New research finds link between built environment and non-communicable diseases


You need the toilet‚ so you walk off to the bathroom in your house and shut the door.

Now imagine being a child in the Taiwan informal settlement in Khayelitsha.

You need the toilet‚ but you must first walk across many dusty streets lined with shacks.

Before you can use the communal loo‚ you must knock on the door of a stranger who keeps the key in his or her shack.

Before you’ve even relieved yourself‚ you must ask yourself: am I safe?

This is daily life for slum dwellers in South Africa‚ and now‚ a recent study that used the powerful technique of “bodymapping” has drawn bold lines between the built environment and non-communicable diseases in Khayelitsha‚ which has the largest concentration of poverty in the city of Cape Town.

Warren Smit‚ head of research at the African Centre for Cities‚ presented this ground-breaking study at the urban health in Africa conference this week near Somerset West.

“For body-mapping‚ participants trace the outlines of their bodies on large sheets of paper. Each one then annotates the map of his/her own body illustrating different aspects of their health and well-being‚” he explained.

He said this provided “very rich detail and information about where people lived and their subjective feelings on how where they lived impacted on their health”.

The participants – 10 from three different areas in Khayelitsha ranging from formal housing to the abject poverty of shack-dwelling – gradually worked on the mapping over the course of five days‚ “drawing the organs inside as they knew them‚ and then annotating these drawings to represent different aspects of their health and wellbeing (for example‚ adding ‘scars to the skin’ and ‘scars under the skin’)”.

They were also asked to draw their life histories onto the maps.

What transpired was a rich slate of information on the lived experiences of the participants.

In terms of shelter‚ said Smit‚ what emerged in Taiwan was a picture of annual flooding in shacks every winter‚ with dwellers doing everything in their power to try keep dry and warm.

This is a direct result of there being no stormwater drainage.

With toilets in Taiwan‚ it isn’t only kids who have to face their fears.

“Nobody goes to the toilets at night because they are afraid‚” said Smit.

Regarding public spaces: there are very few and those that exist are not well maintained.

“They aren’t used by children as they are considered dangerous‚ and where gangsters and drug addicts hang out‚” said Smit.

Also‚ many dwellers cook on the side of the road and sell their food to others‚ “but there is no protection from sand‚ wind‚ heat and rain as there is no infrastructure provided for these traders”‚ explained Smit.

People had also suffered mental health problems by living close to shebeens which were noisy and threatening.

In conclusion‚ said the researchers: “Tackling NCDs clearly requires both lifestyle interventions and interventions in the urban environment. However‚ as the case of Khayelitsha demonstrates‚ it is important to recognise the economic‚ social and political forces underpinning built environments such as these.”

– TMG Digital/TimesLIVE

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