As part of a new public lecture series exploring healthy cities in collaboration with LSE Cities and LSE Health, Professor Vanessa Watson of University of Cape Town discusses the future of urban health in Africa, asking whether and how we might move towards healthy African cities, including by re-thinking planning and design.

African cities have a long history of being the receivers rather than the generators of urban policy knowledge, theories and solutions. During both colonial and postcolonial times, the American, British and European territories of the world, with only a few exceptions, produced and transplanted urban planning and policy ideas to Global South cities. This has been true for urban planning, housing policies, transport policies and more recently a newer body of thinking about how population health in cities can be improved.

While there is no doubt value in many of these ideas, there is a fundamental flaw underlying many of them: they are based on assumptions regarding the social, economic, political, cultural and spatial context in which these ideas are implemented, which may hold true in the Global North but cannot be simply generalised for all parts of the world. This is a central reason why so many urban policies attempted in African cities have little positive impact, and often have highly negative and unforeseen outcomes. Yet African politicians, professionals and researchers continue to look beyond the continent for the next “best practice” solution that promises to solve the ills of urban Africa.

This has been an important factor behind the establishment of the African Centre for Cities at the University of Cape Town. From 2007 it has used innovative approaches and methodologies to uncover the particularities of the urban African context and develop ideas to address them – not ignoring the global stock of policy ideas, but considering what might be appropriate to the African urban context. One of these methodologies has been the CityLab – a way of co-producing knowledge drawing on the insights from actors and groups in the public, private, civil and academic spheres.

The Healthy Cities CityLab has drawn more specifically on an interdisciplinary group of researchers and professionals, but the combination of ideas from planners, sports scientists, health professionals and anthropologists has resulted in fascinating research and findings. The most commonly used concepts and tools for understanding the relationship between the physical urban environment and health and wellbeing are largely based on empirical work undertaken in the global North, as are the concepts of “health” and “urban” which underpin this body of knowledge. Existing guidelines on how to create healthy urban environments are therefore of limited use in cities such as Cape Town, South Africa, where contextual realities are largely different from those in the global North, and where many of the assumptions underpinning the dominant body of knowledge do not necessarily apply.

Three key sets of assumptions, which underpin knowledge on the relationship between human health and the physical urban environment, were challenged in the Cape Town work. The first are assumptions about the nature of “human health and well-being”, the second are about what is a viable urban environment, and the third has to do with conceptions of choice in relation to health-related behaviours. This understanding emerged from research carried out in a poor and informal area of Cape Town, using an ethnographic research method termed body-mapping. The results of this showed just how difficult it is to apply global North concepts and tools to the very different contexts in global South cities. The way people interact with the physical urban environment is strongly mediated by social factors, and people’s conceptions of health and wellbeing go beyond the biomedical into the realms of the spiritual and emotional. The use of space is strongly influenced by fear of violence. Findings from case studies such as these indicate that there is a relationship between space and health, and planners should be concerned about how their work can promote health and well-being. But how they do this in rapidly urbanising and poor cities has not yet been properly addressed in mainstream healthy cities literature.

Vanessa Watson is a Professor and Deputy Dean of the Faculty of Engineering and the Built Environment at the University of Cape Town.

Healthy African Cities was produced in collaboration with LSE Health and Africa Talks. It was the first in a new series of free public events on the topic of “Cities, health and well-being”. The second lecture, ‘Interdisciplinary Action for Urban Health’ will take place on Friday 26 April 18.30 – 20.00 in the Thai Theatre, New Academic Building, London School of Economics and Political Science. For more information please visit our website.

LSE Cities is an international centre at the London School of Economics and Political Science supported by Deutsche Bank that carries out research education and outreach activities in London and abroad. Its mission is to study how people and cities interact in a rapidly urbanising world, focusing on how the design of cities impacts on society, culture and the environment. Through research, conferences, teaching and projects, the centre aims to shape new thinking and practice on how to make cities fairer and more sustainable for the next generation of urban dwellers, who will make up over 70 per cent of the global population by 2050.