In Khayelitsha, climate-related risks are closely tied to everyday living conditions, from flooding and extreme heat to pressure on housing and infrastructure. These conditions shape how people live, work, and care for their families. They also shape health, sometimes directly, and often through pathways that are less visible in city planning.

In many households, women carry a significant share of the responsibility for managing these risks in daily life. From securing water and maintaining household health to caring for children and older family members, women often navigate the practical realities of flooding, heat, and inadequate infrastructure. Understanding how city decisions shape these conditions is therefore closely tied to understanding how climate risks affect the wellbeing of families and communities.

Lebogang Matlakala, a CASCADE fellow based at the Climate System Analysis Group (CSAG) at the University of Cape Town, is researching how urban policies influence climate-related health vulnerability in informal settlements. Her work explores how decisions about housing, infrastructure, and urban development shape the lived experience of climate risk in Khayelitsha, and what this means for health outcomes.

Her research asks a broader question: how do city decisions shape vulnerability over time? Drawing on City of Cape Town development goals and policy documents from 2003 to 2024, as well as expert interviews, Lebogang explores how policy pathways shape climate-related health vulnerability in Khayelitsha.

Her early findings highlight an important gap. The City of Cape Town has long acknowledged climate change as a major challenge for building a resilient and socially just urban environment. Yet climate-related health vulnerabilities in townships are still not consistently addressed in development and implementation processes.

This is partly because health is shaped by many decisions that are not usually framed as health policy. In cities, wellbeing is closely tied to urban form. Choices about public space, spatial planning, drainage, housing standards, safety, and service delivery all influence exposure to environmental risks and households’ ability to cope when those risks intensify.

Lebogang’s work highlights examples where integrated interventions and responses can shift these risk pathways. Localised initiatives, such as enhancing open spaces, improving flood detention systems, creating jobs, and implementing safety-oriented urban design through the Violence Prevention through Urban Upgrading (VPUU) programme, a pilot project in Khayelitsha, (read more here and here), demonstrate how urban design can mitigate environmental risks while improving safety, income, and health outcomes. These examples highlight the value of place-based approaches that integrate climate resilience, infrastructure, and everyday wellbeing. They also point to an important practical insight: understanding how urban planning decisions affect vulnerability can help identify where interventions are likely to have the greatest impact.

Her findings also highlight why implementation is often difficult. Interventions can be delayed by safety and security concerns, feasibility constraints, and institutional or regulatory hurdles. Large infrastructure projects require multiple approvals and coordination across departments, sometimes across policies that do not align. In rapidly growing informal or township settlements, the pace and scale of interventions can struggle to match the pace of change.

These insights matter in a city facing increasing climate pressures. Flooding and heat events are becoming more frequent, while the city is also under pressure to meet its commitments to provide adequate housing, safety, and comfort for residents, particularly those most exposed to risk. Lebogang’s research contributes to a clearer understanding of how both current and historical interventions in public housing standards, transport, and urban planning shape vulnerability, and how this understanding can inform future planning and prioritisation.

This also raises an important question about accountability. One way to strengthen accountability is to track whether city-led infrastructure and upgrading projects explicitly include health objectives or embed adaptation in the day-to-day decisions for informal settlement communities. Building this kind of monitoring into planning and budgeting cycles can help make health considerations more visible within urban decision-making.

Lebogang’s work contributes to CASCADE’s wider effort to understand how climate risks shape health in African cities, and to ensure that the realities of residents in the most exposed communities are visible in the evidence that informs local decisions.

Authors: Alacia Armstrong & Lebogang Matlakala