Creating Healthier Urban Environments
High levels of ill-health are often associated with poverty and inequality. What can be done to break this link and improve the lives of people living in crowded and under-resourced areas?
Cape Town's levels of inequality are among the highest in the world and almost 40 percent of households are classified as poor.
Slums are the most tangible manifestation of poverty and inequality in Cape Town, with an estimated 280 000 households living in informal dwellings.
Inequality and poverty is also reflected in high levels of disease and health inequity. The most recent age-standardised mortality rate for Cape Town is 1 011 per 100 000people.
This is considerably higher than in most cities in the global north; for example, it is 60 percent higher than the latest mortality rate for New York City.
Health indicators also vary enormously between health districts; for example, the mortality rate for communicable diseases is about five times higher in the Khayelitsha Health District than in the Southern Peninsula Health District (550 deaths per 100 000 people a year versus 112).
There are five elements that make the burden of disease in Cape Town particularly complex.
l HIV/Aids, which is the leading cause of premature mortality in Cape Town.
l Other communicable diseases closely linked to poverty, such as tuberculosis and diarrhoea (which are both in the top 10 causes of premature mortality in Cape Town), continue at high levels.
Many of these diseases are linked to overcrowding, inadequate shelter and inadequate access to basic services and affordable and healthy food.
l Chronic diseases of lifestyle, such as diabetes and heart disease (which are both in the top 10 causes of premature mortality in Cape Town) are growing rapidly. These are linked to changes in lifestyle associated with rural-urban migration and the transition of some households to more affluent lifestyles.
l Injuries. Cape Town has particularly high incidences of murder and traffic accidents, which are the second-most frequent and fourth-most frequent causes respectively of premature mortality.
l High levels of stress and depression.
Improving the health and well-being of residents of Cape Town is a challenge that is being taken up by the African Centre for Cities with the support of UCT's Programme for the Enhancement of Research Capacity.
The limited health data available makes policy development difficult. It is of crucial importance that we have a better understanding of how the physical urban environment influences health and well-being, so that we can begin to plan and build a city that is more conducive to the health and well-being of all residents.
Literature on the relationship between the physical urban environment and health suggests a number of important linkages and possible interventions that can improve health and well-being.
However, the existing bodies of knowledge on the relationship between human health and the physical urban environment are overwhelmingly based on work undertaken in the global north (Europe and North America), and the concepts of health and urbanity that underpin this body of knowledge are also largely derived from the particular historical and cultural contexts of the global north.
The many manuals on how to create healthy urban environments are therefore of limited use in cities such as Cape Town, where contextual realities are often very different, and where many of the underlying assumptions do not necessarily apply.
In response to this disjuncture between our context and the bodies of knowledge on the relationship between human health and the physical urban environment, the African Centre for Cities at the University of Cape Town established its Healthy Cities CityLab programme to bring researchers from different disciplines at the University of Cape Town together in a long-term interdisciplinary applied research programme on the relationship between the physical urban environment and health and well-being in Cape Town. …