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Susan Parnell - Macro-demographic trends of significance for health and development
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Susan Parnell - Macro-demographic trends of significance for health and development

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In this presentation given for the IDS seminar 'Global demographic shifts: The 21st century burden of disease', Professor Sue Parnell examines major shifts in global demographics -- especially......

In this presentation given for the IDS seminar 'Global demographic shifts: The 21st century burden of disease', Professor Sue Parnell examines major shifts in global demographics -- especially regarding urbanisation -- and their implications for national health systems. In particular, she argues the the development studies community must recognise that the poorest are living in cities, and are no longer farmers living in the countryside.

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  • 1. SOME MACRO DEMOGRAPHIC TRENDS OF SIGNIFICANCE FOR HEALTH & DEVELOPMENT Sue Parnell Department of Geography University of Cape Town
  • 2. We live in an urban world
  • 3. But what is urban?Confusion over location, size, function and process
  • 4. What is urban?• There is no single definition of ‘urban’• Some nations (like South Africa) shift the definition or try to avoid using a formal definition• Typically definitions of ‘urban’ draw on a combination of: • Settlement density • Economic functionality • Population size • Administrative system • Cultural association/identity as ‘urban’
  • 5. The process of urbanisation• Urbanization represents the increasing share of a national or provincial population that is urban, rather than rural – Urbanization refers to the movement of people from a rural to an urban area through migration – Urbanization refers to the movement of people from urban areas of other provinces through migration – Urbanization includes the movement of people from other countries though immigration – Urbanization includes the existing urban population’s natural growth
  • 6. Globally the transition is to cities; butas these figures of urban populations show, also to poorer cities
  • 7. By 2020 the urban population of developing countries will exceed the rural.By 2030, the urban population of Africa will exceed the rural. 4 700 600 3 500 Rural MillionBillion 400 2 Rural 300 Urban 1 200 Urban 100 Estimates Projections Estimates Projections 0 0 1960 1970 1980 1990 2000 2010 2020 2030 1960 1970 1980 1990 2000 2010 2020 2030
  • 8. Is the global health agenda fit for purpose, given the big urban transitions? Whose responsibility is fixing it? Urban population by major geographical area (in % of total population)Source: United Nations, Department of Economic and Social Affairs, Population Division: World Urbanization Prospects, the 2009 Revision. New York, 2010
  • 9. The demographic transition of the late twentieth and early twenty first century has shifted the locus of the urban population from the Global North to the Global South.As the theoretical epicentre of scholars and health professionals adjusts to accommodate this transition, some reallignment in how ideas are weighted and applied is inevitable.This recalibration, while not necessary confortable to those in established positions of intellectual or policy-based power, is desirable and may even be overdue.
  • 10. The numbers and trends are important• Africa’s population is large (965 million in 2007) and growing fast (3.3%p.a) – In absolute and relative terms cities are becoming more NB – Urbanization is the key overall trend• Data on African migration and urbanization is too poorly researched to make substantive statements – Circular migration – Settlement classification is poor – The data is too weak to be specific
  • 11. Regional African Trends % Urban, 2007 Ave Annual Ave annual pop Urbanization rate growth rate 2005- 2005-10 10North Africa 50.92 2.40 2.40West & Central 41.75 4.02 4.03AfricaEast Africa 20.48 4.05 3.92Southern Africa 45.60 2.56 1.47Africa 38.70 3.31 3.31
  • 12. Is Africa’s urbanization pattern unique? (UN Habitat, 2009, p.24)
  • 13. Source: United Nations, Department of Economic and Social Affairs, Population Division: World Urbanization Prospects, the 2009 Revision. New York, 2010
