Poverty, housing and health in Johannesburg: exploring intra-urban inequalities   22 nd  August 2011 Liz Thomas, PhD – Wit...
Four aims for today <ul><li>To explain the framework for understanding the determinants of health in Johannesburg. </li></...
Developmental local government “ local government committed to working with citizens and groups within the community to  f...
Defining health <ul><li>Health  is a state of complete physical, mental and social well-being and not merely the absence o...
Measuring health <ul><li>Indicators </li></ul><ul><ul><li>Morbidity </li></ul></ul><ul><ul><li>Mortality </li></ul></ul><u...
WHO Commission on the Social Determinants of Health (2008)
Gini coefficient in selected South African cities   (Figure adapted from UN-HABITAT, 2008: 72)
A quadruple burden of disease <ul><li>Diseases of poverty ;  </li></ul><ul><li>Emerging chronic diseases ;  </li></ul><ul>...
National YLL leading cause of Premature Mortality  DB 2006 using 2000 data pg 6 Differentiation between urban formal, urba...
Urban informal settlements are associated with urbanisation.  <ul><li>Responses to urban informal settlements must engage ...
So what do we know? <ul><li>Communicable  </li></ul><ul><li>Non communicable  </li></ul>wealthiest -----------------------...
HIV prevalence in adults aged 15 – 49 years by locality type, South Africa, 2005 (HSRC, 2005)
Urban informal settlements <ul><li>Informal settlements present a range of  interlinked development challenges  to the mun...
24 hours Dietary Diversity Score: respondents residing informally are more likely to have a deficient dietary score Chi-sq...
Perception of risk of HIV Chi-square = 14.221; p = 0.0002 In a context of high HIV prevalence, urban informal settlement r...
Inadequate access to basic services <ul><li>No electricity  (despite upgrading) </li></ul><ul><ul><li>Paraffin and candles...
<ul><ul><li>“ We live next to the toilets and cooking outside and there are flies and rubbish is lying everywhere. It make...
Housing
<ul><li>“ Because we have no fridge we must use the vegetables we buy very quickly. Otherwise it is rotten by tomorrow, be...
Schooling
Transit camps
Development…..
Key messages <ul><li>Health is determined by a range of factors .  Many of these factors are outside the control of the in...
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Poverty, housing and health in Johannesburg

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Input made to the City of Johannesburg's Growth and Development Strategy 2040.

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  • Add photos to illustrate Start with showing the different types of housing Diseases of lifestyle go across
  • Not sure that we need this slide as the data/findings are presented over the next few slides….
  • There are several ways of viewing food security: dietary diversity is one. Also access to food…. But I’m trying to keep it simple. I can ‘talk to it’ if needed (i.e. about other ways we measured food security).
  • I can talk to this (I’ve not put numbers).
  • Poverty, housing and health in Johannesburg

