At the Heart of the Problem: Health in Johannesburg’s Inner-City

Résumé

Urban life in the twenty-first century is marked by numerous stresses and shocks, resulting from rapid urbanisation, frequent migration and crowding, massive unemployment, climate change, physical disasters, and disease outbreaks, among other challenges.This realityaccording to the '100 Resilient Cities' initiative of the Rockefeller Foundationis why the concept of resilience is critical to a sustainable future: cities must learn to "survive and thrive, regardless of the challenge" [1].In cities in the global South that face a heavy HIV burden, this health crisis is often inseparable from a wider set of interlinked social challenges, ranging from acute economic inequality to chronic political mismanagement and failed states.What 'resilience' means in such contexts is hard to imagine, but at the very least, as UNAIDS' Michel Sidibé puts it, "people must be at the centre of the response" [2].This Supplement to BMC Public Health brings together articles on the health status and needs of people living in the inner-city of Johannesburg, South Africa, with a particular focus on the impact of the HIV epidemic and on identifying ways to improve healthcare service delivery.At the centre of the inner-city lies Hillbrow, with its dense population of economic migrants and refugees, a neighbourhood that figures in the public imagination as a space virtually synonymous with slums, crime, drug dealing and sex work.Daily life for residents is profoundly shaped by a chronically neglected public infrastructure and lack of investment in human capital.Prevalence of HIV and TB is high, diseases linked to poor sanitation and water quality are common, and morbidity resulting from violence and substance abuse is among the highest in the country [3][4][5].By any measure, standards of health and wellbeing among the population of Hillbrow and its surrounding inner-city areas are alarming.But in terms of healthcare services, this part of the inner-city is, quite inspiringly, a place of 'many firsts'.

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