Greater Johannesburg is home for the third largest urban population in greater urbanised areas in South Africa (after Cape Town and Durban). In Gauteng (the second populous province after Kwazulu-Natal) it is one of the very highly populated regions, with the fastest growing population.

POPULATION PERSENTAGE DISTRIBUTION

The majority of the population is situated within the SMLC which is also the area that is characterized by high densities, low education levels, poor income levels and  poor infrastructure and service delivery, as well as poor environmental quality. The disease profile support the assumption that poor socio-economic status are linked to environmental health related diseases that are closely linked to infrastructure, service delivery and an improvement in the socio-economic status of a community.

POPULATION COMPOSITION BY AGE

A large number (20,63%) of people in the age category 25-34, migrate into Greater Johannesburg for job opportunities. This age group is also the child bearing age group which increase natural population growth. This then increase the burden on the over-capacitated infrastructures and the environment.

Since 1980 the population growth rate of Greater Johannesburg has been approximately 1,1%, while large disparities in growth rates do exist within greater Johannesburg - the annual population growth rate of the towns in Greater Johannesburg range between 0,14% and 4,29%, (projections, 1995-2001). This is especially concerning as Greater Johannesburg is still in an exponential growth rate pattern which result in high population growth. It is well known that an exponential growth rate occurs during a demographic transition of poor socio economic status coupled with high mortality and high fertility rates.

An increase in population growth may have the following impact in relation to environment and health:

• Increase in air pollution and poor air quality
• Increase in water pollution and poor water quality
• Increase in a demand for adequate sanitation
• Increase in inadequate housing
• Increase in poor socio economic conditions such as poverty and
• Increase in a demand for infrastructure.

POVERTY (SOCIO ECONOMIC STATUS)

INCOME LEVELS

High disparities exists in income levels among the various race groups and MLC. The fact that 48,6% of the population within Greater Johannesburg are without any source of income, and 51,8% earn low wages, has an impact on the affordability of basic needs and services. Lack of access to income results in people not being able to pay for health and medical facilities, therefore increasing health problems which increase poverty.

Income poverty and ill health are tightly linked in a vicious downward cycle. People living in poor housing without access to clean water, sanitation or basic health facilities are more likely to become sick. Ill-health conditions; people are in a poorer position when they are unable to work and have to exhaust their meagre savings on health care and medication.

EMPLOYMENT

The unemployment rate in Johannesburg is high and it marks variations by gender and by population group, with the unemployment rate of African women is higher than that of African men and that of the African population group is higher than that of the white population. The unemployed, within the African population are people in the prime of their working lives. Of the economically active population within Greater Johannesburg, 45,7% are non-active or unemployed.

For those who are employed, some work in the formal sector and others in the informal sector of the economy. The informal sector provides an important source of employment and income for many people. Women dominate the informal sector. This is because women tend to cluster into elementary occupations such as domestic work and hawking. Of the estimated 2.15 million formal sector workers employed in Gauteng province in 1991 approximately a third are employed in Greater Johannesburg.

Employment of low-skilled labour in the mining and manufacturing sectors is declining thus increasing unemployment figures. Industrial development is now concentrated and expanding towards the north and the east (Sandton, Midrand and the area north of Johannesburg international airport), leaving the CBD in a state of decline.

While the north of Johannesburg is developing the south, where low-income households live is still affected by poverty. The high unemployment rate in Greater Johannesburg result in high crime rates. Johannesburg is popularly referred to as the country’s crime capital and the most violent city in the world (Louw et.al., 1998).

The high levels of crime are driving people out of the metropolitan area and threatening business and investor confidence in the economic heart of the country. The CBD, perceived as the most dangerous part of Johannesburg, is facing decline as formal businesses leave for the relative safety of the suburbs and satellite CBD’s. The impact of businesses leaving Johannesburg’s could only mean less employment opportunities for an increasing urban population and also an increase in the informal sector.

EDUCATION

In Johannesburg there are large disparities in the level of educational attainment of Africans when compared with whites (more whites have attained secondary education than Africans). Amongst the African population, more males have secondary education than females, and there are more females with no education at all, than there are males.

Education by age group in many townships in Johannesburg is as follows: more people aged between 20 years and 35 have attained secondary education than people who are 35 years and above.

As far as unemployment is concerned, the same people with secondary education, contribute more to the unemployment rate. Three out of ten matriculants find jobs every year and most cannot afford tertiary education. This shows that the level of education equals the level of job and income.

