www.migration.org.za
Migration, inequality and urban health in the
Southern African Development Community
(SADC): learning...
http://www.routledge.com/books/details/
9780415686853/
Vearey, J. (2013) Migration, urban
health and inequality in
Johanne...
Today
1. Migration, inequality and urban health in SADC:
diverse contexts & social justice
• Urban growth; mixed migration...
(1) Migration, inequality and urban health
in SADC: diverse contexts & social justice
The Southern Africa Development Community
(SADC)
Diversity
Heterogeneity
(contexts: migration; urbanisation; health system...
World Urbanization Prospects (2005 Revision), United Nations, Department of Economic and
Social Affairs
By 2030, 50% or mo...
Social Determinants of Health
Inequalities
urban
Migration
and mobility
Urban inequalities:
inequity in health
0.54
0.4
0.55
0.31
0
0.1
0.2
0.3
0.4
0.5
0.6
Africa (26 cities) Asia (38 cities) La...
Spaces of vulnerability (IOM, 2010)
“….health vulnerability stems not only from
individual but also a range of environment...
Top 30 city epidemics in Eastern and Southern Africa
(Estimated Number of Adult PLHIV, 2011)
489,978245,803233,870184,0941...
(2) The case of Johannesburg
Gini coefficient in selected South
African cities
0.74
0.67
0.72
0.75
0.74
0.75
0.73
0.72 0.72
0.62
0.64
0.66
0.68
0.7
0.7...
Percentage of international
migrants living in urban
settlement by District
Municipality
Urban growth
• Estimated population of nearly 3.9 million;
• Estimated that the population will reach 4.1 million
by 2015 ...
16
DIEPSLOOT EXT. 1: 2000 - 2009
Urban informal settlements
Overlapping vulnerabilities
Food
insecurity
Access to
services
Fragile
livelihood
activities
Ho...
Higher HIV prevalence in urban
informal settlements (South Africa)
Thomas, 2011
• Urban poor groups
(Mitlin & Satterthwaite, 2004: 15)
• Migrants in the city
• > describing SDH
• Access to positive
dete...
A summary of the structural determinants of health
inequity and the social determinants of health experienced
by internal ...
(3)Action to address inequities in urban health
• Healthy urban governance
• Intersectoral action
• Localised responses
• ...
Overlapping vulnerabilities:
gender; food insecurity; lack of cash; living on the periphery;
struggle to meet basic needs
...
Migration, inequality and urban health
in SADC: learning from Johannesburg
Jo Vearey, PhD
University of the Witwatersrand
...
Migration, inequality and urban health in SADC:  learning from Johannesburg
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Migration, inequality and urban health in SADC: learning from Johannesburg

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  • Inadequate and often unstable income; Inadequate, unstable or risky asset base; Poor-quality and often insecure, hazardous and overcrowded housing; Inadequate provision of ‘public’ infrastructure (as this increases the health burden); Inadequate provision of basic services, including health services; Limited or no safety net, such as access to grants*; Inadequate protection of poorer groups’ rights through the law; and Poorer groups’ voicelessness and powerlessness within political systems and bureaucratic structures.
  • Migration, inequality and urban health in SADC: learning from Johannesburg

