Sustainable Development Goals and Urban Health

The book is structured into 11 chapters. This chapter introduces the study by articulating the urban health problem and how it compromises the attainment of healthy cities. Healthy cities promote and enhance the livability of cities and the well-being of citizens. This discussion is situated in the context of the Sustainable Development Goals (SDGs) set by world leaders as global indicators and measures of progress and development across nations. This book focuses on the nexus of urban health and selected SDGs and the attainment of the targets relating to urban health. The selection of the South African case study has been purposive and helps understand the enablers and disablers of attaining healthy cities and the SDGs through local perspectives and experiences.

Cities and human settlements play pivotal roles in influencing people’s well-being and are essential in realizing the wider objectives of global development as stated in the 2030 Agenda. The primary goal of sustainable development is to create cities and human settlements that are inclusive, secure, resilient and sustainable. This is achieved by addressing various aspects including housing, transportation, sanitation, healthcare, access to public green areas and fostering sustainable urban development. Despite significant economic progress in recent years, South Africa continues to grapple with the challenges of extreme poverty, with spatial planning playing a significant role in shaping its prevalence and persistence. Bloemfontein is one of the nine major cities in South Africa, representing an important case study for understanding the complexities of poverty and its impact on urban health. The paper employs a qualitative case study method in the Phomolong informal settlements to highlight nuances of the complex interactions between urbanization, poverty, health and the pursuit of Sustainable Development Goals (SDGs). Comprehending the factors influencing extreme poverty and urban health, especially in marginalized communities is crucial for achieving SDG objectives. The findings indicate that we are far from reaching these objectives. The apparent absence of essential services is at the core of these challenges, which significantly hampers the overall well-being of the residents. The paper concludes by emphasizing that attaining the SDGs targets in Bloemfontein will only become a reality if the state intentionally focuses its efforts on these communities to promote social justice, inclusivity and improved health outcomes for all residents.

Urban food systems in Africa are confronted with three major challenges, providing nutrition and food security for a rapidly expanding urban population, assisting urban farmers and other food chain members, and accomplishing all of this in an environmentally sustainable manner. The situation is particularly dire for the urban poor, who appear to be disproportionately excluded from markets and food because of location-based prejudices that are maintained by segregated urban forms that date back to colonial times. Ending hunger, establishing food security, improving nutrition, and promoting sustainable agriculture are the main goals of SDG 2, while many of the other targets depend on nutrition. This chapter examines how SDG 2 can promote urban health by improving food security. To gather lived experiences, phenomenological methods including in-depth interviews, walking interviews, and observation were used in four distinct communities in Mangaung. The study has found that food insecurity was a problem that was becoming more serious in both formal and informal households. Notwithstanding the impact of climate change on food production, efforts have been made to improve food production at the community level. Aiming to accomplish objective 2 of the SDGs, certain corporations and non-governmental organisations (NGOs) have taken the initiative to fund agricultural production and community development programmes to guarantee that families have wholesome meals and diets. Therefore, Improved food security based on sound, equitable, and sustainable food systems that benefit from modern information and sustainable and equitable agricultural technologies is essential for countries to meet the SDGs.

Rapid urbanisation has become one of the greatest threats to urban health, particularly among low-income urban areas in the Global South. One of the key aspects of urban health is access to water and sanitation for all as stated in the Sustainable Development Goal (SDG) 6. While substantial progress has been made in increasing access to clean drinking water and sanitation, billions of people, mostly in developing countries, still lack these basic services. Cholera outbreaks and the COVID-19 pandemic demonstrated the critical importance of sanitation, hygiene, and adequate access to clean water to create environments, which are conducive to preventing and containing diseases. Women and girls, especially those living in urban poverty, are disproportionately affected by access to water and sanitation. This chapter explores the gender disparities and implications of inadequate water and sanitation in Mangaung Metropolitan Municipality. We explore local water and sanitation coping strategies among women in selected communities in Mangaung. Data for this study is based on qualitative surveys and key informant interviews. We conclude that gender equality with regards to access to water and sanitation in African cities should be emphasised as basic human rights and are fundamental in achieving other SDGs. We suggest prioritising women’s participation in water governance in their communities, increasing the availability of sex-disaggregated data on water, sanitation, and hygiene, challenging social norms around women’s leadership, and gender-based violence in water and sanitation issues.

