Poverty and health

Slum Upgrading and Health Equity
Corburn J; Sverdlik A: International Journal of Environment Research and Public Health 14(4), 2017

Informal settlement upgrading is widely recognised for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. The authors conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment and adopting an urban health in all policies framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.

Impoverishing effects of catastrophic health expenditures in Malawi
Mchenga M; Chirwa G; Chiwaula L: International Journal for Health in Equity 16(25), 2017

Out-of-pocket (OOP) health spending can potentially expose households to risk of incurring large medical bills, and this may impact on their welfare. This work investigates the effect of catastrophic OOP on the incidence and depth of poverty in Malawi. The paper is based on data that was collected from 12,271 households that were interviewed during the third Malawi integrated household survey (IHS-3). The paper considered a household to have incurred a catastrophic health expenditure if the share of health expenditure in the household's non-food expenditure was greater than a given threshold ranging between 10 and 40%. As the authors increase the threshold from 10 to 40%, they found that OOP drives between 0.73%-9.37% of households into catastrophic health expenditure. The extent by which households exceed a given threshold (mean overshoot) drops from 1.01% of expenditure to 0.08%, as the threshold increased. When OOP is accounted for in poverty estimation, an additional 0.93% of the population is considered poor and the poverty gap rises by 2.54%. The authors’ analysis suggests that people in rural areas and middle income households are at higher risk of facing catastrophic health expenditure. The authors conclude that catastrophic health expenditure increases the incidence and depth of poverty in Malawi. They call for financing measures to minimise the incidence of catastrophic health expenditure especially to the rural and middle income population.

New Open Access Book: Sustainable Food Systems: The Role of the City
Biel R: UCL Press, UK, December 2016

Faced with a global threat to food security, it is perfectly possible that society will respond by reasserting co-operative traditions. This open access book, by a leading expert in urban agriculture, proposes a solution to today’s global food crisis. By contributing more to feeding themselves, it argues that cities can allow breathing space for the rural sector to convert to more organic sustainable approaches. Biel’s approach connects with current debates about agroecology and food sovereignty. It asks key questions, and proposes lines of future research. He suggests that today’s food insecurity – manifested in a regime of wildly fluctuating prices – reflects not just temporary stresses in the existing mode of production, but more profoundly the troubled process of generating a new one. He argues that the solution cannot be implemented at a merely technical or political level: the force of change can only be driven by the kind of social movements which are now daring to challenge the existing unsustainable order.

Safe and inclusive cities survey
Institute of Environmental Studies, University of Zimbabwe, 2015

The proportion of people worldwide living in urban areas has been increasing over the past century. Southern Africa is one of the least urbanised but fastest urbanising region. The pace of urbanisation in sub-Saharan Africa is twice the global average, making it the highest in the world. The urban population annual growth rate for the region is pegged at 3.75%. South Africa and Botswana have urban populations of more than 60% and Zimbabwe 33%. The survey was conducted in 4 purposively sampled urban high density suburbs. A multi-stage random sampling was then used to select households in the 4 suburbs. The sampling frame for selecting households was obtained from ZIMSTAT, the country’s statistical office. Data was collected over a period of a week in each of the sampled suburbs. During the week the enumerators would conduct household interviews in the Enumeration Areas (EAs). Household questionnaire were used to collected data from the sampled households. The questionnaire covered: characteristics of household members; availability of and access to shelter, water and sanitation; energy sources; income sources; assets. Results shows that where the council provided the houses, the critical services were provided and water, electricity and sanitation were not an issue. The urban councils developed the properties, but their role was not clear in the new urban landscape. Issues of restitution in the event of evictions in these areas were grey areas and people did not know where to go to get assistance when evicted, to where to access legal advice. Residents wanted advice on issues to do with access to land for vending, law enforcement and women empowerment, on land tenure and how to get title deeds. Most lease agreements and title deeds were in the name of the husband, giving men more access to land for housing than women.

Food security and coping strategies of an urban community in Durban
Mtolo A: Durban University of Technology Thesis, 2016

This study determined the food security status, coping strategies, food intake and the nutritional status of the Kenneth Gardens community, in urban KwaZulu-Natal. Residents are low income bracket earners and many rely on state disability and pension grants for survival. The research tools included; a food security questionnaire, anthropometric measurements, a socio-demographic questionnaire, a food frequency questionnaire, and 24-hour recall questionnaires conducted in triplicate. The most commonly used coping strategy during periods of food scarcity was “Rely on less expensive and preferred food”. The second used coping strategy was “Reduce the number of meals eaten in a day” , followed by “Contribute to a food stokvel in order to ensure food over a scarce period" and “Restrict consumption by adults in order for small children to eat”. Utilisation of these food coping strategies indicate a degree of food insecurity. Low income and high unemployment increased the prevalence of food insecurity, leading to the coping strategies reported.

