Rapid urbanization and urban sprawl has placed pressure on attempts to redress backlogs in infrastructure and service provision. People living in unserviced housing are most at risk of contracting communicable disease given that they lack access to clean water, sanitation and/or a safe energy source for cooking and heating.

Research shows that the middle and lower reaches of many of the CMA’s rivers are polluted. Untreated human waste, industrial discharges and agricultural run-off into rivers and waterbodies increases loads of faecal pathogens, toxic chemicals, pesticides and fertilisers and heightens the health risk to users.

Approximately 72 000 dwellings in the CMA are without operational drainage. Standing water in informal and squatter settlements is therefore a common feature. When contaminated with faecal pathogens it can give rise to gastro-intestinal diseases.

Children attending schools in close proximity to heavily trafficked roads and living in dilapidated and dusty houses, display raised blood lead burdens.

Research into the ill health symptoms experienced by the inhabitants of informal settlements shows a high incidence of respiratory illness. Up to 80% of dwellings in a Cape informal settlement was found to have indoor pollutant levels well in excess of international WHO guidelines. There has been a marked increase in the cases of pulmonary tuberculosis, particularly in overcrowded areas of the CMA.

The improved supply of water to communities has resulted in a decrease in the incidence of diarrhoeal disease in the CMA during recent years. High levels of faecal coliforms in a number of rivers (e.g. Langa Canal displayed 1 million E. coli per 100 ml) increase the risk of contracting of diarrhoeal disease.

Waterbodies in the CMA display high levels of pollution. For example, high trophic levels in the Wildevoëlvlei near Kommetjie have resulted in toxic algal blooms that pose a significant health risk to users of the vlei. In 1998, there were two toxic algal blooms at Wildevoëlvlei.

• Exceedances of WHO guidelines for lead, SO_x and NO_x and UK guidelines for PM₁₀.
• Exceedances of WHO guidelines for E. coli.
• Number of toxic algal blooms.

Refer to indicators for air quality, water quality and waste.

Air quality:

• A strategy has been developed to implement the recommendations of the Brown Haze Study and the Volatile Organic Compounds Study.
• The number and distribution of monitoring stations across the CMA have been increased. This has included a station in or near an informal settlement on the Cape Flats and the monitoring carbon monoxide and carbon dioxide levels.

Water quality:

• A number of studies have been initiated to address water quality problems in all major catchments.

• Do not make fires in confined and poorly ventilated spaces.

  Do not drink from stagnant waterbodies and urban rivers.

  Do not swim in or collect food from vleis that are experiencing toxic algal bloom episodes.