SOME MACRO DEMOGRAPHIC TRENDS OF SIGNIFICANCE FOR HEALTH & DEVELOPMENT

SOME MACRO DEMOGRAPHIC TRENDS OF SIGNIFICANCE FOR HEALTH & DEVELOPMENT

Sue ParnellDepartment of GeographyUniversity 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.

Rural

Urban

0

1

2

3

4

1960 1970 1980 1990 2000 2010 2020 2030

Billion

Estimates Projections

Rural

Urban

0

100

200

300

400

500

600

700

1960 1970 1980 1990 2000 2010 2020 2030

Million

ProjectionsEstimates

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 2005-

10

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

Africa

0

1

2

3

4

5

6

Urb

an

gro

wth

ra

tes

(%

)

Growth in urbanpopulation share

Natural populationgrowth

Latin America and the Caribbean

0

1

2

3

4

5

6

1950-1955

1955-1960

1960-1965

1965-1970

1970-1975

1975-1980

1980-1985

1985-1990

1990-1995

1995-2000

2000-2005

2005-2010

2010-2015

2015-2020

2020-2025

2025-2030

2030-2035

2035-2040

2040-2045

2045-2050

Growth in urbanpopulation share

Natural populationgrowth

Asia

0

1

2

3

4

5

6

Growth in urbanpopulation share

Natural populationgrowth

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

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

PatriarchyThe 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)

Botswana Sudan (North) Ethiopia Cote d'Ivoire Ghana0

10

20

30

40

50

60

70

80

90

100

Rural to Rural

Urban to Rural

Urban to Urban

Rural to Urban

Per

cent

age

Rapid growth of small and medium cities and lack of capacity create extreme

vulnerabilityAnnual growth rate of the world's cities by region and size

(1990 - 2000 around)

2.49%

1.81%

2.49%2.40%

3.00%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

Small cities Intermediate cities Big cities Large cities Total

Africa LAC Asia (China) (India) Developing regions Developed regions World total

Figures shown in the graph are developing regions average.

Note: cities w ith more than 100,000 inhabitantsSource: UN Statistics Division, Demographic Yearbook, UN Population Division, World Urbanization

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

Predictions of sea level rise will dramaticallyincrease the vulnerability of

Africa’s coastal settlements

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

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

1946 1951 1960 1970 1980 1991 1996 2001

Date

Popu

latio

n

J oburgeThekwini

Ekurhuleni

Nelson Mandela

Buffalo CityMangaungMsunduzi

Tshwane

Cape Town