Journal of Housing and the Built Environment

, Volume 28, Issue 4, pp 615–627 | Cite as

Housing and health in an informal settlement upgrade in Cape Town, South Africa

  • Niamh K. ShorttEmail author
  • Daniel Hammett
Policy and Practice


Taking a socio-ecological perspective the World Health Organisation recognizes that housing comprises four interrelated dimensions—the physical structure of the house, the home, the neighbourhood infrastructure and the community. Housing related health vulnerability arises when residents are exposed to poor conditions in any one of these dimensions and augmented when two or more co-exists. Regardless the relationship between housing and health in the global south remains largely under explored; in particular there has been little focus on health outcomes resulting from upgrading of informal settlements. Applying this framework we report from an in situ upgrading of the informal settlement of Imizamo Yethu in Cape Town, South Africa. Data gathered from surveys are used to determine whether differences in each of these dimensions exist between housing type; both formal upgrades and shacks. Results show that whilst no significant differences exist in self-reported physical health, residents of formal housing are less likely to report mental health issues, have a stronger sense of belonging and report greater satisfaction with both neighbourhood and home than shack residents. However, these contested spaces are not easily interpreted and community tension, exclusion and disadvantage highlight the complex interactions between each of the interrelated dimensions and policies regarding housing intervention. The paper highlights the complex relationship between housing and health that is often lost in simplistic measures of housing when outcomes related to the indoor environment alone are considered.


Informal settlement Housing and health Housing upgrade South Africa Township 



The researchers are grateful for funding from the Hayter Travel Fund, administered through Centre of African Studies, University of Edinburgh. We would like to thank the Niall Mellon Township Trust and the Imizamo Yethu Development Forum, as well as the local community, for their support and assistance with this research. Thanks are due to Leapfrog Consulting for their co-operation with this project.


