Environment & Health Research Unit

Urbanization and Health

More than half of the world’s population now lives in cities, and more than two-thirds are expected to do so within the next 30 years. The health of the world’s people is therefore increasingly a matter of urban health. However, urban growth, especially in sub-Saharan Africa, has occurred mainly in informal settlements and other areas of concentrated disadvantage, with the prospect of increasing burdens of ill health and rising inequities. In order to gain an understanding of differentiation within cities, an increasing number of studies are now trying to provide a finer picture of urban socio-economic gradients.

With a high and rising GINI coefficient (0.59 in 1995, rising to 0.72 in 2005/6), South Africa is amongst the most unequal societies in the world. Johannesburg is South Africa’s largest city, with a population of around 3.2 million people. However, Johannesburg is also part of a larger urban agglomeration, including the municipalities of Tshwane (Pretoria) and Ekurhuleni, with a total population of more than 10 million people. Among the biggest challenges faced by city managers in Johannesburg are high levels of poverty and inequity, rapid urbanization and a process of ‘unbundling’ of households towards the formation of smaller units (with a concomitant increase in demand for housing and basic environmental health services). Thus the remarkable housing delivery efforts of the past decade in the region have been undermined to some extent by increasing demand. For example, between 1996 and 2001 the number of households living in free-standing dwellings increased by around 475 000. Yet over the same period the number of households living in informal dwellings increased by around 166 000 (SSA, 1998; SSA, 2003). As a result, a large proportion of poor Johannesburg households continue to be housed in informal settlements, backyard dwellings and areas of inner city degeneration.

To further investigate the health dimensions of urban life, the Johannesburg-based World Health Organisation Collaborating Centre for Urban Health (WHOCCUH) initiated, in 2006, a study to monitor socio-environmental conditions and health status in five Johannesburg housing settlements over a period of five years. The WHOCCUH is an urban health research & policy partnership of the South African Medical Research Council, the University of Johannesburg, the University of the Witwatersrand and the City of Johannesburg. The working title of the project is the Health, Environment and Development (HEAD) study. In consultation with senior City of Johannesburg officials, five sentinel sites were selected on the basis of their perceived status as sites of relative impoverishment and rapid change. The sites were also selected to reflect the predominant housing types (inner city, high-rise, mass-based low-cost housing from the apartheid and democratic eras and informal settlements) available to the urban poor in Johannesburg. The aim of this paper is to describe, using data from the first year (2006) of the 5-year HEAD study, the variation across the selected study sites in terms of a range of variables: economic, social, health and environmental. It then identifies the policy implications of this more disaggregated picture of urban life.

Selected Publications from the Head Study
(copies are obtainable from Ms Mirriam Mogotsi – mirriam.mogotsi@mrc.ac.za):

• Combrink A, Irwin N, Laudin G, Naidoo K, Plagerson, Mathee A. Highly elevated prevalence of Hookah Pipe smoking among secondary school students in a disadvantaged community in Johannesburg. South African Medical Journal, 2010, 100(5): 297-299.
• Plagerson S, Patel V, Harpham T, Kielmann K, Mathee A. Does money matter for mental health? Evidence from the Child Support Grants in Johannesburg, South Africa (Global Public Health - in press)
• Mathee A, Harpham T, Barnes B, Swart A, Naidoo S, de Wet T and Becker P. Inequity in poverty: the emerging public health challenge in Johannesburg. Development Southern Africa, 2009, 26 (5): 721- 732.
• Mathee A, Harpham T, Naicker N, Barnes B, Plagerson S, Feit M, Swart A, Naidoo S. Overcoming fieldwork challenges in urban health research in developing countries: a research note. International Journal of Social Research Methodology, 2009, 23: 1464 - 5300.
• Mathee A, Singh E, Mogotsi M, Timothy G, Maduka B, Oliver J, Ing D. Lead- based paint on playground equipment in public children’s parks in Johannesburg, Tshwane and Ekurhuleni. South African Medical Journal, 2009, 99: 819 – 821.