    1. 1. Poverty, housing and health in Johannesburg: exploring intra-urban inequalities 22 nd August 2011 Liz Thomas, PhD – Wits/MRC Jo Vearey, PhD - Wits
    2. 2. Four aims for today <ul><li>To explain the framework for understanding the determinants of health in Johannesburg. </li></ul><ul><li>To show how health differs across the city. </li></ul><ul><li>To highlight the determinants and impacts of poor health outcomes on the urban poor, with a focus on informal settlements. </li></ul><ul><li>To suggest what needs to be done. </li></ul>
    3. 3. Developmental local government “ local government committed to working with citizens and groups within the community to find sustainable ways to meet their social, economic and material needs and improve the quality of their lives ” (RSA, 1998: 23)
    4. 4. Defining health <ul><li>Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. </li></ul><ul><li>Communicable diseases </li></ul><ul><li>Non-communicable diseases </li></ul>
    5. 5. Measuring health <ul><li>Indicators </li></ul><ul><ul><li>Morbidity </li></ul></ul><ul><ul><li>Mortality </li></ul></ul><ul><ul><li>Years of life lost </li></ul></ul>
    6. 6. WHO Commission on the Social Determinants of Health (2008)
    7. 7. Gini coefficient in selected South African cities (Figure adapted from UN-HABITAT, 2008: 72)
    8. 8. A quadruple burden of disease <ul><li>Diseases of poverty ; </li></ul><ul><li>Emerging chronic diseases ; </li></ul><ul><li>Injuries ; and </li></ul><ul><li>HIV/AIDS. </li></ul><ul><li>D Bradshaw, M Schneider, R Dorrington, D Bourne, R Laubscher. South African cause of death profile in transition – 1996 and future trends. S Afr Med J 2002; 92: 618-23. </li></ul>
    9. 9. National YLL leading cause of Premature Mortality DB 2006 using 2000 data pg 6 Differentiation between urban formal, urban informal and rural 1 HIV/AIDS Higher in urban areas, especially in informal housing areas with dense social networks. In 2 Homicide and violence Urban areas, especially young men associated with alcohol use 3 TB Overcrowded areas, closer proximity of people, poor ventilation, low immunity due to poor nutrition, HIV etc 4 Diarrhoeal diseases Poor sanitation urban informal, higher chance of transmission due to density of people, and rural poor sanitation 5 Lower respiratory Exposure to indoor air pollution, elderly and under 5s, poor immunity, higher ambient air pollution where biomass fuels used for cooking and heating 6 Road traffic accidents Urban pedestrians especially with high alcohol levels 7 Stroke Disease of lifestyle 8 Ischaemic heart disease High stress, poor diet, low exercise, smoking and alcohol 9 Low birth weight Under 5’s – born to poor urban and rural woman, esp with low education levels, limited access to health facilities 10 Protein energy malnutrition Under 5’s - poor urban and rural contexts esp with low education levels of mothers
    10. 10. Urban informal settlements are associated with urbanisation. <ul><li>Responses to urban informal settlements must engage with this: </li></ul><ul><li>Respectful, informed responses </li></ul><ul><li>In-situ upgrading </li></ul>
    11. 11. So what do we know? <ul><li>Communicable </li></ul><ul><li>Non communicable </li></ul>wealthiest -----------------------------------middle --------------------------------------poorest <ul><li>Diseases of/ </li></ul><ul><li>associated with </li></ul><ul><li>poverty and development </li></ul><ul><ul><li>Food insecurity, malnutrition </li></ul></ul><ul><ul><li>Violence and injury (homicide) </li></ul></ul><ul><ul><li>Maternal and perinatal conditions </li></ul></ul><ul><ul><li>Diarrhoea </li></ul></ul><ul><ul><li>Ari </li></ul></ul><ul><ul><li>HIV </li></ul></ul><ul><ul><li>TB </li></ul></ul><ul><li>Diseases of lifestyle (chronic) </li></ul><ul><li>Stroke </li></ul><ul><li>Diabetes </li></ul><ul><li>Hypertension </li></ul><ul><li>Asthma </li></ul>HIV 2x HIV in informal .
    12. 12. HIV prevalence in adults aged 15 – 49 years by locality type, South Africa, 2005 (HSRC, 2005)
    13. 13. Urban informal settlements <ul><li>Informal settlements present a range of interlinked development challenges to the municipality, including : </li></ul><ul><ul><li>Inadequate food security; </li></ul></ul><ul><ul><li>Poor access to basic services; </li></ul></ul><ul><ul><li>Inappropriate development process; </li></ul></ul><ul><ul><li>Mobility – the importance of “home”; </li></ul></ul><ul><ul><li>High HIV prevalence; and </li></ul></ul><ul><ul><li>High perceived risk of HIV. </li></ul></ul>
    14. 14. 24 hours Dietary Diversity Score: respondents residing informally are more likely to have a deficient dietary score Chi-square 89.880; p = <0.0001 Score 0 - 3 Score 4 - 6 Score 7 - 9 24 hour Dietary Diversity Score In a context of high HIV prevalence, urban informal settlements have poor food security.
    15. 15. Perception of risk of HIV Chi-square = 14.221; p = 0.0002 In a context of high HIV prevalence, urban informal settlement residents perceive themselves at risk of HIV
    16. 16. Inadequate access to basic services <ul><li>No electricity (despite upgrading) </li></ul><ul><ul><li>Paraffin and candles </li></ul></ul><ul><li>Water </li></ul><ul><ul><li>Communal taps </li></ul></ul><ul><li>Sanitation </li></ul><ul><ul><li>Communal toilets </li></ul></ul><ul><ul><li>Open bush </li></ul></ul><ul><li>Waste removal </li></ul><ul><ul><li>Irregular collection </li></ul></ul><ul><ul><li>Dumping </li></ul></ul><ul><li>Negative impact on health, especially for people living with HIV . </li></ul><ul><li>(Mporetji, 2008; Bezuidenhout, 2009; RENEWAL, 2009) </li></ul>
    17. 17. <ul><ul><li>“ We live next to the toilets and cooking outside and there are flies and rubbish is lying everywhere. It makes the sickness worse. It is not healthy to stay in such conditions”. </li></ul></ul><ul><ul><li>Female respondent </li></ul></ul>
    18. 18. Housing
    19. 19. <ul><li>“ Because we have no fridge we must use the vegetables we buy very quickly. Otherwise it is rotten by tomorrow, because it is hot. We can’t have leftover food, when we have food we need to use it quickly. That means that on some days we have nothing to eat.” </li></ul><ul><li>Female respondent </li></ul>
    20. 20. Schooling
    21. 21. Transit camps
    22. 22. Development…..
    23. 23. Key messages <ul><li>Health is determined by a range of factors . Many of these factors are outside the control of the individual. </li></ul><ul><li>There is a need for improved and disaggregated data to understand and respond to intra-urban health differentials. </li></ul><ul><li>There is a need to ensure that community voices are heard and included in developing responses. </li></ul><ul><li>Urban informal settlements present a range of interlinked developmental challenges to the municipality that require inter-departmental, integrated, respectful and informed responses. </li></ul>

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