UCT School of Public Health

Dear Premier Zille,

UCT School of Public Health Supports Call for Affordable Housing in Sea Point & Other well-located neighbourhoods

Today, more than 50% of the world’s population live in urban centres, with rapid urbanisation in many countries including South Africa. The need to create healthy cities for all inhabitants will be one of the biggest public health challenges of the 21st century. Doing so successfully depends not just on providing medical care, but on preventing ill-health, promoting health, and improving the living conditions of billions of people.

Twenty years after the end of Apartheid, Cape Town remains one of the most spatially divided cities in the world. This presents many adverse personal and societal consequences, not least on public health. Like most South African cities, Cape Town is characterised by great health inequity, and this inequity is closely linked to where people live. Historically disadvantaged Black African and Coloured communities on the urban periphery experience the worst health outcomes. A vital means of progressively addressing this lies in government promoting more mixed-income neighbourhoods in well-located areas.
We know much – from local and international research, experience and best practice – about what healthier communities look like. The most important of these lessons in Cape Town’s context include:

  • We must introduce measures to address inadequate, overcrowded and poorly maintained housing. Living in these conditions have been shown to increase risk of injury, respiratory problems, infectious diseases, and mental illness. This applies to the 20% of Capetonians living in informal settlements, but also the hundreds of thousands living in overcrowded homes, backyard dwellings, apartments and hostels. Government must play a much stronger role in both regulating private rental conditions, and increasing the supply of government-supplied affordable housing for working families, as well as for those with special needs such as the disabled and the elderly.
  • We must not only deliver more houses, but consider where they are built. Housing is a significant determinant of health. However, housing extends beyond the physical structure; and the different dimensions of housing defined by the World Health Organization also include: the home (psychosocial, economic and cultural construction created by the household); neighbourhood infrastructure (physical conditions of the immediate housing environment); and the community (social environment and the population and services within the neighbourhood). Location is therefore a key factor in determining one’s health. We know that people living in mixed-income communities, close to their places of work and studies, are much more likely to have positive health outcomes than those living in overwhelmingly poor dislocated neighborhoods. They are much less likely to contract chronic illnesses or mental illness, be exposed to violence, or fall victim to addiction. Numerous studies have highlighted the positive contribution that mixed housing can make towards more sustainable human settlements. Government’s current tendency to push poor and working households further and further away from the city centre runs counter to the basic principle that mixed-income neighborhoods are better for everyone.
  • Long public transit commutes result in personal and societal health, safety and environmental costs. Many poor and working Capetonians spend several hours a day commuting. Public transport has been shown to be a major factor in the rising TB rates due to transmission risks associated with long commutes in crowded buses, taxis and trains. In addition to the effect on the individual, there is also evidence to show that health and wellbeing of children is negatively impacted by long commutes by primary caregivers. In addition, the vast quantities of carbon monoxide long commutes produce have a serious impact on the environment, and leads to serious respiratory problems like Asthma. Many people – but particularly women and children – are vulnerable to violent crime when walking to and from public transport that can have a lasting effect on physical and mental health.
  • Public space and amenities are important for public health and wellbeing. Non-communicable diseases and their risk factors including obesity, high blood pressure, and diabetes represent a significant health and economic burden in Cape Town and South Africa; and this burden is disproportionately borne by socio-economically disadvantaged populations. Key to addressing this epidemic is promoting healthier lifestyles including increasing physical activity and reducing fast food and processed food consumption. Whilst the City of Cape Town encourages a healthy lifestyle, as exemplified by a recent statement by the Executive Mayor de Lille on 08 May 2016, farflung peripheral communities have inferior access to recreational public space, healthy food options, and leisure. A greater proportion of free time spent commuting reduces time available for physical exercise and further impedes access to these health-promoting environments. By contrast, living closer to work, closer to outdoor recreational areas, with good public amenities, and in neighbourhoods where walking is safe and possible is associated with better health and healthier choices. These facilities tend to be more prevalent in well-located central city neighborhoods.
  • Preventive health is cheaper than curative health care. Many factors that influence the health of the public lie outside the health sector. As housing is a key factor influencing health, by promoting health through investing in improved living conditions and healthier neighborhoods, significant cost-savings can be made in the long term. Preventing chronic illnesses before they occur could save the state billions of Rands, relieving an overburdened healthcare system. Importantly, the responsibility for implementing strategies to prevent these illnesses does not solely lie with the health sector but involves all sectors that influence health, including housing.

The Tafelberg site in Sea Point provides a prime opportunity to implement the above recommendations. A great many people commuting into Sea Point each day to work would benefit greatly from having a home nearby. Workers already living in Sea Point often reside in overcrowded and poorly ventilated “Maid’s Quarters”. Residents have shared accounts of living underground with inadequate air circulation, broken doors, rats running about, lack of electricity and very insecure tenure. They should not have to choose between these conditions, and living 90 minutes away. Furthermore, Sea Point has some of the best public spaces, social services and amenities in the city – perhaps the country – which should be accessible to residents across income groups. Consistent with the City’s own densification policy, greater socio-economic urban integration is not only a priority for development, but also a contributor to enhancing social capital, thereby contributing to enhancing the overall health prospects of Cape Town’s diverse residents.
The Tafelberg site could provide homes to hundreds of working families, and serve as a transformative model to improve health outcomes and promote equity among residents and the neighbourhood, which could be replicated elsewhere. It would be an evidence-based decision and one which might enable Cape Town to join other South African cities in leading by example in South Africa. We urge you, Madam Premier, to grasp this timely and important opportunity.

Dr. Tolu Oni 

Senior Lecturer, Division of Public Health Medicine

Prof. Leslie London

Head, Division of Public Health Medicine
PDF here.

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