  1. Abbott, J. (2001). An analysis of informal settlement upgrading and critique of existing methodological approaches. Habitat International, 26, 303–315.CrossRefGoogle Scholar
  2. Ali, S. I. (2010). Alternatives for safe water provision in urban and peri-urban slums. Journal of Water and Health, 8, 720–734.CrossRefGoogle Scholar
  3. Angotti, T. (2006). Apocalyptic anti-urbanism: Mike Davis and his planet of slums. International Journal of Urban and Regional Research, 30(4), 961–967.CrossRefGoogle Scholar
  4. Arku, G., Luginaah, I., Mkandawire, P., Baiden, P., & Asiedu, A. B. (2011). Housing and health in three contrasting neighbourhoods in Accra, Ghana. Social Science and Medicine, 72, 1864–1872.CrossRefGoogle Scholar
  5. Beall, J., Crankshaw, O., & Parnell, S. (2000). Victims, villains and fixers: The urban environment and Johannesburg’s poor. Journal of Southern African Studies, 26(4), 833–855.CrossRefGoogle Scholar
  6. Boraine, A., Crankshaw, O., Engelbrecht, C., Gotz, G., Mbanga, S., Narsoo, M., et al. (2006). The state of South African cities a decade after democracy. Urban Studies, 43(2), 259–284.CrossRefGoogle Scholar
  7. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge: MA, Harvard University Press.Google Scholar
  8. Butala, N. M., Vanrooyen, M. J., & Patel, R. B. (2010). Improved health outcomes in urban slums through infrastructure upgrading. Social Science and Medicine, 71, 935–940.CrossRefGoogle Scholar
  9. Christopher, A. J. (2005). Further progress in the desegregation of South African towns and cities, 1996–2001. Development Southern Africa, 22(2), 267–276.CrossRefGoogle Scholar
  10. City of Cape Town. (No Date) City of Cape Town—Census 2001—Imizamo Yethu.
  11. de Wet, T., Plagerson, S., Harpham, T., & Mathee, A. (2011). Poor housing, good health: A comparison of formal and informal housing in Johannesburg. South Africa: International Journal of Public Health Online first.Google Scholar
  12. Dixon, J., & Ramutsindela, M. (2006). Urban resettlement and environmental justice in Cape Town. Cities, 23(2), 129–139.CrossRefGoogle Scholar
  13. Duvall, D., & Booth, A. (1978). Housing environment and women’s health. Journal of Health and Social Behavior, 19(4), 410–417.CrossRefGoogle Scholar
  14. Evans, G. W., Wells, N. M., & Moch, A. (2003). Housing and mental health: A review of the evidence and a methodological and conceptual critique. Journal of Social Issues, 59(3), 475–500.CrossRefGoogle Scholar
  15. Froestad, J. (2005). Environmental health problems in Hout Bay: The challenge of generalising trust in South Africa. Journal of Southern African Studies, 31(2), 333–356.CrossRefGoogle Scholar
  16. Goebel, A. (2007). Sustainable urban development? Low-cost housing challenges in South Africa. Habitat International, 31, 291–302.CrossRefGoogle Scholar
  17. Gosselin, R. A., Spiegel, D. A., Coughlin, R., & Zirkle, L. G. (2009). Injuries: The neglected burden in developing countries. Bulletin of the World Health Organization, 87(4), 246–246a.CrossRefGoogle Scholar
  18. Govender, T., Barnes, J. M., & Pieper, C. H. (2010). Living in Low-Cost Housing Settlements in Cape Town, South Africa-The Epidemiological Characteristics Associated with Increased Health Vulnerability. Journal of Urban Health-Bulletin of the New York Academy of Medicine, 87(6), 899–911.Google Scholar
  19. Hagerty, B. M. K., Lynch-Sauer, J., Patusky, K. L., Bouwsema, M., & Collier, P. (1992). Sense of belonging: a vital mental health concept. Archives of Psychiatric Nursing, 6, 172–177.CrossRefGoogle Scholar
  20. Haque, R., Mondal, D., Kirkpatrick, B. D., Akther, S., Farr, B. M., Sack, R. B., et al. (2003). Epidemiologic and clinical characteristics of acute diarrhea with emphasis on Entamoeba histolytica infections in preschool children in an urban slum of Dhaka, Bangladesh. American Journal of Tropical Medicine and Hygiene, 69(4), 398–405.Google Scholar
  21. Harte, E. W., Childs, I. R. W., & Hastings, P. A. (2009). Imizamo Yethu: A case study of community resilience to fire hazard in an informal settlement Cape Town. South Africa. Geographical Research, 47(2), 142–154.CrossRefGoogle Scholar
  22. Hopton, J. L., & Hunt, S. M. (1996). Housing conditions and mental health in a disadvantaged area in Scotland. Journal of Epidemiology and Community Health, 50(1), 56–61.CrossRefGoogle Scholar
  23. Huchzermeyer, M. (2001). Housing for the poor? Negotiated housing policy in South Africa. Habitat International, 25, 303–331.CrossRefGoogle Scholar
  24. Huchzermeyer, M. (2009). The struggle for in situ upgrading of informal settlements: a reflection on cases in Gauteng. Development Southern Africa, 26(1), 59–73.CrossRefGoogle Scholar
  25. Huchzermeyer, M. (2010). Pounding at the Tip of the Iceberg: The Dominant Politics of Informal Settlement Eradication in South Africa. Politikon, 37(1), 129–148.CrossRefGoogle Scholar
  26. Kyobutungi, C., Ziraba, A. K., Ezeh, A., & Ye, Y. (2008). The burden of disease profile of residents of Nairobi’s slums: Results from a Demographic Surveillance System. Population Health Metrics, 6, 1.CrossRefGoogle Scholar
  27. Lemanski, C. (2007). Global cities in the south: Deepening social and spatial polarisation in Cape Town. Cities, 24(6), 448–461.CrossRefGoogle Scholar
  28. Lizarralde, G., & Massyn, M. (2008). Unexpected negative outcomes of community participation in low-cost housing projects in South Africa. Habitat International, 32, 1–14.CrossRefGoogle Scholar
  29. Mukhija, V. (2001). Upgrading housing settlements in developing countries. Cities, 18(4), 213–222.CrossRefGoogle Scholar
  30. Oelofse, C., & Dodson, B. (1997). Community, place and transformation: A perceptual analysis of residents’ responses to an informal settlement in Hout Bay South Africa. Geoforum, 28(1), 91–101.CrossRefGoogle Scholar
  31. Oldfield, S. (2000). The centrality of community capacity in state low-income housing provision in Cape Town, South Africa. International Journal of Urban and Regional Research, 24(4), 858–872.CrossRefGoogle Scholar
  32. Robinson, J. (2006). Inventions and Interventions: Transforming cities—an introduction. Urban Studies, 43(2), 251–258.CrossRefGoogle Scholar
  33. Skuse, A., & Cousins, T. (2007). Spaces of resistance: Informal settlement, communication and community organisation in a Cape Town partnership. Urban Studies, 44(5), 979–995.CrossRefGoogle Scholar
  34. Smit, W. (2006). Understanding the complexities of informal settlements: Insights from Cape Town. (In M. Huchzermeyer, & A. Karam (Eds.), Informal settlements: A perpetual challenge? (pp. 103-125). Cape Town: UCT Press.).Google Scholar
  35. South African Institute for Race Relations (SAIRR). (2009). 2008/9 South Africa Survey: Demographics.Google Scholar
  36. Sverdlik, A. (2011). Ill-health and poverty: a literature review on health in informal settlements. Environment and Urbanization, 23(1), 123–155.CrossRefGoogle Scholar
  37. Turok, I. (2001). Persistent polarisation post-apartheid? Progress towards urban integration in Cape Town. Urban Studies, 38(13), 2349–2377.CrossRefGoogle Scholar
  38. van Horen, B. (2000). Informal settlement upgrading: Bridging the gap between de facto and de jure. Journal of Planning Education and Research, 19, 389–400.CrossRefGoogle Scholar
  39. Western, J. (2001). Africa is coming to the Cape. Geographical Review, 91(4), 617–640.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Centre for Research on Environment, Society and Health (CRESH), School of GeosciencesUniversity of EdinburghEdinburghUK
  2. 2.Department of GeographyUniversity of SheffieldSheffieldUK
  3. 3.Department of GeographyUniversity of the Free StateBloemfonteinSouth Africa

Personalised recommendations