This document discusses a presentation by Jo Vearey and Scott Drimie at a conference on urbanization, migration, food security and HIV in South African cities. The presentation explores the links between these issues, with a focus on Johannesburg. It challenges common assumptions about urban health, provides an overview of population movements in South Africa, and considers the role of local governments in responding to migration, informal settlements, food insecurity and HIV through strengthened, localized responses.

1. Internal migration, informal
settlements, food security and HIV:
the role of developmental local government
Jo Vearey, PhD and Scott Drimie, PhD
Conference on Urbanisation, Migration and Food
Security in Cities of the Global South, Cape Town,
27th November 2012
jo.vearey@wits.ac.za

2. Through a focus on the City of Johannesburg, to explore the linkages
between urbanisation, migration, and health in South Africa.
1. To present the complexity of the South African urban context
(and to challenge common assumptions).
2. To provide an overview of contemporary population
movements in South(ern) Africa.
3. To consider the role of developmental local government in
responding to migration, urbanisation, informal settlements, food
security and HIV.
4. To provide suggestions for strengthened, localised responses to
migration, urbanisation, food security and HIV in South Africa.
© Monica Mabasa, 2010

3. "Johannesburg – a World Class African City of the Future – a
vibrant, equitable African city, strengthened through its
diversity; a city that provides real quality of life; a city that
provides sustainability for all its citizens; a resilient and
adaptive society."
http://www.joburg.org.za/index.php?option=com_content&view=article&id=7343&catid=73&Itemid=114#ixzz2DPMsf9x5

4. 1.The complexity of the South African urban
context: challenging assumptions
• Urban health advantage v’s an urban penalty
• The urban poor: a growing population
• Interlinked deprivations
• Inequalities and inequities in health
• Quadruple burden of disease
• Social determinants of health

5. 1. Inadequate and often unstable income;
2. Inadequate, unstable or risky asset base;
3. Poor-quality and often insecure, hazardous and overcrowded housing;
4. Inadequate provision of ‘public’ infrastructure (as this increases the
health burden);
5. Inadequate provision of basic services, including health services;
6. Limited or no safety net, such as access to grants*;
7. Inadequate protection of poorer groups’ rights through the law; and
8. Poorer groups’ voicelessness and powerlessness within political systems
and bureaucratic structures.
* It is important to recognise that the South African situation is different to many low-income
country contexts. In South Africa, a social welfare system exists that includes: disability
grants, child support grants, child foster care grants, care dependency grants and old-age

6. Urban inequalities Urban inequalities – differences between rich and poor groups/places - are a predictor of poor
population health. Urban inequalities are experienced in multiple ways, including health
outcomes.
Migration Internal (from within a country) migration and external (cross-border) migration are features of urban
growth and of the urban context. This includes those migrating in pursuit of economic
opportunities as well as individuals fleeing persecution (asylum seekers and refugees). Many
urban migrants remain connected to their household of origin through an interlinked livelihood
system.
Informal settlements Urban growth places pressure on limited appropriate and well-located housing and land tenure
opportunities. This results in increases in the numbers of people residing informally in and on the
edge of urban areas.
Residents with “weak Urban poor groups may experience challenges in claiming their rights within the city. This can include
the right to access basic services, housing, health services and employment.
rights to the city”
(Balbo & Marconi, 2005: 13)
Urban HIV prevalence Whilst not all developing country urban contexts experience high urban HIV prevalence, this is
particularly true in sub-Saharan Africa. In South Africa, urban HIV prevalence is found to be
double that in rural areas, and highest within urban informal settlements. HIV provides a
contextual challenge which requires much more than a sectoral health response.
Fragile livelihoods The livelihoods of urban poor groups are determined by the context in which they are located, and the
opportunities and constraints that this context provides. Survivalist livelihood strategies refer to
individuals working within the informal economy during a time of crisis. A period of survival is
when individuals are unable to plan far into the future, and instead spend their energy surviving
day to day. (Vearey, 2008)
Vearey et al., 2010

