Download NCDs, alcohol and development: South Africa

SOME MACRO DEMOGRAPHIC TRENDS
OF SIGNIFICANCE FOR HEALTH &
DEVELOPMENT
Sue Parnell
Department of Geography
University of Cape Town
We live in an urban world
But what is urban?
Confusion over location, size, function
and process
What is urban?
• There is no single definition of ‘urban’
• Some nations (like South Africa) shift the
definition or try to avoid using a formal definition
• Typically definitions of ‘urban’ draw on a
combination of:
•
•
•
•
•
Settlement density
Economic functionality
Population size
Administrative system
Cultural association/identity as ‘urban’
The process of urbanisation
• Urbanization represents the increasing share of
a national or provincial population that is urban,
rather than rural
– Urbanization refers to the movement of people
from a rural to an urban area through migration
– Urbanization refers to the movement of people
from urban areas of other provinces through
migration
– Urbanization includes the movement of people
from other countries though immigration
– Urbanization includes the existing urban
population’s natural growth
Globally the transition is to cities; but
as these figures of urban populations
show, also to poorer cities
By 2020 the urban population of developing
countries will exceed the rural.
By 2030, the urban population of Africa will
exceed the rural.
4
700
600
500
Rural
Million
Billion
3
2
Urban
400
300
200
1
Estimates
Projections
0
Rural
100
Urban
Estimates Projections
0
1960 1970 1980 1990 2000 2010 2020 2030
1960 1970 1980 1990 2000 2010 2020 2030
Is the global health agenda fit for purpose, given the
big urban transitions? Whose responsibility is fixing
it?
Urban population by major geographical area (in % of total population)
Source: United Nations, Department of Economic and Social Affairs, Population Division: World Urbanization Prospects, the 2009 Revision. New York, 2010
The demographic transition of the late
twentieth and early twenty first century has
shifted the locus of the urban population from
the Global North to the Global South.
As the theoretical epicentre of scholars and
health professionals adjusts to accommodate
this transition, some reallignment in how
ideas are weighted and applied is inevitable.
This recalibration, while not necessary
confortable to those in established positions
of intellectual or policy-based power, is
desirable and may even be overdue.
The numbers and trends are
important
• Africa’s population is large
(965 million in 2007) and
growing fast (3.3%p.a)
– In absolute and relative terms
cities are becoming more NB
– Urbanization is the key overall
trend
• Data on African migration and
urbanization is too poorly
researched to make
substantive statements
– Circular migration
– Settlement classification is
poor
– The data is too weak to be
specific
Regional African Trends
% Urban, 2007
Ave Annual
Urbanization rate
2005-10
Ave annual pop
growth rate 200510
North Africa
50.92
2.40
2.40
West & Central
Africa
41.75
4.02
4.03
East Africa
20.48
4.05
3.92
Southern Africa
45.60
2.56
1.47
Africa
38.70
3.31
3.31
Is Africa’s urbanization pattern unique? (UN
Habitat, 2009, p.24)
Source: United Nations, Department of Economic and Social Affairs, Population Division: World Urbanization Prospects, the 2009 Revision. New York, 2010
Latin America and the Caribbean
6
5
4
Growth in urban
population share
3
Natural population
growth
2
1
0
1950- 1955- 1960- 1965- 1970- 1975- 1980- 1985- 1990- 1995- 2000- 2005- 2010- 2015- 2020- 2025- 2030- 2035- 2040- 20451955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050
The nature of the demographic transition
varies across regions, with natural
population growth a much more
important variable in Africa ….does this
matter??
