Making cities of mothers and children…

In this exclusive article, Tariq Toffa, an architect and academic based at the University of Pretoria, shares insights into how cities affect health.  

Current situation 

The social, economic and urban contexts in South African cities are just beginning to be understood in relation to the health conditions in the city. This is occurring in the context of something of a paradigm shift in the understanding and approaches to communicable diseases (e.g. HIV / AIDS, tuberculosis, etc.) and non-communicable diseases (NCDs) (e.g. cardiovascular diseases, diabetes, etc.). This shift in focus is particularly pertinent in SA where with an obesity prevalence of 28.3% (in 2022) makes it the third highest prevalence in Africa.  

Still more poorly understood is how urban or development conditions can often also underlay many health challenges. For example, 31% of learners in SA do not meet internationally recommended amounts of moderate to vigorous physical activity (MVPA) according to a 2018 study by van Biljon et al.

This suggests that active lifestyles should be considered and integrated from a young age. 

The highly gendered nature of obesity in SA (about 41% of women and 11% of men), along with many of its health risks, is also related to the processes of urbanisation and related socio-economic factors. Working women tend to have low-energy jobs, and mobility is less energy-intensive because of shorter commutes and the use of motorised transportation. Time constraints are also a challenge for many women in preparing healthy meals because of long working hours and greater access to processed foods.  

A key aspect of a more holistic socio-spatial understanding of obesity and physical activity (PA) (identified as one of the leading causes of NCDs) is recognition that the spaces of the child in the city can often become the spaces of the mother as well – the needs and challenges of each one informing the other. This suggests that strategies to address obesity and PA should not be directed at a particular target group in isolation, and should aim to link or cluster the intergenerational and interrelated aspects of socio-spatial environments.

For example,

only one third of children in SA live with both biological parents, and as many as three out of four black African households is headed by an African woman. Female-headed households are often also disproportionately poorer than male-headed households. Such mothers are typically forced to adopt various strategies to access employment opportunities, childcare and quality education for their children, and have to swiftly navigate and traverse different spaces (e.g. home, work, school, household shopping, play and recreation, medical needs, etc.) in order to fulfil multiple roles (e.g. home, community, politics, etc.).

This makes mothers arguably some of the most active users of cities, more so than the average individual and very often far more so than the average man.

Hand-drawn maps of the active lives of mothers in the city of Johannesburg (Parker & Rubin 2017)

Outdoor ​​​​gyms 

One of the most direct and tangible programmes that emerged in SA and internationally out of the emerging approach to NCDs and specifically with regards to PA, was the implementation of outdoor gyms in SA since late 2011. These were taken up rapidly by local governments, and in less than a decade later there were hundreds of outdoor gyms across cities in SA. 

Has this extensive and sustained programme of outdoor gyms improved public health – its raison d’etre? There is little evidence to suggest that it has. There has been little to no follow-up studies focusing on the usage, impact or lessons for improvement, and current utilisation rates are unknown.

In SA, evidence shows that overall health patterns continue to worsen, according to a 2022 study by Nglazi and Ataguba. This suggests that the nationwide rollout of outdoor gyms, even as extensive as it has been, in itself is not sufficient to address the complexity and scale of the challenges.  

Social clusters 

In Johannesburg, the rollout of outdoor gyms intersected with another City programme known as the ‘Corridors of Freedom’ (CoF). As a general principle or approach to urbanism and sustainable development, it also held important social and environmental implications for improving health in the city. 

The ‘social clustering’ at Turffontein, Johannesburg, showing the public open space system of Rotunda Park (foreground), and Linear Park flanked with proposed mixed-use densification (TDC:SAF: 83)

Implemented only in part but already intensively used by local residents, the Turffontein redevelopment in Johannesburg south is perhaps the most successful of the CoF public space initiatives. Employing the integrative notion known as “social clustering”, the project integrated the play, sports, recreation and outdoor gym facilities of this interlinked public open space system (through two parks – ‘Rotunda Park’ and ‘Linear Park’), with a regional healthcare institution (Turffontein Clinic) situated on the edge of the ‘Linear Park’.

In so doing it also integrates the multigenerational activities of parenthood and childhood. 

Within ‘social clusters’ organised around key public transport arterials, each facility, activity and space could potentially become more accessible through its close proximity to other public and intergenerational amenities within a safer and more compact neighbourhood cluster. From a public health perspective, such an approach holds potential to facilitate for recreational and play-related PA to become more integrally a part of everyday urban culture, especially for households, mothers and children, and hence to integrate NCD-related concerns into the matrix of everyday urban lives. 

The Turffontein Clinic healthcare facility (under construction) on the edge of the Linear Park, Johannesburg (photo by author, 2023)

Health as part of social and urban systems 

Health concerns are entangled with others, such as safety and crime, socio-economic stress, time and mobility, and particularly the necessity to consider women and children as a normative aspect of planning and design of the public realm. 

The complexities of such co-constitutive interrelationships mean that a single-issue focus and its targets group can paradoxically have less impact than if coupled with other tightly related concerns and where strategies can function in integrated and mutually supporting ways. While outdoor gyms pointed to the need not to engage health in isolation, social clusters were suggestive of some integrative ways in which multiple challenges can be addressed. This lends further weight for the need to understand health as part of a social and urban system, and for cross-cutting approaches and multiple intervention strategies. 

Health is entangled with safety, crime, socio-economic stress, time and mobility. How do we move towards a caring city? 

Full thanks and acknowledgement to Tariq Toffa. This article is an edited extract of the book chapter published in ‘Navigating Wahala: Claiming Urban Public Space for Physical Activity and Health in Africa and Beyond’, edited by Tolu Oni, Taibat Lawanson and Felix Assah, and published by The British Academy. 

Sources cited: 

• CoJ (City of Johannesburg), 2012, City of Johannesburg Case Studies: 2011 – 2012. 
• Nglazi, M.D., & Ataguba, J.E.‑O., 2022, ‘Overweight and obesity in non-pregnant women of childbearing age in South Africa: subgroup regression analyses of survey data from 1998 to 2017’, BMC Public Health (2022) 22:395.  
• Parker, A., & Rubin, M., 2017, Motherhood in Johannesburg: Mapping the experiences and moral geographies of women and their children in the city, GCRO Occasional Paper # No. 11, Gauteng City-Region Observatory (GCRO), ISBN: 978-0-6399114-3-4. 
• TDC:SAF (Turffontein Development Corridor: Strategic Area Framework), City of Johannesburg, Johannesburg Development Agency, Johannesburg. 
• Van Biljon, A., McKune, A.J., DuBose, K.D., Kolanisi, U., & Semple, S.J., 2018, ‘Physical activity levels in urban-based South African learners: A cross-sectional study of 7 348 participants’, South African Medical Journal 2018;108(2):126-131.