizens to get ill.
Check that your water pipes are connected to a properly operating drain pipe. The drain needs electricity, so don’t forget to hook it up to your power grid.
You’ll also have to make sure you build enough sewage drain capacity as your population grows.
Cause #2: Contaminated Water Source
It’s crucial that your pumping stations and water towers are taking in clean water.
Your citizens will get sick if their water source gets contaminated by pollution.
The most common cause for this is if a water pumping station is taking in wastewater from a nearby drain pipe. Gross!
You must make sure that your drain pipes (wastewater going out) are downstream from your water pumping stations (clean water going in). The water pumping station and drain pipe are visually similar, so it’s easy to confuse the two.
Water pollution spreads a bit (especially if you have several pipes in one area), so as much as possible, keep your water intake pumps as far away from the drain pipes as possible.
If you’re using water towers instead of pumping stations, it’s ground pollution that you need to check for.
Placing your water towers on polluted land will contaminate the water in it.
Cause #3: Ground Pollution
On the subject of ground pollution — your citizens can get sick if ground pollution affects their homes.
Clicking the Pollution info view will show you the affected areas.
Among the buildings that generate ground pollution are:
- Generic industry
- Garbage facilities
- Coal and oil power plants
So keep these away from your residential zones!
A good tip is to zone offices next to your residential zones instead, as offices don’t generate ground pollution.
Cause #4: Noise Pollution
While citizens aren’t as sensitive to noise as they are to water or ground pollution, they can still get sick from noise pollution if it’s bad enough in their homes.
The noise pollution view (the orange headphones on the info views panel) will let you see the noisiest spots, indicated by an orange color.
Here are a few ways to mitigate noise pollution in your towns:
- Zone generic industry away from your residential zones. Office spaces can provide a good buffer between the two since they don’t generate noise.
- Opt for highways with sound barriers and don’t zone residences too close to them
- Garbage facilities and power plants generate a lot of noise so keep them away from homes as much as possible!
- Unique buildings and monuments can produce various amounts of noise, so check the tooltip for each one before placing it.
- You can safely zone commercial buildings right next to your residential zones as long as you do so sparingly, and not in large clusters. Think one or two corner shops every couple of blocks.
- Adding trees can reduce the amount of noise in an area if used in large numbers.
Cause #5: No Access to Healthcare
Even if your city is generally clean and quiet, you will still get the occasional sick citizen. This is normal, and shouldn’t be a problem for you — as long as you have healthcare facilities to take care of them.
If your citizens don’t have access to healthcare, disease can spread in an area, so make sure they’re covered.
The most basic healthcare facility that you can unlock is the medical clinic, which you unlock upon reaching the Tiny Town milestone. Sick citizens can walk or be brought there by ambulance.
Later in the game you can unlock the hospital, which is expensive, but serves a much larger number of patients and has more ambulances.
|Building||Milestone to Unlock||Build Cost (₡)||Patient Capacity||Ambulances|
|Medical Clinic / European Medical Clinic||Little Hamlet||10,000||100||8|
|Hospital / European Hospital||Busy Town||65,000||500||30|
Note: The differences between the Medical Clinic/Hospital and their European counterparts are purely cosmetic.
Cause #6: The “Death Wave”
The dreaded “death wave” is when a high number of your citizens start to die, presumably of old age, at around the same time.
It happens even in fairly well-managed cities, usually as a result of having had a large number of citizens move into your city at the same time (say, if you zoned a large amount of residential while demand was high).
If this happens in your city, the only thing you can really do is ride it out and make sure you have enough death care facilities to handle the sudden demand. You’ll find cemeteries and crematoriums under the Healthcare build menu as well.
If your existing cemeteries and crematoriums are overwhelmed, consider building one or two additional facilities just to handle the wave, if you have the cash. You can just switch off the new extra facilities (to avoid the upkeep costs) or move them to a new part of the city, once the current death wave settles down.
|Death Care Facility||Milestone to Unlock||Build Cost (₡)||Capacity||Hearses|
Tip: Health Boosting Facilities
Apart from the clinics and hospitals to take care of the sick, the game also has buildings meant to boost the health of your citizens.
You’ll find two in the base game, three in the Green Cities DLC, and one in the Snowfall DLC.
|Building||DLC Required||Milestone to Unlock||Build Cost (₡)||Effect|
|Child Health Center||none||Boom Town||18,000||
Increases birth rate within its radius
Health benefit to children and teens
Visitor capacity: 50
|Elder Care||none||Boom Town||22,000||
Increases lifespan of elderly within its radius
Health benefit to the elderly.
|Sports Hall and Gymnasium||Green Cities||Tiny Town||120,000||
Health benefit to area
Visitor capacity: 180
|Community Pool||Green Cities||Busy Town||75,000||
Health benefit to area
Visitor capacity: 120
|Yoga Garden||Green Cities||Small City||90,000||
Health benefit to area
Visitor capacity: 90
Health benefit and happiness boost to nearby area
Visitor capacity: 60
Healthy City Checklist
Here’s a quick recap of the things you need to do to take care of your citizens’ health!
- Check that their sewage is draining properly
- Keep an eye out for any contamination in their water supply
- Keep residences away from polluting buildings and industries
- Make sure it isn’t too noisy where people live
- Provide adequate access to healthcare facilities
- Have cemeteries or crematoriums ready for people dying of old age
- Boost your citizens’ health with child care, elder care, and fitness facilities
- Cities: Skylines Sick Citizens (6 Main Causes & Fixes)