From Corn to Popcorn? Urbanisation and food consumption in Sub-Sahara Africa: Evidence from rural-urban migrants in Tanzania
Cockx L; De Weerdt J: 2016 AAAE Fifth International Conference Paper Number 249270, 2016

Sub-Saharan Africa is currently in the midst of an unprecedented wave of urbanisation that is expected to have wide-ranging implications for food and nutrition security. Though this spatial transformation of the population is increasingly put forward as one of the main drivers of changes in food consumption patterns, empirical evidence remains scarce and the comparative descriptive design of existing research is prone to selection bias as urban residence is far from random. Based upon longitudinal data from the Tanzania National Panel Survey and the Kagera Health and Development Survey, this study is the first to assess the impact of urbanisation on food consumption through comparing individuals’ food consumption patterns before and after they have migrated from rural to urban areas. The authors find that even after controlling for individual fixed heterogeneity, baseline observable characteristics and initial household fixed effects, urbanisation is significantly associated with important changes in dietary patterns, including a shift away from traditional staples towards more processed and ready-to-eat foods. While there is some evidence of changes that can be deemed beneficial from a nutritional point of view - including increased consumption of vegetables and animal source foods - the results also largely confirm concerns about the association between urbanisation and heightened consumption of sugar and fats. In addition, the authors find no support for the hypothesis that urbanisation is associated with more diverse diets. Finally, the results indicate that rural-urban migration significantly contributes to reducing volatility in food consumption.

Participatory Slum Upgrading Programme
Okello M; Oenga I; Chege P: Practical Action, 2017

Launched in 2008, the Participatory Slum Upgrading Programme (PSUP) is a joint effort of the African, Caribbean and Pacific (ACP) Group of States, the European Commission (EC) and UN-Habitat. To date, the programme has reached out to 35 countries, 160 cities, and 2 million slum dwellers. The approach is grounded in integrating slum dwellers into the broader urban fabric using city-wide participatory planning methods. In practical terms, PSUP puts slums on the ‘urban’ maps and facilitates dialogue at local, national and regional levels that is necessary for a ‘mind-set change’, key for inclusive urbanisation. PSUP provides tools and practical experience of inclusive integrated slum upgrading through which all stakeholders learn key lessons. It builds confidence in participatory planning; institutionalises partnerships and improved governance arrangements, equips government with key financing mechanisms for slum upgrading including mechanisms to engage and empower slum dwellers themselves to advance delivery of relevant, community led improved infrastructure in slums.

Picture a Poverty Free City, Tanzania
Mtwapa Participatory Slum Upgrading Programme, 2015

What would a city free from poverty really look like for urban youth in Tanzania? Dr Nicola Banks, ESRC Future Research Leader, in this video presented information from local research on young people’s vision for a poverty-free city in Tanzania. The video reports evidence from participatory discussion with youth. Urban youth make up a huge proportion of city populations- and the video highlights the economic and social opportunities Tanzanian youth raised in their discussions.

Psychosocial risk and protective factors associated with perpetration of gender-based violence in a community sample of men in rural KwaZulu-Natal, South Africa
Mngoma N; Fergus S; Jeeves A; Jolly R: South African Medical Journal 106(12) 2016

Rates of gender-based violence (GBV) in South Africa (SA) are among the highest in the world. In societies where social ideals of masculinity encourage male dominance and control over women, gender power imbalances contribute to male perpetration and women’s vulnerability. The drivers that cause men to perpetrate GBV and those that lead to HIV overlap and interact in multiple and complex ways. Multiple risk and protective factors for GBV perpetration by males operate interdependently at a number of levels; at the individual level, these include chronic anxiety and depression, which have been shown to lead to risky sexual behaviours. This study examined psychosocial risk factors (symptoms of anxiety and depression) as well as protective factors (social support and self-esteem) as self-reported by a cohort of males in rural KwaZulu-Natal (KZN) Province, SA; and to determine whether there are differences in anxiety, depression, social support and self-esteem between perpetrators and non-perpetrators. The participants were relatively young (median age 22 years); over half were school goers, and 91% had never married. Over 43% of the sample reported clinical levels of anxiety and depressive symptoms. Rates of GBV perpetration were 61%, 24% and 10% for psychological abuse, non-sexual physical violence and sexual violence, respectively. GBV perpetration was associated with higher depression, higher anxiety, lower self-esteem and lower social support. Interventions to address GBV need to take modifiable individual-level factors into account.

Towards the Human City
Collaborative Media Advocacy Platform: Port Harcourt, Nigeria

The Human City Project is a community-driven media, architecture, urban planning and human rights movement in Port Harcourt, Nigeria. It is a collaboration between local and international community organisers, filmmakers, broadcasters, urban planners, architects, designers, university researchers and ordinary people from across Port Harcourt’s informal settlements. Those involved share skills and technologies for communities to record their experiences, tell their stories and change their lives. They are moved by the conviction that democratic design principles can make cities more creative and just. Based on community mapping of needs and priorities, a community radio station was started – Chicoco Radio – formally owned by Chicoco Community Media Initiative, an incorporated board of trustees drawn from communities across the city. With a campaign of 'the people live here' communities in the informal settlements in Port Harcourt have resisted eviction, and are carrying out activities to map and make visible their conditions and needs, develop their voice and capacity to participate meaningfully in the shaping of their city, including to change the way the city is imagined and inhabited on principles of social justice and equity. With the means to tell their stories on film, on air and in court, charting their reality on maps and describing their visions in urban action plans, these communities are changing their lives and shaping their city.