The geography of health in the Durban Metropolitan Area.
In presenting a Geography of Health of the Durban Metropolitan Area, the researcher has chosen a conceptual framework within which to sharply challenge the definition of health in a perfunctory/ functionalist way. Thus, the Geography of Health is, at the outset, locationally positioned in a socio-economic and environmental context of society. This argument is developed through a multi-conceptual approach that leads the thesis into building a framework with the central arching principles of biomedicine, social and humanistic philosophy in three randomly selected informal settlement contexts. The specific focus of this approach is on the growing poverty and homelessness, the inadequate health delivery system and the relationship between disease, physical, social and residential environments and structural inequalities. Thus, this study is embedded in numerous related contexts, the most important of which is the spatial! geographical and the social context in which health and health care is seen in relation to the nature of society and everyday life. To some extent this research endeavour is concerned with health and health care issues amongst specific categories of people within marginalized communities rather than some homogenous, non-existent category called "poor people". The key questions raised in the study relate thus to several variables that impact informal dwellers with the specific objective of determining socio-economic profiles, housing and environmental circumstances; the location and nature of health services; health status of people; the ways in which people conceptualise and prioritise health and the need for and possibility of community involvement in health and health care. In dealing with the above issues, a multi-faceted methodological approach allowed for the generation of 155 tabulations from the quantitative empirical data to be triangulated with the qualitative data produced through focus group interviews and also with the secondary data obtained. The most significant finding emerging from the study was the fact that the relationship between health and abject poverty is bi-directional. Respondents identified numerous factors that affected their health, the most important of which was poverty in respect of poor dwellings, lack of basic services, access to certain health services and the prevalence of disease. It is hardly surprising that a biomedical perspective largely prefaced the respondent's understanding of health. This can be attributed to locational factors but more specifically to the overriding socialising influence of biomedicine in South African society. In the focus group interviews with informal dwellers, the ranking exercises demonstrated that high health risks emerge from multiple and complex factors related to personal, economic, social, environmental and political factors. It is the contention of this thesis that health status improvement and the reduction of health risks of disadvantaged individuals and communities needs a multi-pronged approach with multiple solutions drawing on resources from international, national and local agencies and organisations. Finally, the study concludes by presenting an extensive pool of more concrete systematic and holistic interventions that would not only improve the quality of public health care, but also redefine the Geography of Health in South Africa. These, it is argued are seldom attainable in the short term as it is a continuous process underpinned by priorities, possibilities and planning.
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