The persistent urban health  challenges of migration and informal settlements in the context of HIV:  Towards the developm...
Overview of presentation <ul><li>Background: </li></ul><ul><ul><li>An urbanising world; </li></ul></ul><ul><ul><li>Urban h...
World Urbanization Prospects (2005 Revision),  United Nations, Department of Economic and Social Affairs An urban world In...
World Urbanization Prospects (2005 Revision),  United Nations, Department of Economic and Social Affairs
World Urbanization Prospects (2005 Revision),  United Nations, Department of Economic and Social Affairs By 2030, 50% or m...
Urban health frameworks <ul><li>It is increasingly important to  ensure and maintain the public health of urban population...
An example of an urban health framework Freudenberg, Galea and Vlahov, 2005 Social determinants of health
Why a revised framework for urban health? <ul><li>The  complexity  of developing country urban environments presents addit...
Developing country urban  environments (1) <ul><li>High rates of  migration ; </li></ul><ul><li>Increasing pressure on app...
Developing country urban  environments (2) Urbanisation Migration Interlinked development challenges Urban health needs HI...
The PhD research question <ul><li>How should  local government respond  to the persistent urban challenge of  migration , ...
<ul><li>Urban growth </li></ul><ul><li>Estimated population of nearly  3.9 million ; </li></ul><ul><li>The City has grown ...
HIV: increasingly urban and informal <ul><li>Urban HIV prevalence is  double that of rural areas ; </li></ul><ul><li>Highe...
The PhD:  Three interlinked case studies Assessing non-citizen access to ART in inner-city Johannesburg Evaluating a local...
Urban migrants <ul><li>Large, diverse and increasing group ; </li></ul><ul><ul><li>Internal :  rural to urban migrants; </...
Urban informal settlements <ul><li>Persistent in-migration ; </li></ul><ul><li>Overcrowding ; </li></ul><ul><li>High level...
© Thuli Zwane ‘… .  They stay in the shacks and they are trying to cope with the situation.’
© Ntombifuthi Ngwenya ‘ This is (a) Squatter Camp and the people are using the public toilets.  They are feeling very bad ...
© Busisiwe Zondo
© Nathi Makhanya ‘ This woman was pictured fetching some water down the hole.  This is the only source where water is foun...
Access to services: residents of informal settlements and migrants <ul><li>Access to continuum of HIV-related services ; <...
Towards a revised framework…. <ul><li>Developing country urban environments are  complex ; </li></ul><ul><li>Understanding...
Key components of a revised framework <ul><li>Facilitate local level action  that is multidisciplinary; </li></ul><ul><li>...
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The persistent urban health challenges of migration and informal settlements in the context of HIV: Towards the development of a framework to guide local level responses in Johannesburg, South Africa

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The persistent urban health challenges of migration and informal settlements in the context of HIV: Towards the development of a framework to guide local level responses in Johannesburg, South Africa