In this chapter, we explore the progress in achieving Sustainable Development Goal (SDG) 9, which is to build resilient infrastructure and promote and foster innovation in relation to urban public health. The chapter takes a multifocal view of the relationship between infrastructure and urban public health. The conceptual and global perspective is explored before attention is given to the South African scope. Primary data were collected from four marginalised urban communities in Bloemfontein, South Africa, through direct observations, key informant interviews and in-depth interviews, which are triangulated with secondary sources. Current urban public health challenges, state of existing urban public health infrastructure, community innovation, and institutions responsible for urban public health infrastructure and innovation in marginalised communities were determined. Additionally, new forms of infrastructure and innovation to improve the state of urban public health in the marginalised communities were explored. We argue that a focus on building resilient infrastructure and fostering innovation for urban public health in African cities’ marginalised communities is urgently required to support progress on achieving SDGs as well as other global and regional public health targets.

This chapter examines the implications of Sustainable Development Goal (SDG) 11 on urban health, particularly service delivery in a South African hostel accommodation. The aim of SDG 11 is to create inclusive, safe, resilient, and sustainable human settlements with enhanced access to adequate housing and basic services. The recent global pandemic has underscored the urgency of addressing human settlement challenges in low-income communities while aligning with SDGs and urban health indicators. Through a qualitative case study, primary data were collected through observations, focus group discussions, interviews, and community meetings in Mangaung (South Africa). Secondary data from literature, policy and legislative reports, and media sources supplemented this. A thematic analysis was employed to analyse the findings. The study reveals significant inadequacies in housing, sanitation, and garbage removal in the study area, highlighting the need for sustainable urban development efforts. The paper argues that while achieving SDG 11 targets may present challenges in a municipality facing administrative hurdles, Mangaung has the potential to lead in sustainable human settlements by addressing urban health challenges through collaborative efforts involving the state, community, private sector, academia, and other stakeholders. This research underlines the opportunity to remodel hostel accommodation into liveable residences through integrated and collaborative approaches.

Sustainable Development Goal (SDG) 13 on climate action greatly relates with urban health. The focus of this chapter is to consider community health in the context of climate change regarding those living in precarious housing conditions in the Mangaung Metropolitan Municipality. The chapter used two gridded datasets, the Climate Hazards Group IntraRed Precipitation with station rainfall data (CHRIPS) and the AgERA5 reanalysis data product spanning 1990–2022. Trend results were based on the World Meteorological Organization Commission for Climatology and Indices Expert Team on Climate Change Detection (ET-SCI). Indices describing warm spells and heavy rainfall events were calculated using the ClimPact software. Results showed that consecutive three-day warm spell events increased over the study period, with rate increases of 0.26 days/year in Mangaung Metropolitan. Heavy rainfall days (>10 mm) increased with rates of 0.12 days/year and 0.07 days/year in Bloemfontein and Botshabelo, respectively. Overall, the Mangaung Metropolitan experienced an increase in three consecutive warm spell days (WSDI₃)_, with rate increases of 0.26 days/year from 1990–2022. Similarly, an increased trend was evident for heavy rainfall days (r10 mm) in the Mangaung Metropolitan. No increasing or decreasing rate was evident over the study period. The study emphasises the need for further analysis of these extreme climatic events with a focus on community health in formal and informal settlements under projected increases of these events in the Mangaung Metropolitan.

Urban green spaces play a vital role in promoting the mental and physical well-being of urban residents. Understanding the health benefits derived from these green spaces is essential for effective urban planning, improving the health sector, and ensuring sustainable urban management. However, studies that focus on the availability and accessibility of urban green space in Africa are scarce. This study investigates the impact of changes in urban green spaces on public health in Bloemfontein, South Africa. The study quantifies the availability and accessibility of urban green spaces in the study area between 2010 and 2020. The significance of urban green spaces for the well-being of residents are determined by assessing potential health impacts resulting from changes in availability and accessibility. Urban green spaces were extracted, and their availability and accessibility were calculated. The results reveal a concerning decrease of 2.09% in urban green spaces between 2010 and 2020. Accessibility to these spaces also declined by 6.72%. Such decreased rates have adverse effects on residents, affecting their physical and mental well-being. This, in turn, hampers the country’s pursuit of achieving sustainable development goals (SDGs), particularly SDG3 (Good Health and Well-being), SDG13 (Climate Action), and SDG15 (Life on Land). Addressing the findings of this study can provide valuable guidance to municipalities, forest managers, government agencies, and other stakeholders. By strategically increasing urban green spaces, these entities can promote the achievement of the SDGs, especially those related to urban trees, ultimately fostering sustainable development and public health in the area.

