SOME MACRO DEMOGRAPHIC TRENDS OF SIGNIFICANCE FOR HEALTH & DEVELOPMENT

1. SOME MACRO DEMOGRAPHIC TRENDS OF SIGNIFICANCE FOR HEALTH & DEVELOPMENT Sue Parnell Department of Geography University of Cape Town

3. We live in an urban world

4. But what is urban?Confusion over location, size, function and process

5. 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’

6. 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

7. Globally the transition is to cities; but as these figures of urban populations show, also to poorer cities

8. By 2020 the urban population of developing countries will exceed the rural. By 2030, the urban population of Africa will exceed the rural.

9. 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

10. 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.

11. 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

13. Regional African Trends

14. Is Africa’s urbanization pattern unique? (UN Habitat, 2009, p.24)

15. Source: United Nations, Department of Economic and Social Affairs, Population Division: World Urbanization Prospects, the 2009 Revision. New York, 2010

16. The nature of the demographic transition varies across regions, with natural population growth a much more important variable in Africa ….does this matter??

17. 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

18. 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

20. 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

23. Migration is not all rural to urban (adapted from Todaro 2009. P. 344)

24. Rapid growth of small and medium cities and lack of capacity create extreme vulnerability

25. Predictions of sea level rise will dramatically increase the vulnerability of Africa’scoastal 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

26. 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

27. 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

28. The demographic transition in South Africa – the whole population

29. The demographic transition in South Africa – the African population

31. Cape Town’s 3% pa average growth rate is normal in South Africa