    1. 1. www.migration.org.za Migration, inequality and urban health in the Southern African Development Community (SADC): learning from Johannesburg Jo Vearey, PhD University of the Witwatersrand jo.vearey@wits.ac.za Colloque International: Dynamiques Urbaines & Enjeux Sanitaires Universite Paris Ouest-Nanterre la Defense, France, 12th September 2013
    2. 2. http://www.routledge.com/books/details/ 9780415686853/ Vearey, J. (2013) Migration, urban health and inequality in Johannesburg. In: Migration and Inequality. Bastia, T. (ed). Routledge.
    3. 3. Today 1. Migration, inequality and urban health in SADC: diverse contexts & social justice • Urban growth; mixed migration; mobility • Social determinants of health; inequality & inequities in health • Spaces of vulnerability; urban poor groups • HIV; HIV in cities 2. The case of Johannesburg • Migration; HIV; urban growth; informal settlements 3. Action to address inequities in urban health • Healthy urban governance; intersectoral action; localised responses; pro-poor policy; cross-border responses http://hesperian.org/2012/07/12/hesperian-at- the-3rd-people%E2%80%99s-health-assembly-in- south-africa/ http://www.relationships.org.au/corporate- centre/news-and-events/urgent-need-to- address-health-inequity
    4. 4. (1) Migration, inequality and urban health in SADC: diverse contexts & social justice
    5. 5. The Southern Africa Development Community (SADC) Diversity Heterogeneity (contexts: migration; urbanisation; health systems; governance; communicable diseases)
    6. 6. 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 Urbanisation processes in South Africa • Urban population is stabilising at just over 60% (Bocquier) • Rural population has not decreased • Circular migration • Peripheral urban informal settlements
    7. 7. Social Determinants of Health Inequalities urban Migration and mobility
    8. 8. Urban inequalities: inequity in health 0.54 0.4 0.55 0.31 0 0.1 0.2 0.3 0.4 0.5 0.6 Africa (26 cities) Asia (38 cities) Latin America and Caribbean (19 cities) Eastern Europe and CIS (18 cities) Ginicoefficient (Figure adapted from UN-HABITAT, 2008: 63)
    9. 9. Spaces of vulnerability (IOM, 2010) “….health vulnerability stems not only from individual but also a range of environmental factors specific to the unique conditions of a location, including the relationship dynamics among mobile and sedentary populations.” Urban Urban informal
    10. 10. Top 30 city epidemics in Eastern and Southern Africa (Estimated Number of Adult PLHIV, 2011) 489,978245,803233,870184,094146,516143,640135,667109,428107,533 93,746 89,131 85,202 83,804 74,492 70,259 69,719 65,286 60,094 56,671 51,332 49,237 49,427 48,667 48,429 48,182 48,125 47,856 46,588 39,781 0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 GautengProvince eThekwiniMetro(Durban) CapeTown Harare LusakaDaresSalaam MaputoCity Nairobi NMandelaBayMetro(PortElizabeth) Bulawayo Msunduzi(Pietermaritzburg) Mangaung(Bloemfontein) AddisAbaba BuffaloCityMetro(EastLondon) Mbombela(Nelspruit) Luanda Matola Kitwe Kampala BlantyreGaborone(agglo) Polokwane(Pietersburg) Mombasa Rustenburg Nkomazi Lilongwe Beira Matjhabeng Thulamela Kigali Gauteng 1, 25 million The 30 biggest city epidemics in Eastern and Southern Africa host an estimated total of 4.2 million Adult PLHIV. This corresponds to 30% of the HIV epidemic in Eastern and Southern Africa and 13.7% of the global HIV epidemic. In comparason these 30 cities have a total population of 55 million inhabitants this is 0.78% of the world population. Slide courtesy of Henk Van Renterghem, UNAIDS HIV in cities: ESA • The 30 biggest city epidemics in ESA host an estimated 4.2million adult PLWHIV. • This corresponds to 30% of the HIV epidemic in ESA, 13.7% of the global HIV epidemic. • In comparison, these cities have a total population of 55 million inhabitants, 0.78% of the world population. • The 30 biggest city epidemics in ESA host an estimated 4.2million adult PLWHIV. • This corresponds to 30% of the HIV epidemic in ESA, 13.7% of the global HIV epidemic. • In comparison, these cities have a total population of 55 million inhabitants, 0.78% of the world population.
    11. 11. (2) The case of Johannesburg
    12. 12. Gini coefficient in selected South African cities 0.74 0.67 0.72 0.75 0.74 0.75 0.73 0.72 0.72 0.62 0.64 0.66 0.68 0.7 0.72 0.74 0.76 Bloem fontein C apeTown D urbanEastLondon EastR andJohannesburg Pieterm aritzburgPortElizabeth Pretoria Ginicoefficient (Figure adapted from UN-HABITAT, 2008: 72)
    13. 13. Percentage of international migrants living in urban settlement by District Municipality
    14. 14. Urban growth • Estimated population of nearly 3.9 million; • Estimated that the population will reach 4.1 million by 2015 and between 6 and 8 million by 2040. Johannesburg: a complex urban context (City of Johannesburg, 2011) Migration  A ‘city of migrants’:  Rural to urban – internal;  Cross border – external. Informal housing  Almost 25% estimated to live informally. HIV
    15. 15. 16 DIEPSLOOT EXT. 1: 2000 - 2009
    16. 16. Urban informal settlements Overlapping vulnerabilities Food insecurity Access to services Fragile livelihood activities Housing density Migration and mobility Access to housing HIV
    17. 17. Higher HIV prevalence in urban informal settlements (South Africa) Thomas, 2011
    18. 18. • Urban poor groups (Mitlin & Satterthwaite, 2004: 15) • Migrants in the city • > describing SDH • Access to positive determinants of urban health http://accessdeniedblog.wordpress.com/ “Weak rights to the city” (Balbo & Marconi, 2005: 13) http://urban africa.net/cal endar/2011/ 10/06/struct ured- inequity- and- differentiate d- citizenship- effects- different- health-care Marcos Almada Rivero, 2011
    19. 19. A summary of the structural determinants of health inequity and the social determinants of health experienced by internal and cross-border migrants in Johannesburg (adapted from Malmusi et al, 2010; Solar and Irwin 2007) Vearey, 2013
    20. 20. (3)Action to address inequities in urban health • Healthy urban governance • Intersectoral action • Localised responses • Pro-poor policy • Cross-border responses
    21. 21. Overlapping vulnerabilities: gender; food insecurity; lack of cash; living on the periphery; struggle to meet basic needs The social determinants of health: socioeconomic and political context; structural determinants; intermediary determinants Urbanisation Migrationandmobility Inequality in the city HIV Governance (response): healthy urban governance; intersectoral action; health in all policies; localised responses; cross-border responses Inequity in the city Access to positive determinants of health in the city: basic services; healthcare; housing; education; secure livelihood activities; food security Theurbanpoor
    22. 22. Migration, inequality and urban health in SADC: learning from Johannesburg Jo Vearey, PhD University of the Witwatersrand jo.vearey@wits.ac.za Colloque International: Dynamiques Urbaines & Enjeux Sanitaires Universite Paris Ouest-Nanterre la Defense, France, 12th September 2013

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