  • 14. Latin America and the Caribbean6543 Growth in urban population share The nature of the demographic transition2 Natural population growth varies across regions, with natural1 population growth a much more01950- 1955- 1960- 1965- 1970- 1975- 1980- 1985- 1990- 1995- 2000- 2005- 2010- 2015- 2020- 2025- 2030- 2035- 2040- 2045-1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 important variable in Africa ….does this matter?? Africa Asia 6 6 5 5 4 Urban growth rates (%) 4 3 Growth in urban Growth in urban population share 3 population share Natural population 2 growth Natural population 2 growth 1 1 0 55 5 60 0 65 5 70 0 75 5 80 0 85 5 90 0 95 5 00 0 05 5 10 0 15 5 20 0 25 5 30 0 35 5 40 0 45 5 0 19 95 19 96 19 96 19 97 19 97 19 98 19 98 19 99 19 99 20 00 20 00 20 01 20 01 20 02 20 02 20 03 20 03 20 04 20 04 05 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 50 0 19 5 0 5 0 5 0 5 0 5 0 5 0 5 0 5 0 5 0 5 0 95 96 96 97 97 98 98 99 99 00 00 01 01 02 02 03 03 04 04 05 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 50 55 60 65 70 75 80 85 90 95 00 05 10 15 20 25 30 35 40 4519 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 20
  • 15. African fertility rates are high because … Lack of access to affordable health care Lack of education among women No urban jobs, social safety nets or security Patriarchy The widespread commoditization of sex
  • 16. Even without GEC, there is already a pattern of environmentally-induced migration in Africa, some of it voluntary and some forced; some of it temporary, somepermanent; some of it to town and some between rural areas” • There is no consensus on what causes migration • 1. Push – the decline of rural areas • 2. Pull – the attraction of urban areas • 3. Push and pull – circular and oscillating migration • 4. Other drivers of settlement change
  • 17. Do economic and or environmental stress create animperative to hold a base in both town and countryside?• not what the evidence on urban growth is showing ..• Nor is what we see when we do have detailed data that allows us to track in and out migration
  • 18. Migration is not all rural to urban (adapted from Todaro 2009. P. 344) 100 90 80 70 60Percentage Rural to Rural 50 Urban to Rural Urban to Urban 40 Rural to Urban 30 20 10 0 Botswana Sudan (North) Ethiopia Cote dIvoire Ghana
  • 19. Rapid growth of small and medium cities and lack of capacity create extreme vulnerability Annual growth rate of the worlds cities by region and size (1990 - 2000 around)5.0% Figures shown in the graph are developing regions average.4.0% 3.00%3.0% 2.40% 2.49% 2.49%2.0% 1.81%1.0%0.0% Small cities Intermediate cities Big cities Large cities Total Africa LAC Asia (China) (India) Developing regions Developed regions World total Note: cities w ith more than 100,000 inhabitants Source: UN Statistics Division, Demographic Yearbook, UN Population Division, World Urbanization
  • 20. Predictions ofsea level rise willdramaticallyincrease thevulnerability ofAfrica’scoastalsettlements Note ribbon development of small and medium cities all along the coast Half Africa’s capital ciities are on the coast 35 million in LECZ LAGOS and CAIRO
  • 21. • Massive shift in the burden ofWhat are some of the diseasehealth implications of • Urbanisation the burden of diseasean urban lifestyle become more complexamong poor people? – What people eat, how they exercise what work they do, what pollutants they are exposed to (water, sanitation but also air) – Age cohorts shift – Exposure to different risks • Urbanisation alters what the environmental determinants of health are – Crime, traffic, pollution etc • Urbanisation shifts the nature of the health care response and organisation • Urbanisation creates new opportunities for health education
  • 22. Main messages that flow from the trend of increased urbanisation1. Cities are critical sites of developmental action in the 21st century2. The urban ‘hot spots’ are in the Global South, with Africa presenting particular challenges3. Patterns of urban growth are not uniform, and need careful scrutiny and analysis4. The quantitative data is of variable quality – there is consensus on the big picture – but little certainty in the detail
  • 23. The demographic transition in South Africa – the whole population
  • 24. The demographic transition in South Africa – the African population
  • 25. Population Economic People livingCity significance (% of national) activity ( % GVA) under LMM (% national)•Gauteng city region 22 39 13•Coastal city regions 16 26 10•Cities 6 5 5•Regional Services Centres 14 16 14•Service towns 3 3 3•Local and niche settlements 9 2 13URBAN as a % of National 72 94 60•Clusters and dispersed rural 21 2 31settlements•Farms/rest of SA 7 4 9RURAL as a % of National 28 6 40
  • 26. Cape Town’s 3% pa average growth rate is normal in South Africa 3 ,5 0 0 ,0 0 0 Joburg 3 ,0 0 0 ,0 0 0 eThekw ini Cape Tow n 2 ,5 0 0 ,0 0 0 Ekurhuleni Population 2 ,0 0 0 ,0 0 0 Tshw ane 1 ,5 0 0 ,0 0 0 1 ,0 0 0 ,0 0 0 Nelson Mandela Buffalo City Mangaung 5 0 0 ,0 0 0 Msunduzi 0 1946 1951 1960 1970 1980 1991 1996 2001 Date