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