A child-centred food system

by Dr Scott Drimie

Children’s needs must be at the heart of a sustainable, affordable and healthy food system. The 2020 Child Gauge contends that the current food system is driving the double burden of malnutrition and damaging both children’s health and the environment. This is because it does not consider children or their health and is increasingly flooded by cheap, unhealthy food. Powerful actors shape and continuously reshape the food system, increasing the distance between consumers and the source of their food. The result is rapidly increasing access to highly processed food and food that is less healthy for both humans and the environment.

Current food systems push children to grow up in obesogenic environments, where food choices in homes and early childhood development centres and programmes are contributing to nutrition-related disease and death. This adversely affects affect national development, drives up health costs and costs billions in GDP.  The COVID-19 pandemic has foregrounded the failures of the food system to provide sufficient, healthy, nutritious food. It is not serving the most vulnerable in South Africa, including children of all ages.

Our goal should be to enable all people but especially the most marginalised to participate in their own decision-making about food practices and behaviours. This ambitious goal requires a package of actions to coherently reorient flows of food towards healthy diets for children. The Child Gauge offers important practical suggestions about doing impactful things in a different and better way.

Because malnutrition affects future generations, a life course approach unveils opportunities to focus on women of child-bearing age, pregnant women, infants and young children and school aged children. Existing government policies acknowledge these groups but fall short in drawing in the wide range of actors needed to recalibrate the system as a whole.

Interventions should start before preconception to help women optimise their health, micronutrient status and weight before they become pregnant. The availability of dietary counselling available through schools and every point of contact with the health care system should be the norm. The potential of modern marketing techniques, so powerfully used by the private sector, should be harnessed to raise awareness of the long-term benefits of preconception and maternal health and nutrition.

While breastfeeding is recognised as the optimal feeding option for young children, South Africa has not progressed sufficiently to create an enabling environment for mothers to successfully breastfeed. Challenges remain with nutritional and psycho-social support programmes for pregnant and breastfeeding mothers and the provision of paid maternity leave for at least six months. Despite a set of scientifically based age-specific Paediatric Food-Based Dietary Guidelines since 2013, South Africa has not endorsed these guidelines to be used by government and civil society.

Guidelines, however, fall short when the broader system fails to enable the choices people need to make. Individual food choices are limited by poverty and rising food prices.

The 2015 National Integrated ECD Policy defines an essential bundle of services to promote children’s optimal development. This includes health care services, support for primary caregivers and early learning programmes. Their potential is yet to be realised. Beyond early childhood, schools provide an important platform for improving the nutritional status of older children and adolescents. The Life Orientation curriculum, learner support materials and school health services should all be leveraged to identify and respond to poor health and nutrition. The regulation and enforcement of the marketing and sale of unhealthy foods in and around schools is crucial.

Coherence amongst government policy and unfolding programmes is essential to address undernutrition and overweight simultaneously. The Child Gauge proposes leveraging existing policies including more stringent regulation of food retailers and comprehensive restrictions on child-directed marketing of food and beverages. Coherence implies that sectors such as agriculture should play a role. We need to seek opportunities that would make the production of healthy food more attractive to farmers in local food systems and improve the availability of more nutritious food, especially for vulnerable households. In a context of high unemployment, existing social protection mechanisms such as the Child Support Grant should be increased to the level of the food poverty line and the national call for a permanent Basic Income Support for working-age adults who are unemployed prioritized.

To ensure effective implementation of interventions, a centralised body with authority should be galvanised to act across sectors and spheres of government and increases budget transparency of child nutrition policies. By drawing in other actors, a whole-society approach will be enabled to build and sustain an irresistible momentum to transform the food system. If we don’t commit ourselves to shaping and acting on food systems to make them better serve the diet and nutrition needs of children, South Africa will pay an extraordinary price for generations to come.

Scott Drimie is Director of the Southern Africa Food Lab. This article was first published in the Sunday Times on 28 February 2021.