South Africa is the southernmost country of Africa, stretching latitudinally from 22° to 35° South and longitudinally from 17° to 33° East. Its surface covers an area of 1 219 090 km2, surrounded on the eastern, southern and western border by a coastline of about 3 000 kilometres, and having common boundaries with Namibia in the northwest, Zimbabwe and Botswana in the north, and Mozambique and Swaziland in the northeast. The Kingdom of Lesotho and Swaziland lie within the southeast part of the country, bordered by South African territory.70 (Figure 1.1.)
Paleontological research into the origins of humanity indicates that modern humans have lived in South Africa for over 100,000 years, and their ancestors for some 3,3 million years.70 Among the first peoples known to have lived in the country, are the San and KhoiKhoi people, estimated to have lived in southern Africa for between 10,000 and 20,000 years.71 About 2000 years ago, Bantu-speaking agro-pastoralists from the north began arriving in southern Africa, settling in the eastern coastal region of southern Africa and introducing domesticated crops and an Iron-Age culture into the region.70
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Figure 1.1: Map of Africa, with South Africa on the southern tip of the continent. Source: http://www.lib.utexas.edu/maps/africa/africa_pol
Since the 1400s, Portuguese seafarers on route to the east visited the South African coast from time to time. In 1652, the Dutch established the first permanent European settlement in what was then the Cape of Good Hope (Cape Town). The first population enumerations were conducted shortly thereafter.72 From 1654, slaves were imported to the country from Indonesia, Madagascar, Mozambique, and western Africa to work on the settler farms, and from 1859, indentured labourers from India were brought to what was then Natal, on the north-eastern coast.
South Africa’s people and geography were subjected to imperialistic and ideological segregation and demarcation for an extended period. In 1910, the Union of South Africa was founded, with four provinces.71 Since 1910, and before democratization in 1994, in addition to the four provinces, four independent states (Bophuthatswana, Ciskei, Transkei, and Venda, or the TBVC countries), and six self-governing territories (Gazankulu, KaNgwane, KwaNdebele, KwaZulu, Lebowa, and Qwaqwa) were established. These areas were ideological outcomes of separate-development policies and legislation, which will be referred to in Chapter 2. After the
12 first fully democratic election in 1994, the 10 geo-political territories were re-incorporated into the remainder of the country, and the country was divided into nine provinces, as shown in Figure 1.3, each with its own legislature, premier and executive council.70
The mid-year population for 2013 was estimated at 52,982,000 people, with a 48.7/51.3% male/female split. The overall annual population growth rate increased from an estimated 1,30% in the period 2002–2003 to 1,34% for 2012–2013, despite a declining rate of natural increase. This increase in the growth rate has been attributed to the high number of international immigrants assumed in the projection.73 The Africani population group constitutes an estimated 42,284 million people, or 79.8% of the total population; Whites, 4.602 million (8.7%); Coloureds, 4.766 million (9.0%); and Indians/Asians, 1.329 million (2.5%). Three in ten, 29.2% (11,640 million), of the population, is estimated to be younger than 15 years; 7.8% (4.133 million) 60 years or older;73 and the median age was 25 years at Census 2011.74 Unlike most countries in sub-Saharan Africa, population figures indicate fast demographic ageing in South Africa over the past few decades, with population ageing in 2013 most pronounced in Whites (19.7%) and Indians (10.7%), and least in Coloureds (7.4%) and Africans (6.6%), but older Africans making up the majority, 66%, of the total older (60+ years) population.75 Although population ageing in South Africa is less pronounced than in developed nations, it has the highest proportion of older persons in mainland sub-Saharan Africa. Second to Nigeria, it accommodates the largest number of older persons in the subcontinent.76 Population estimates show steep increases in the South African population above the age of 60, and growth in this population is estimated to be considerably more extensive than in younger cohorts. Moreover, the majority of older South Africans have lived through several decades of discriminating policies during colonization and apartheid, expected to have impacted detrimentally on the prospects they have for healthy ageing.77
i The term ‘population group’ is used for a collective term that may elsewhere be called ‘race’ or ‘ethnic group’. The use of the terms “African”, “Coloured”, “Indian/Asian” and “White” is not intended to support or legitimise a racial or ethnic classification system, neither to denote biological difference. Under previous governments, South Africans were classified according to skin colour, and this went hand in hand with disparities in many spheres of life, including health. To acknowledge this impact, and to contribute to tracking progress in redressing past inequalities on the basis of this classification, these terms are used in the thesis. Additionally, the thesis takes a historical perspective at times, necessitating references to the classification terms.
13 Partly due to natural population growth and high levels of rural-to-urban migration, the rate of urbanisation has increased substantially over the past few years.78 The population census of 2001 indicated that 56% of South Africans lived in urban areas,79 a proportion which increased to about 60% by 2011.78 While urbanization can be associated with increased living standards, in South Africa many rural-to-urban migrants have no choice but to settle down in informal settlements on the periphery of cities. These settlements are often characterized by rapid growth, placing a strain on local and national authorities to provide basic services to residents,80 and by pervasive levels of poverty, inadequate housing, poor sanitation, and high levels of unemployment.81 These conditions increase the risk of disease, injury and death for people who experience them.