The South African nation comes from diverse cultural and ethnic backgrounds and has 11 official languages. This diverse population is characterised by eight distinct factors, namely race (population group), culture, ethnicity, language, religion, class, education and politics. The South African population in 2015 was estimated at 54 956 900 people, of whom approximately 51% (some 28, 07 million) were female. The Western Cape population in 2015 was estimated at 6 200 100, which constituted 11, 3% of the country’s total population, having declined slightly since 2014 when it constituted 11, 4% of the total South African population. The female population in the province is slightly higher, comprising 50, 73% of the total population. The Western Cape’s population is predominantly urban, mainly as Cape Town’s population makes up a significant portion of the provincial population.
The total number of households in Cape Town grew from 653 085 in 1996 to 1 068 572 in 2011, which represents an increase of 63, 6%. There seems to be a trend towards smaller household units across all population groups. In 1996, the average household in Cape Town had three, 92 members, which dropped to three, 50 in 2011. Fertility, mean age at marriage, and divorce are the three main demographic determinants influencing household size. Households become less extended, more nuclear and smaller as societies industrialize and urbanize. The Human Sciences Research Council (HSRC) studied the factors responsible for the reduction in household sizes throughout South Africa. Their analysis revealed that a mixture of interrelated legal, economic and social processes have contributed towards this trend since 1994. These involve greater legal protection and social acceptance of youth and women claiming rights to housing, the emergence of a powerful youth culture driving modern aspirations, the increasing effects of high unemployment, and women’s earning power eroding patriarchal values and changing the nature of the institution of marriage.
Cape Town’s average household size is below that of developing countries (five members) and is moving closer to that of many developed countries (two to three members). This is already the case in certain population groups, particularly the white and black African groups (with the former averaging at around 2, 5 and the latter at 3, 25 in 2011).
Even though the trend of smaller household sizes may have be seen as positive, it does pose certain challenges to Cape Town, as to other South African metros and developing-country cities. These include the increased demand for housing supply to accommodate the trend, with the consequent increase in housing prices; increased competition for scarce urban land for new housing developments, and the breakdown of the extended family, which is often considered as powerful social support network.
The demographic trend for South Africa and the Western Cape indicates an ageing population across all population groups. This pattern is also evident in Cape Town. The amount of children (0 to 14 years) in Cape Town decreased from 29, 10% in 2002 to 26, and 18% in 2015. In the same period, the percentage of the population who are economically active (15 to 64 years) increased from 66, 58% to 67, 73%, while the aged population (65 years and above) grew from 4, 31% to 6, 09%. However, the total age dependency ratio for Cape Town decreased during this period from 0, 50 to 0, and 48. According to the UN classification, Cape Town’s population has moved towards the upper end of a mature or middle-aged population. A population is considered mature or middle age if 4 to 7% of the population are aged 65 and above. Of the economically active (15 to 64 years), 53, 30% were absorbed into the economy in 2015. Even though this increased from 2009, when the labour absorption rate was 52, 50%, it has still not improved to the 2008 level of 54, 20%. This showed that Cape Town’s economy is not growing fast enough to support the increasing economically active population. However, it also displays the impact of the economic recession from late 2008 to the end of 2009 on the economy, and a degree of recovery since then.
South Africa’s health profile reflects the historical challenges associated with its economic and geographical inequalities. South Africans experience an increasing number of non-communicable diseases associated with age and lifestyle, while communicable diseases (mainly the (HIV) and (TB)) also remain paramount concerns. Life expectancy at birth in South Africa increased from 61,2 years in 2012, to 62,2 years in 2013, to 62,9 years in 2015, which represents an annual rate of increase of 0,57 years. At this rate, the National Development Plan (NDP) vision of 70 years for life expectancy by 2030 is very likely to have be achieved. The Western Cape has the highest life expectancy at birth (68 years), which is very close to achieving the NDP 2030 vision.
The infant mortality rate is a key indicator of health and development in a society. It is associated with a broad range of social, economic and environmental factors, which are also indicative of the health status of the broader population.
The IMR in South Africa significantly reduced from 2009 (39, 0) up to 2012 (27, 0), but had increased slightly by 2014 (28, 0), although it was still significantly lower than in 2009. This downward trend is also seen in Cape Town, where there was a clear trend towards a decrease in the IMR in the Cape metro between 2003 and 2012, dropping from 25,2 to 16,4 (per 1 000 live births) (refer table 1).
Table 1: Cape Town infant mortality rate (IMR) trends (per 1 000 live births), 2003 to 2012
Diseases that are readily preventable or treatable cause most child deaths. Globally, infectious diseases and newborn complications are responsible for the vast majority of deaths below the age of five. South Africa did not meet its MDG target of reducing deaths per 1 000 live births to 20 by 2015 (based on projections), it has however significantly improved its child health and under-5 mortality rate. The latter dropped by an annual average of 10, 3% between 2006 and 2011 (the fourth fastest rate of decline globally).
This decline was largely attributed to the programme for the prevention of mother-to-child transmission (PMTCT) of HIV, improved immunisation rates to protect children against vaccine-preventable diseases such as diarrhoea and pneumonia, and vitamin A supplementation, which has decreased vitamin A deficiencies. South Africa is one of only a few countries that have introduced rotavirus and pneumococcus vaccines to reduce the incidence of, and death due to, diarrhoea and pneumonia in children.
The main causes of child deaths during 2010 in Cape Town (figure 1) include diarrhoea (13%), other illnesses (11%), pneumonia (10%) and injuries (10%). The data for the causes of child deaths in Cape Town were previously generated by the Medical Research Council (MRC). However, the National Department of Home Affairs has introduced certain law amendments, which now forbid access to medical certificates, except for Stats SA. Therefore, the MRC was unable to generate data that are more recent. Stats SA’s report on mortality and causes of death only presents a national overview of the causes of death for the under-5 group.
There was a general increase in TB cases and incidence from 1997 to 2014 in Cape Town. From 2010 to 2014, however, a downward trend started to emerge. This downward trend is consistent with global and national TB trends. In Cape Town, data reveal that the number of HIV-positive TB cases, which previously increased, is now falling. Substantial improvements in TB outcomes had been achieved in the past number of years.
In spite of these improvements, however, the following factors continue to fuel the TB epidemic in Cape Town:
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