Migration, settlement change and health in post-apartheid South Africa: triangulating health and demographic surveillance with national census data.
BACKGROUND
World population growth will be increasingly concentrated in the urban areas of the developing world; however, some scholars caution against the oversimplification of African urbanization noting that there may be "counter-urbanization" and a prevailing pattern of circular rural-urban migration. The aim of the paper is to examine the ongoing urban transition in South Africa in the post-apartheid period, and to consider the health and social policy implications of prevailing migration patterns.


METHODS
Two data sets were analysed, namely the South African national census of 2001 and the Agincourt health and demographic surveillance system. A settlement-type transition matrix was constructed on the national data to show how patterns of settlement have changed in a five-year period. Using the sub-district data, permanent and temporary migration was characterized, providing migration rates by age and sex, and showing the distribution of origins and destinations.


RESULTS
The comparison of national and sub-district data highlight the following features: urban population growth, particularly in metropolitan areas, resulting from permanent and temporary migration; prevailing patterns of temporary, circular migration, and a changing gender balance in this form of migration; stepwise urbanization; and return migration from urban to rural areas.


CONCLUSIONS
Policy concerns include: rural poverty exacerbated by labour migration; explosive conditions for the transmission of HIV; labour migrants returning to die in rural areas; and the challenges for health information created by chronically ill migrants returning to rural areas to convalesce. Lastly, suggestions are made on how to address the dearth of relevant population information for policy-making in the fields of migration, settlement change and health.
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, South Africa. mark@agincourt.co.za
Mark A
MA
Collinson
Stephen M
SM
Tollman
Kathleen
K
Kahn
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003710:Demography; D004641:Emigration and Immigration; D005260:Female; D006291:Health Policy; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011157:Population Dynamics; D011159:Population Surveillance; D011640:Public Policy; D012424:Rural Population; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014505:Urban Population