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31 August 2020 | Story André Damons | Photo Supplied
Prof Ivan Turok
Prof Ivan Turok

The number of people infected by the coronavirus is linked to the density of urban living. South Africa’s townships and informal settlements are bearing the brunt of the disease, on top of all their existing problems of unemployment, poverty, hunger, and crime. This is a disturbing situation and demands greater attention across society.

This is according to Prof Ivan Turok from the Human Sciences Research Council (HSRC), the Department of Economics and Finance, and the Centre for Development Support at the University of the Free State (UFS), who has recently been awarded a Research Chair in City-Region Economies at the UFS by the South African Research Chairs Initiative (SARChI).

Prof Turok was part of a webinar discussion on ‘Urban Living Post-COVID-19’ with Dr Geci Karuri-Sebina – who manages the research programme at South African Cities Network and who has two decades’ experience working and publishing in the fields of urban development, innovation, and foresight – and Mr Thireshen Govender, architect and founder of UrbanWorks. They analysed how COVID-19 challenges urban living, social distancing, and the de-densification of cities as South Africa heads towards 70% of its population living in urban areas.

According to Prof Turok, urban density has been blamed for the spread of the virus. “The fear of people crowding together has caused negative reactions from government, from business, and from households. This is unlikely to be a short-lived, temporary phenomenon. It will be with us for some time to come.”

“The virus poses an ongoing risk to society, with the prospect of second and third waves taking hold. A lockdown could be re-imposed and further efforts could be made to enforce distancing and de-densification of cities, particularly our densest settlements,” said Prof Turok.

 

De-risking urban density

There was a simple but compelling idea at the heart of his presentation, which should also be “at the heart of a more effective and inclusive response to the pandemic”. At the moment, the government’s response to the crisis facing our poorest communities is uninspiring. “We need a more positive vision for the future than wearing masks and washing our hands.”

“We need to be bolder and more imaginative about de-risking urban density. In other words, making crowded neighbourhoods safer and more secure for people to live in. Density poses multiple risks to residents. How do we reduce these risks in ways that generate wider benefits, rather than business as usual – forcing people to change their behaviour and follow protocols?”

With reference to New York, which was severely affected by the virus, Prof Turok showed that it was not density per se that was the problem, but rather the type of density. The densest part of the city (Manhattan) was far less affected by the virus than poorer outlying communities. “This gives us a clue that more floor space in taller buildings helps to prevent crowding and makes density more liveable,” said Prof Turok.

The reality in South Africa is also different when you drill down and distinguish between different kinds of places. Big cities have been affected worse than towns and rural areas – in terms of the incidence of infections and the number of deaths. Within cities, there have been far more problems in the townships and informal settlements than in the suburbs. In Cape Town, for example, the southern and northern suburbs and the central city have been barely affected by the virus. However, infections have been very high on the Cape Flats, including Khayelitsha, Langa, Gugulethu, Philippi, and Mitchells Plain.

“Population densities in some of these areas are more than 100 times higher than in the affluent suburbs. The differences are very striking.”

“Incomes on the Cape Flats are also much lower than elsewhere in the city. So, there is a correspondence between density and the disease, unlike New York,” says Prof Turok.

All the discussions about the pandemic so far has focused on the negative aspects of urban density for the risk of transmission. This ignores all the benefits of dense urban living. Intense human interaction fosters learning and creativity, which raises productivity and innovation. Concentrated populations generate economies of scale in the provision of infrastructure and institutions such as universities. Cities give firms greater choice of workers and vice versa.

 

Pure population density and economic density

Prof Turok continued by saying that physical distancing can be socially and economically damaging. “Attempts to force people apart through de-densification undermine all kinds of personal networks, weaken the social fabric of communities, and erode the economic advantages of proximity that are so important for cities.”

“We need to understand that people crowding together in dense informal settlements is a symptom of something more fundamental, namely poverty. The pressure on land reflects the fact that low-income households can’t afford the space standards of middle- and upper-income groups. Forcing people apart (or to stay home) to reduce the risk of transmission just treats the symptoms of the problem. It cannot be a lasting solution. It doesn’t build resilience to confront the multiple challenges facing poor communities,” said Prof Turok.

A key part of a lasting solution can be summed up as building economic density. This involves increasing investment in two- or three-storey buildings to give people more living space and to free up land at ground-floor level to accommodate essential infrastructure and more public space for markets and social interaction. A better living and working environment would strengthen community resilience to public-health problems and promote all-round development. The idea of economic density offers a practical vision that can inspire hope in a better future, rather than the status quo of wearing masks in crowded places.

“We need to de-risk urban density through tangible investment, rather than forced distancing or dispersal. This will help to bring about far-reaching improvements to people’s lives in cities. At the moment, the lack of economic density in impoverished communities is a much bigger problem than excessive population densities.”

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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