In a similar vein, the study conducted by Davies (2007) of the local politics of social inclusion in two UK cities, argues that empowerment may depend less on network democracy than on strong, independent community organizations capable of acting separately and coercively against governing institutions and elites (p.779).
Finally, the paper by Welch (2009) examines the implications of the changing architecture of societies – the continued fragmentation of authority in which state power is transferred to expanding commercial markets – and the health impact in the context of Iraq. The de-coupling of policing and government or the dispersion of state power to the private sector in the context of Iraq raises concerns for health equity.
New actors have appeared in the urban policy arena and decisions taken at supra-local level continue to have an important impact on urban policy processes for health equity. Knowledge of the historical, political and cultural context is critical. The case of South Africa is of interest to evaluate the possibilities and constraints.
Contextualizing urban governance
South Africa has inevitably followed the global trend of urban growth, exacerbated by the marginalisation and underdevelopment of rural livelihoods under apartheid, together with the newly established freedom of movement of rural communities (de Swart et al, 2005). The result has been a dramatic increase in inequity (Scott et al, 2008), where wealthy middle class suburbs back onto poor overcrowded, informal settlements with few basic facilities (Robbins 2002, Puoane & Tsolekile 2008, Sanders & Chopra, 2006, DWAF 2002, Beall et al., 2000, Sangoco et al., 2009, Scott et al., 2008).
South Africa also provides an interesting example of what promised to be a model of good governance. The new democracy boasts a progressive constitution and pro-equity policies and programmes, which encourage effective partnerships and participation (Mathekga & Buccus, undated, Sanders and Chopra 2006). It also has a strong participatory culture dating back to anti-apartheid activism (Marais 1998). Finally, unlike most sub-Saharan countries, it has the economic potential of a middle-income country.