Africa
Asia
6
6
5
4
3
2
Growth in urban
population share
Urban growth rates (%)
5
Natural population
growth
4
3
2
1
1
19
50
-1
95
19
5
55
-1
96
19
0
60
-1
96
19
5
65
-1
97
19
0
70
-1
97
19
5
75
-1
98
19
0
80
-1
98
19
5
85
-1
99
19
0
90
-1
99
19
5
95
-2
00
20
0
00
-2
00
20
5
05
-2
01
20
0
10
-2
01
20
5
15
-2
02
20
0
20
-2
02
20
5
25
-2
03
20
0
30
-2
03
20
5
35
-2
04
20
0
40
-2
04
20
5
45
-2
05
0
0
19
50
-1
19 95
55 5
-1
19 96
60 0
-1
19 96
65 5
-1
19 97
70 0
-1
19 97
75 5
-1
19 98
80 0
-1
19 98
85 5
-1
19 99
90 0
-1
19 99
95 5
-2
20 00
00 0
-2
20 00
05 5
-2
20 01
10 0
-2
20 01
15 5
-2
20 02
20 0
-2
20 02
25 5
-2
20 03
30 0
-2
20 03
35 5
-2
20 04
40 0
-2
20 04
45 5
-2
05
0
0
Growth in urban
population share
Natural population
growth
African fertility rates are high because
…
 Lack of access to
affordable health care
 Lack of education
among women
 No urban jobs, social
safety nets or security
 Patriarchy
 The widespread
commoditization of sex
Even without GEC, there is already a pattern of
environmentally-induced migration in Africa, some of it
voluntary and some forced; some of it temporary, some
permanent; some of it to town and some between rural areas”
• There is no consensus on
what causes migration
• 1. Push – the decline of
rural areas
• 2. Pull – the attraction of
urban areas
• 3. Push and pull – circular
and oscillating migration
• 4. Other drivers of
settlement change
Do economic and or environmental stress create an
imperative to hold a base in both town and
countryside?
• not what the evidence
on urban growth is
showing ..
• Nor is what we see
when we do have
detailed data that
allows us to track in and
out migration
Migration is not all rural to urban (adapted from Todaro
2009. P. 344)
100
90
80
70
Percentage
60
Rural to Rural
Urban to Rural
50
Urban to Urban
Rural to Urban
40
30
20
10
0
Botswana
Sudan (North)
Ethiopia
Cote d'Ivoire
Ghana
Rapid growth of small and medium
cities and lack of capacity create
extreme vulnerability
Annual growth rate of the world's cities by region and size
(1990 - 2000 around)
5.0%
Figures shown in the graph are
developing regions average.
4.0%
3.00%
3.0%
2.40%
2.49%
2.49%
1.81%
2.0%
1.0%
0.0%
Small cities
Africa
LAC
Intermediate cities
Asia
(China)
(India)
Big cities
Developing regions
Large cities
Developed regions
Total
World total
Note: cities w ith more than 100,000 inhabitants
Source: UN Statistics Division, Demographic Yearbook, UN Population Division, World Urbanization
Predictions of
sea level rise will
dramatically
increase the
vulnerability of
Africa’s
coastal
settlements
Note ribbon
development of small
and medium cities all
along the coast
Half Africa’s capital
ciities are on the
coast
35 million in LECZ
LAGOS and CAIRO
What are some of the
health implications of
an urban lifestyle
among poor people?
• Massive shift in the burden of
disease
• Urbanisation the burden of disease
become more complex
– What people eat, how they exercise
what work they do, what pollutants
they are exposed to (water,
sanitation but also air)
– Age cohorts shift
– Exposure to different risks
• Urbanisation alters what the
environmental determinants of
health are
– Crime, traffic, pollution etc
• Urbanisation shifts the nature of
the health care response and
organisation
• Urbanisation creates new
opportunities for health education
Main messages that flow from the
trend of increased urbanisation
1. Cities are critical sites of developmental action in
the 21st century
2. The urban ‘hot spots’ are in the Global South,
with Africa presenting particular challenges
3. Patterns of urban growth are not uniform, and
need careful scrutiny and analysis
4. The quantitative data is of variable quality –
there is consensus on the big picture – but little
certainty in the detail
The demographic transition in South
Africa – the whole population
The demographic transition in South
Africa – the African population
City significance
Population
(% of national)
Economic
activity
( % GVA)
People living
under LMM
(% national)
•Gauteng city region
22
39
13
•Coastal city regions
16
26
10
•Cities
6
5
5
•Regional Services Centres
14
16
14
•Service towns
3
3
3
•Local and niche settlements
9
2
13
URBAN as a % of National
72
94
60
•Clusters and dispersed rural
settlements
21
2
31
•Farms/rest of SA
7
4
9
RURAL as a % of National
28
6
40
Cape Town’s 3% pa average growth rate is
normal in South Africa
3 ,5 0 0 ,0 0 0
Joburg
eThekw ini
3 ,0 0 0 ,0 0 0
Population
Cape Tow n
2 ,5 0 0 ,0 0 0
Ekurhuleni
2 ,0 0 0 ,0 0 0
Tshw ane
1 ,5 0 0 ,0 0 0
Nelson Mandela
1 ,0 0 0 ,0 0 0
Buffalo City
Mangaung
Msunduzi
5 0 0 ,0 0 0
0
1946
1951
1960
1970
1980
Date
1991
1996
2001