City living hurts health

Unless the feedback from residents of existing settlements is taken into account in urban planning, the inhabitants of new housing projects and informal settlements will suffer poor health and well-being, according to ongoing research from the African Centre for Cities’ Healthy Cities CityLab.

The research comes at an especially relevant time, as Cape Town and other South African cities are undergoing large-scale, state-driven transformation through national programmes for the provision of low-income housing, infrastructure and the renewal of low-income residential areas.

“The physical urban environment is seen as influencing health in a variety of ways, such as through access to shelter and services, and through its influence on physical activity and on diet and nutrition. Our research shows that in South Africa, the physical environment has effects that haven’t been taken into account, and as such are influencing residents’ health,” says Dinky Levitt of the Chronic Disease Initiative South Africa (CDIA), one of the key collaborators in the research.

The Healthy Cities CityLab, an inter-disciplinary research collaboration with representatives from different departments of the University of Cape Town, the African Centre for Cities, the CDIA and others, aims to develop new conceptualisations of urban health, test out new methodologies and contribute to new theories about the relationship between the physical urban environment and health.

The researchers used a variety of techniques including body-mapping, a process where participants trace the outlines of their body and then annotate the tracing to discuss their health and well-being in whatever ways they understand these as concepts. They also drew representations of the environment in which they live and how this impacts on their health and well-being. Citylab conducted in-depth interviews with participants and asked all of them to take photographs, using disposable cameras, of aspects of their environment that they felt influenced their health and well-being.

“By undertaking body-mapping workshops in different types of neighbourhoods, such as informal settlements and new housing projects, to determine grassroots perceptions of health and well-being, we determined that, while there are exceptions, many new housing projects still tend to provide sterile living environments that are not conducive to mental health or to safe outdoor activity - both in terms of aesthetic appeal and protection from hazards, such as traffic, crime and flooding,” says co-ordinator of Healthy Cities CityLab, Warren Smit.

Smit says that the stress that this results in, can also further contribute to physical illness.

“While basic needs are being met, the complexity of the South African context means that many other needs are being overlooked completely. Improving health is not an explicit objective in any of these programmes and evaluations of some interventions suggest that they can sometimes have a negative impact on the health of households. An ongoing illustration is where relocation to the urban periphery results in the disruption of livelihoods strategies and social support networks, with very negative impacts on the health and well-being of residents,” says Smit.

For example, the relocation of residents from an informal settlement in Langa, close to central Cape Town, to a relocation area in Delft, about 15 kilometres away, resulted in 20% of households losing a source of income, and a up to a five times increase in monthly transport costs for those who retained their jobs.

Another failing in current urban planning  is the fact that instruments for measuring ‘walkability’ in the creation of new settlements assume that there are clearly defined streets, plots or dwelling units and land uses, as well as clear separations between urban and rural, residential and commercial, and public and private.

Unfortunately, this is generally not how things work in Africa.

“African urbanism is characterised by informality, complexity and the lack of neat separations. In the informal settlements found in African cities, for example, there are no clearly defined streets and no clear separations between vehicle space and pedestrian space, between public and private space, and between land uses; residential dwellings are often also the site of home-based businesses,” says Smit.

He says that similarly, plots and dwelling units are not clearly defined, and the CityLab research shows that even the idea of a household can be fairly fluid, with extended families spread across urban and rural homes and with frequent movement between them.

“All of this can make the relationship between residents and their neighbourhood environment far more complex than in the conventional conception of the Western modern city, which a lot of South Africa’s urban planning seems to be based upon. The main implication of this is that some of the tools relied on to create healthier urban environments in developed parts of the world, such as land-use zoning schemes, will have only a limited effect in cities of developing countries, where large segments of cities fall outside the realm of formal regulations.”

Smit says that in Cape Town and other African cities, there needs to be more emphasis on guiding the physical creation and management of the urban environment through participatory processes that involve both formal and informal structures: “In going forward in new developments, planners and policy makers need to understand the physical links between the urban environment and health and well-being, and also take into account the participatory knowledge of those who live in such environments”.

To this end, the CityLab project ultimately plans to produce a handbook on how policy makers can produce healthier urban environments.  

“Creating healthier urban environments is primarily about governance, politics and decision-making. It is crucial to ensure that policy-makers are aware of key health issues, such as health inequity levels, and how the physical urban environment contributes to this, and how interventions that would not necessarily involve more expenditure, just differently distributed, can contribute to improving health and well-being for all,” says Levitt.

(Press Release, Rothko Marketing and Communications, February 2012)