Satisfaction comes from basic goods being supplied, health, housing, unemployment, poverty, city amenities (parks, towers) and the internet. If approval is below the threshold on election day (40-60% depending on difficulty), the game ends.
Population changes through births, deaths and migration. Causes of death: old age, healthcare gaps, pollution, work accidents, epidemics, famine and war. Income groups are set by the work people do.
Crises break out (epidemics, famine, drought); strong healthcare capacity softens an epidemic considerably.