  1. 1. The persistent urban health challenges of migration and informal settlements in the context of HIV: Towards the development of a framework to guide local level responses in Johannesburg, South Africa Jo Vearey PhD Student School of Public Health University of the Witwatersrand [email_address] ARI Symposium University of the Witwatersrand 19 th November 2008
  2. 2. Overview of presentation <ul><li>Background: </li></ul><ul><ul><li>An urbanising world; </li></ul></ul><ul><ul><li>Urban health frameworks; </li></ul></ul><ul><ul><li>Developing country urban environments are complex; </li></ul></ul><ul><ul><ul><li>Migration; </li></ul></ul></ul><ul><ul><ul><li>Informal settlements; </li></ul></ul></ul><ul><ul><ul><li>HIV. </li></ul></ul></ul><ul><li>Towards a revised urban health framework……… </li></ul>
  3. 3. World Urbanization Prospects (2005 Revision), United Nations, Department of Economic and Social Affairs An urban world In 2008, over half of the world’s population is now urban
  4. 4. World Urbanization Prospects (2005 Revision), United Nations, Department of Economic and Social Affairs
  5. 5. World Urbanization Prospects (2005 Revision), United Nations, Department of Economic and Social Affairs By 2030, 50% or more of the African population will be living in a city
  6. 6. Urban health frameworks <ul><li>It is increasingly important to ensure and maintain the public health of urban populations ; </li></ul><ul><li>Several frameworks exist that attempt to guide appropriate responses to urban health needs; </li></ul><ul><li>Focus on developed countries in North America and Europe; </li></ul><ul><li>None are appropriate for the challenges experienced in less developed country urban environments . </li></ul>
  7. 7. An example of an urban health framework Freudenberg, Galea and Vlahov, 2005 Social determinants of health
  8. 8. Why a revised framework for urban health? <ul><li>The complexity of developing country urban environments presents additional challenges: </li></ul><ul><ul><ul><ul><li>Migration; </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Informal settlements. </li></ul></ul></ul></ul><ul><li>A revised framework is required to assist local level policy makers and implementers respond effectively. </li></ul>HIV
  9. 9. Developing country urban environments (1) <ul><li>High rates of migration ; </li></ul><ul><li>Increasing pressure on appropriate housing ; </li></ul><ul><li>High urban HIV prevalence rates – highest in urban informal areas; </li></ul><ul><li>Dependency on survivalist livelihoods located within the informal sector; </li></ul><ul><li>Increasing urban inequalities that impact ‘urban poor’ groups. </li></ul>
  10. 10. Developing country urban environments (2) Urbanisation Migration Interlinked development challenges Urban health needs HIV Informal settlements
  11. 11. The PhD research question <ul><li>How should local government respond to the persistent urban challenge of migration , and the accompanying increase in informal housing , in the context of HIV ? </li></ul>
  12. 12. <ul><li>Urban growth </li></ul><ul><li>Estimated population of nearly 3.9 million ; </li></ul><ul><li>The City has grown by 20.5% since 2001 ; </li></ul><ul><li>Average growth rate of 4.16% per year ; </li></ul><ul><li>Estimated that the population will reach 5.2 million by 2015 . </li></ul>Case study: Johannesburg - complex urban context (City of Johannesburg, 2008) <ul><li>Migration </li></ul><ul><li>A ‘city of migrants ’: </li></ul><ul><ul><li>Rural to urban – internal; </li></ul></ul><ul><ul><li>Cross border – external. </li></ul></ul><ul><li>Informal housing </li></ul><ul><li>Almost 25% estimated to live informally. </li></ul>HIV
  13. 13. HIV: increasingly urban and informal <ul><li>Urban HIV prevalence is double that of rural areas ; </li></ul><ul><li>Highest in urban informal : </li></ul><ul><ul><li>18% urban informal v’s 9% urban formal (Shisana et al. 2005) ; </li></ul></ul><ul><li>HIV is not viewed as a developmental challenge by urban planners: </li></ul><ul><ul><li>Vertical, predominantly health driven responses to HIV prevail. </li></ul></ul>
  14. 14. The PhD: Three interlinked case studies Assessing non-citizen access to ART in inner-city Johannesburg Evaluating a local level developmental approach to HIV in informal settlements Migration, housing, HIV and access to healthcare: comparing urban formal and informal Revised framework for urban health HIV
  15. 15. Urban migrants <ul><li>Large, diverse and increasing group ; </li></ul><ul><ul><li>Internal : rural to urban migrants; </li></ul></ul><ul><ul><ul><li>Almost 60% of South Africans are now urban – increasing; </li></ul></ul></ul><ul><ul><li>Cross-border : </li></ul></ul><ul><ul><ul><li>Work, study, asylum, undocumented; </li></ul></ul></ul><ul><li>Context specific vulnerability and resilience to HIV: </li></ul><ul><ul><li>Vulnerability to HIV increases in destination ; </li></ul></ul><ul><ul><li>Impact of HIV on ability to maintain a livelihood …… </li></ul></ul>
  16. 16. Urban informal settlements <ul><li>Persistent in-migration ; </li></ul><ul><li>Overcrowding ; </li></ul><ul><li>High levels of unemployment and high levels of poverty ; </li></ul><ul><li>Poor health outcomes ; </li></ul><ul><li>High HIV prevalence……… </li></ul>
  17. 17. © Thuli Zwane ‘… . They stay in the shacks and they are trying to cope with the situation.’
  18. 18. © Ntombifuthi Ngwenya ‘ This is (a) Squatter Camp and the people are using the public toilets. They are feeling very bad about that situation.’
  19. 19. © Busisiwe Zondo
  20. 20. © Nathi Makhanya ‘ This woman was pictured fetching some water down the hole. This is the only source where water is found for the whole settlement…’
  21. 21. Access to services: residents of informal settlements and migrants <ul><li>Access to continuum of HIV-related services ; </li></ul><ul><ul><li>ANC and PMTCT; </li></ul></ul><ul><ul><li>ART. </li></ul></ul><ul><li>Discriminatory attitudes – service providers, general population; </li></ul><ul><ul><li>Rural migrants; </li></ul></ul><ul><ul><li>Xenophobia. </li></ul></ul><ul><li>Access to documentation – access to grants and services: </li></ul><ul><ul><li>Rural migrants; </li></ul></ul><ul><ul><li>International migrants. </li></ul></ul>
  22. 22. Towards a revised framework…. <ul><li>Developing country urban environments are complex ; </li></ul><ul><li>Understanding how to ensure and sustain the public health of urban populations of increasing importance ; </li></ul><ul><li>A developmental approach is required: HIV is more than a health issue; and </li></ul><ul><li>A broad, integrated, multisectoral response is required to address the challenges outlined. </li></ul>
  23. 23. Key components of a revised framework <ul><li>Facilitate local level action that is multidisciplinary; </li></ul><ul><li>See HIV and migration as cross-cutting issues that bring multiple actors together – an opportunity? </li></ul>

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