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Migration, inequality and urban health in SADC: learning from Johannesburg
This document discusses migration, inequality, and urban health in Southern African cities. It first provides context on urban growth, migration patterns, and health inequities across diverse Southern African Development Community (SADC) contexts. It then focuses on Johannesburg as a case study, noting its complex urban dynamics including high levels of inequality, migration, and informal settlements which experience overlapping vulnerabilities and higher HIV prevalence. The document calls for actions like healthy urban governance, intersectoral collaboration, localized responses, pro-poor policies, and cross-border cooperation to better address the social determinants of health and reduce inequities experienced by urban poor groups.
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Migration, inequality and urban health in SADC: learning from Johannesburg
- 1. www.migration.org.za Migration, inequality andurban 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. 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. Today 1. Migration, inequalityand 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. (1) Migration, inequalityand urban health in SADC: diverse contexts & social justice
- 5. The Southern AfricaDevelopment Community (SADC) Diversity Heterogeneity (contexts: migration; urbanisation; health systems; governance; communicable diseases)
- 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. Social Determinants ofHealth Inequalities urban Migration and mobility
- 8. Urban inequalities: inequity inhealth 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. 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. Top 30 cityepidemics 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. (2) The caseof Johannesburg
- 12. Gini coefficient inselected 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. Percentage of international migrantsliving in urban settlement by District Municipality
- 15. Urban growth • Estimatedpopulation 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
- 16. 16 DIEPSLOOT EXT. 1:2000 - 2009
- 17. Urban informal settlements Overlappingvulnerabilities Food insecurity Access to services Fragile livelihood activities Housing density Migration and mobility Access to housing HIV
- 18. Higher HIV prevalencein urban informal settlements (South Africa) Thomas, 2011
- 19. • Urban poorgroups (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
- 20. A summary ofthe 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
- 21. (3)Action to addressinequities in urban health • Healthy urban governance • Intersectoral action • Localised responses • Pro-poor policy • Cross-border responses
- 22. Overlapping vulnerabilities: gender; foodinsecurity; 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
- 23. Migration, inequality andurban 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
Editor's Notes
- #20 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.