7. Urban inequality
Urban inequities in health
0.76 0.75 0.75
0.74 0.74
0.74 0.73
0.72 0.72 0.72
Gini coefficient
0.72
0.7
0.68 0.67
0.66
0.64
0.62
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(Figure adapted from UN-HABITAT, 2008: 72)

8. A quadruple burden of disease The Lancet, 2009
HIV/AIDS
Maternal, and
newborn and TB
child health
Food
security
Non-communicable Violence and
diseases injury

9. Urban informal settlements:
overlapping vulnerabilities = inequities in health
Food Fragile
insecurity livelihood
activities
Access to Housing
services density

10. DIEPSLOOT EXT. 1: 2000 - 2009
10

11. WHO Commission on the Social
Determinants of Health (2008)

13. Thomas, 2011

14. In a context of high HIV
prevalence, urban informal
settlements have poor food
security.
Score 0 - 3 Score 4 - 6 Score 7 - 9
Chi-square 89.880;
24 hour Dietary Diversity Score
p = <0.0001

15. 2. South(ern) Africa is associated with
historical and contemporary population
movements.
 Internal > cross-border
 Heterogeneity

16. Approximately 214 million cross-border migrants
(around 3% of the world’s population) and
740 million internal migrants globally.
“......migration is not a random individual
choice. People who migrate are highly
organised and travel well-worn paths.”
(Harcourt, 2007: 3)
Therefore, responses to urban health must engage with
migration as a key social dynamic.
Source: HDRO staff estimates based on University of Sussex (2007) database

17. Migrants reflect health characteristics
of place of origin
AND
additional influences that result from
the process of migration
Gushulak & McPherson, 2006

18. Migration is an ongoing process. Migrants do not report moving to
Spaces of vulnerability access health care, ART or other
services.
Heterogenity: internal, cross-
border, young, old, men, women, On arrival, migrants tend to be
families, urban-rural, urban-urban. healthier than the host population.
Migrants have been in the city for This “healthy migrant effect”
differing lengths of time: long-term tends to fall away quickly.
v’s recent v’s always Johannesburg.
If they become too sick to work,
The overwhelming majority of migrants will return back home to
migrants move in order to seek seek care and support (salmon
improved livelihood opportunities. effect).
© Thembi, 2010

20. 44% of 28.1% of
4.4% of the
Gauteng’s Western Cape’s
South African
population were population were
population were
born in a born in a
born outside of
different different
South Africa
province province
2,199,871 people
were born outside
of South Africa
Census 2011

21. Percentage of international
migrants living in urban
settlement by District
Municipality

22. 7,4% of
Gauteng’s
population are
non-citizens
3.3% of Western
Cape’s
population are
non-citizens
3.3% of the
South African
population are
non-citizens
Census 2011

23. Cross-border migrants as share of
the population
1990 2010 2011
Namibia 7.9 6.3
Botswana 2.0 5.8
South Africa 3.3 3.7 3.3
Swaziland 8.3 3.4
Mozambique 0.9 1.9
Malawi 12.2 1.8
Zambia 3.5 1.8
DR Congo 2.0 0.7
Lesotho 0.5 0.3
Source: http://esa.un.org/migration/p2k0data.asp

24. 3. In South Africa, developmental local
government has a critical role to play in addressing
the health consequences of migration and
urbanisation.

25. “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)

26. Source: INCA CBF MRC DPLG Handbook

27. 4. Localised responses are required.
Data
Analysis
Disaggregation: place, migrant categories, housing type

29.  Cities are complex spaces
 Multi-level, intersectoral responses that engage with complexity are required
 Context is key: who are the most deprived? Migration status? Housing type?
Place in the city? Urban-rural linkages? Urban-urban linkages?
 Migration, urbanisation and urban health present interlinked
development challenges to local government
 The developmental mandate of local government is evolving slowly
 Improved data (and analysis) is needed for pro-poor policy and
programming
 Design and analysis: engage with complexity
 Disaggregate at the local level: place, migration status, housing type

30. Internal migration, informal
settlements, food security and HIV:
the role of developmental local government
Jo Vearey, PhD and Scott Drimie, PhD
Conference on Urbanisation, Migration and Food
Security in Cities of the Global South, Cape Town,
27th November 2012
jo.vearey@wits.ac.za