Challenging urban health: towards an improved local government response to migration, informal settlements, and HIV in Johannesburg, South Africa

Figures & data

Table 1. The key themes covered in the PhD thesis and associated papers

	I Migration, access to ART, survivalist livelihoods	II Strategies of internal migrants in JHB	III Migration, informal settlements, HIV	IV Upholding the right to access health services	V Intervention evaluation
	AJAR 2008	Urban Forum 2010	Health & Place 2010	Global Public Health 2011
Rights to the social determinants of urban health	ART access	Access to housing	Basic services, health services, access to documentation	ART access, health access	Basic services, health services, access to documentation
Urban livelihoods	Migrant livelihoods, impact of access to ART	Survivalist livelihoods, strategies and tactics	Livelihoods, food security as an outcome of the livelihood system
Policy and governance	Migration, access to ART, employment		Urban development, social protection, local government	Assessing access to health services, policy v's implementation	Local responses, participatory local government
Urban methodologies	Cross-sectional survey, semi-structured interviews, household survey	Participatory film and photography, hidden populations	Sampling in an urban context, informal and formal	Cross-sectional surveys, semi-structured interviews, household surveys	Process evaluation, participatory photography

Table 2. Developing country urban contexts present six central urban health and development challenges 21

Challenge	Description
1. Urban inequalities	Urban inequalities – differences between rich and poor groups/places – are a predictor of poor population health. Urban inequalities are experienced in multiple ways, including health outcomes and manifest spatially as intra-urban health inequalities.
2. Migration	Internal (from within a country) migration and external (cross-border) migration are features of urban growth and of the urban context. This includes those migrating in pursuit of economic opportunities as well as individuals fleeing persecution (asylum seekers and refugees). Many urban migrants remain connected to their household of origin through an interlinked livelihood system.
3. Informal settlements	Urban growth places pressure on limited appropriate and well-located housing and land tenure opportunities. This results in increases in the numbers of people residing informally in and on the edge of urban areas.
4. Urban HIV prevalence	Whilst not all developing country urban contexts experience high urban HIV prevalence, this is particularly true in sub-Saharan Africa. In South Africa, urban HIV prevalence is found to be double that in rural areas, and highest within urban informal settlements. HIV provides a contextual challenge that requires much more than a sectoral health response.
5. Residents with ‘weak rights to the city’ (24, p. 13)	Despite a commitment to ‘rights for all’ within the South African Constitution 25, urban poor groups may experience challenges in claiming their rights within the city. This can include the right to access basic services, housing, health services, and employment.
6. Survivalist livelihoods	The livelihoods of urban poor groups are determined by the context in which they are located and the opportunities and constraints that this context provides. Survivalist livelihood strategies refer to individuals working within the informal economy during a time of crisis. A period of survival is when individuals are unable to plan far into the future and instead spend their energy surviving day to day 22 .

Figure 1.  This hidden space in inner-city Johannesburg could be mistaken for a rural area. Residents mostly originate from rural South Africa. © Nathi Makhanya.

Figure 2.  Inadequate sanitation is a reality where these spaces remain hidden from state service provision. © Nathi Makhanya.

Figure 3.  Shacks are constructed from salvaged wood from the nearby industrial areas. © Thulisile Zwane.

Vearey J, Palmary I, Thomas L, Nunez L, Drimie S. Urban health in Johannesburg: the importance of place in understanding intra-urban inequalities in a context of migration and HIV. Health & Place. 2010; 16: 694–702. 10.3402/gha.v4i0.5898.

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Balbo M, Marconi G. Governing international migration in the city of the south. Global Commission on International Migration. Geneva, 2005

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The Republic of South Africa. The Constitution of the Republic of South Africa – No. 108 of 1996. Pretoria: The Department of Constitutional Development. 1996.

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Vearey J. Migration, access to ART and survivalist livelihood strategies in Johannesburg. Afr J AIDS Res. 2008; 7: 361–74. 10.3402/gha.v4i0.5898.

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