This chapter addresses several issues pertinent to health governance and health inequalities. To attain the Sustainable Development Goals (SDGs), peaceful, just, and inclusive societies are required. Effective and inclusive governmental institutions can help to deliver quality healthcare, fair economic policies, and inclusive environmental protection to advance the SDGs. Governments, civil society, and communities must work together to implement long-term solutions to minimise violence, deliver justice, battle corruption, and always promote inclusive participation to achieve peace, justice, and inclusion. Regardless of ethnicity, faith, or sexual orientation, people everywhere must be free of fear of all forms of violence and feel safe as they go about their daily lives. The right to express oneself must be protected in private and public spaces. People must be able to participate in decisions that impact their lives. Discrimination needs to be avoided when enforcing laws and policies. Conflicts must be resolved through well-functioning political and legal systems. Institutions at the national and local levels must be held accountable. They must be in place to provide essential services to families and communities equitably and non-bribable. Violence has a pervasive impact on civilisations; it generates trauma and makes social inclusion more difficult. Children’s health, development, and well-being, as well as their potential to thrive, are all affected by violence. Armed violence and insecurity negatively impact a country’s development, slowing economic progress and causing long-standing community discontent. A democracy and peacebuilding approach will be employed in this chapter, and it is suggested as a practical way to foster peaceful and inclusive societies for sustainable development.

The purpose of this chapter is to show the pattern of use and the typologies of energy sources relied on by settlement dwellers of selected communities in Bloemfontein. The chapter explores the coping strategies used by settlement dwellers in areas with low-income households that have difficulties of accessing energy in light of loadshedding in Bloemfontein. The chapter uses the lens of Sustainable Development Goals 7 and 12 to explore low-income energy consumers of settlements in Bloemfontein. The study engaged key informant interviews, focus group discussions, observations and a survey involving some 160 respondents randomly selected in the Phomolong, Bochabela, Phase 2, and Turflaagte informal neighbourhoods. The major issues emanating from the ground is that most households depend on unclean energy sources like paraffin, wood, and petroleum gas. The households argue that the cost of these unclean energy sources continue to escalate despite government regulation on the commodities and limited access to healthcare facilities. The reason is the involvement of middlemen who buy the commodity at a very low cost and then sell it at an exorbitant level to them. Another observation is the wide presence of gadgets (like satellite television sets) within the informal settlement; this fashionable trend is the emulation by the low-income earners living like the affluent people. Generally, livelihoods strategies in informal settlements revolve around the commoditization of electricity and related products as people seek to charge their cell phones, among other gadgets. The successful attainment of Sustainable Development Goals is challenged mainly by the marginalisation and powerlessness of informal settlement dwellers.

With the rapid urbanisation characterising Global South cities, cities are confronted with a myriad of socio-economic and environmental challenges that are increasing in intensity and frequency. There are mounting protests by communities over the lack of service delivery, cases of misgovernance and corruption in public and private institutions, climate change-induced disasters and disease epidemics. While some cities are still grappling with the legacies of the inequalities of the colonial/apartheid government systems, these serious challenges exacerbate the already grim living conditions of the residents, especially those residing in poor neighbourhoods. In this context, achieving the Sustainable Development Goals (SDGs) is a growing challenge in most Global South cities. Here many individuals and communities continue to be ‘left behind’ by the inability of their governments to make substantial progress in meeting the SDGs. Understanding the progress made towards the respective SDGs is critical, hence this chapter summarises the key findings and emerging issues using the case of Mangaung Metro Municipality (MMM). Our focus is on the nexus between urban health and the SDGs. This relationship is multifaceted, as the SDGs are dynamic and cross-cutting; consequently, difficult to monitor or generalise the progress on the respective indicators and targets. Despite the complex relationship between SDGs and urban health, progress is being made in some areas, while some areas still fall behind.