Many children aged between 5 and 24 are attending an educational institution. The highest number of illiterate people can be found among the oldest population, within Africans. Most of the people aged 35 and above have little or no education at all. The largest number of these people can be found among the female population. Schooling in Greater Johannesburg shows approximately 19,2% of the population being illiterate. The literacy rate (the percentage of persons 13 years and older with at least a standard 5 qualification) of Gauteng in 1991 was 69%, and the non-school attendance rate in the province was 8,7% (9 out of every 100 children aged 6 to 14 years did not attend school). In 1994 the pupil: educator ratio in Gauteng was 25,7:1.

Most people getting employed are in low wage jobs, because of their low education levels. It is because of this reason, among others, that they are unable to afford basic needs and services, therefore increasing the poverty rate. Low education levels result in people being employed in low wage jobs or not employed at all – lack of basic needs and services- poverty.

MORTALITY RATES

The poor environmental quality resulting from air, water and land pollution in Greater Johannesburg contribute to a number of the mortality and morbidity rates within Greater Johannesburg. The health effects of exposure to polluted air (dust from undisturbed slime dams, chemical fumes, odours, aerosols and solvents) include serious diseases such as asthma, bronchitis, pneumonia, emphysema, lung cancer, and even death in severe cases, (EMLC, 1997). Polluted water causes serious diseases such as diarrhoea, cholera, and fever which results in the deaths of many people (especially children). The linked between income, poverty, environmental quality, and health status are well established and influence the life expectancy of the people.

The AIDS epidemic is reducing the life expectancies of the population. Tuberculosis and the link of TB with AIDS furthermore contribute to high mortality and morbidity rates.

Major causes of death 1992/1993: International Classification of diseases (ICD) codes. See table below:

Mortality rates

Source: Statistical Report: Health, Housing and Urbanization Directorate:  July 1987 to June 1993

According to the medical officer of health’s annual report (1989/1990) the death rate for the Johannesburg population in that year was 5,1 (4 741). The highest deaths were recorded among the African population (3 180). Although still existing, infectious diseases occur much less frequently now than in the past.

The main reason for this is the improved socio-economic status of Johannesburg’s inhabitants, effective preventive efforts especially immunization; and very vigorous control of potential outbreaks, (Annual report of the medical officer of health, 1989/1990). Even though infectious diseases now cause fewer deaths than in the past, none of these diseases, other than smallpox, has yet been eradicated and, consequently, no relaxation of any of the control measures can yet be considered. Important infectious diseases still occur in Johannesburg. Tuberculosis remains the single most prevalent infectious disease in the world today. In South Africa there are up to 10 million people who have been infected with the tubercle bascillus, (Medical officer of health report, 1989/1990). Despite tuberculosis being fairly straightforward to diagnose and cure, people are still dying of TB.

Source: Annual Report of the medical officer of health, 1989/1990

Of the data given in the above table the highest rates were those of the African (1180: 6,8) and coloured (853: 5,7) population.

The high death rate resulting from unhealthy environments and high crime levels in Greater Johannesburg, have a detrimental effect on the economy. When the life expectancy of the population is reduced, people die at the age where they should be working, which in turn reduce the labour force and contribute to orpherns. The people who are affected the most by these diseases are women and children, therefore resulting in high infant mortality rate.

INFANT MORTALITY RATE

There is a high infant mortality rate among the poor population because of the poor socio economic status. The high Infant mortality rate among the African and coloured populations is a result of the poor conditions which most of the populations were forced to live under, including lack of access to primary health services. Poverty within women headed households and lack of education about child care also affect infant mortality.

Indoor air pollution from cooking and lighting fire is the cause of infant mortality. Acute respiratory infections as a result of indoor air pollution are one of the most important causes of death in young children under the age of 5 years. Environmental pollution (air, water and land pollution) result in infectious diseases which increases the death of small children.

A large percentage of children in South Africa (61%) as well as in Greater Johannesburg live in poverty. Poor children suffer from a number of health problems, and their development is much retarded as a result of a high disease burden, low access to health services, as well as under nutrition.

According to the 1989/1990 annual health report of Johannesburg the total infant mortality rate for the Johannesburg population was 14.1% (219):

HEALTH CARE FACILITIES

A large percentage of the poor are unemployed, resulting in them being dependent on social pensions and remittance and state-run support systems. The impoverished will rather spend money on food and clothing than on health care. Not getting enough or sufficient health care results in high deaths, and increased poverty, because people are unfit to work and support their families.

The care received by richer quintiles is considerably more costly. This is partially due to the higher quality of care they receive. In addition, since the poor rely mostly on free (or heavily subsidized) health services, their costs are much lower. The poor rather stay home even if they are ill because of the costs of going for treatment.