I don't remember this aspect of civilization ever being a concern in any other 4x I've seen. I could be wrong though.

Regardless, I don't think it would add anything interesting to the game. Probably just more tedium, especially when infrastructure expands.

Don't need it, just more micromanagement garbage.  Although a hospital or something that let units health recover faster would be usful.  Or simply just make health recover faster in cities than it does now, yea, thats even better.

Hospitals or healing structures is understandable and I'm also suprised none were included. All the Civilizations had them (minus maybe 5), FFH had them, and I believe that Gal Civ had something to do with it... maybe... maybe not.

Sanitation or sewers... not so much. I can see how they could miss this.

In fantasy setting, sewers are purely a quest area, and have nothing to do with sanitation 

In general, 4x games have used sanitation as a method of curbing rapid growth. In the civ series, you had city health as the problem which required hospitals and clean food sources. In the TW series, you build sewers and baths to help prevent an outbreak of plague which is probably one of the worst things that can happen to a city in those games as it affects stationed units as well as the populations.

I think this is kind of a cop out. Elemental is far from "magic heavy", as every magic user in the entire game supposedly comes from the single source of the sovereign, who himself doesn't really heal people. While I understand that sanitation and health seems like it would add a large amount of undue micromanagement, most games do not implement them with this in mind. Generally, the idea is simply a method to limit city growth by using an understandable mechanic. On top of this, does heavy magic somehow make people no longer require to take baths or use the restroom? 

It seems like the only building constructions are those that are: gold, knowledge, arcane, military, and diplomatic related. It's like the game wants to be a city-builder (choosing city sites, buildings to build, research, caravan routes), but stops short & doesn't go the whole way. It's like a 50% city-builder strategy game. In my opinion, it seems they abstracted anything out of the game that wasn't related to the 5 catagories above .. from my POV this game is 50% of a strategy game and 50% of a RPG mixed together.

Personally, I would like to see a huge in-depth city-building mechanism like civ, but most players would not like that level of macromanagement unless there were advisors or automated construction (I'd presume anyway). Sewers & hospitals would be a great way to increase or decrease (their lack) population growth.

Then what's the point? Under this model there's no decision making at all. Once you get to size X, you need the building. You spend the time to build it, and then you forget it exists for the rest of the game.

I'm not seeing the part where this adds a game mechanic that contributes something to the game. It's complexity for the sake of complexity.

Like Kinghobbit said, you get this for every building, but if you want complexity you can add something with the level of the city: specialisation. I explain: when you level your city, you get certains bonus (20% or random units) but you could simply add another layer for lvl 4 and 5 like if you choose to specialise your city Between Civilisation/Warfare/Adventure/Diplomacy/Magic, then you get special building attach to that specialisation. You make some choice to determine if you want a city that will produce your equipment, finance and health (civ) or maybe some uber army with special abilitys (warfare) or maybe special quest or ressource (elementium) (adventure) or maybe a special unit that can advantage you in your relation like spy or diplomat (diplomacy) or maybe some magic mechanism (magic). That could be fun.

Well, I dont think that the poster wanted to "add" sanitation in the game, but add some building that reflect a good sanitation and add some bonus for clean city.

And that's one of the biggest problems with the game. You don't think about bulidings. You just plop them down whenever you gain the ability to do so.

Adding more of that doesn't fix the problem. It's just more problem. Adding sanitation for the sake of adding sanitation does nothing to make the game better. That's the part I'm waiting for - what game mechanic goes with this and how it improves the game.

It's not so much about city spamming but still completely unspecialized cities. Level-up bonuses don't make a city specialized. Every city is still an economic and military city, just slightly more or less so than others. This isn't specialization.. 

I would like to see a richer city builder in the game as well.  Perhaps an expansion would be better suited for that than 1.1.