Malnutrition in a time of abundance

Refilwe is five months old. Born in Kayamandi township on the outskirts of Stellenbosch, Refilwe may have the aptitude to become a doctor someday, but it will never happen. The reason isn’t education, or opportunity – those may come – the reason is stunting. Refilwe’s mother lives below the breadline and can’t afford to feed herself. As a result, Refilwe was born with a low birth weight. She thought she was unable to breastfeed her child, since someone told her that her milk was too “weak”. She makes do with what she can, and mostly feeds Refilwe banana or pap. Although there is access to potable water, sanitation is generally poor in their environment. Health services are available but the queues are long.

Childhood under-nutrition (especially during the first 1000 days of life from conception) combined with poor health and care can lead to stunting whereby children are short-for-age as a result of insufficient food over a long period of time. The damage incurred during this critical period in a child’s development goes far beyond height and cannot be reversed. Children who are stunted may have lower brain function, poor organ development and weak immune systems. This results in poor school performance, decreased productivity and earnings later, higher risk of non-communicable diseases such as obesity and diabetes and, in short, little to no chance of ever reaching their full potential. The stats say that a horrifying 27% of South African children are stunted and even more may be undetected.

Further up country, in the township of Diepsloot, Tshepo has just turned sixteen. Tshepo’s mother moved to Gauteng from the former Transkei when she finished school, and Tshepo has lived there all his life. While his mom was raised on a diet replete with home grown vegetables, Tshepo lives primarily on low-cost convenience foods bought at the local spaza. His diet is mostly made up of high calorific, low-nutrient foods like magwinyas (fat cakes) and Kotas (quarter-loaves of white bread filled with processed food such as chips, cheese and polony). While his mom still tries to cook the spinach and cabbage of her youth, fresh foods are less tasty (in Tshepo’s view), more expensive, difficult to keep fresh and far less filling.

Tshepo will join the throng of young South Africans steering the nation to fast become a global leader in childhood obesity. He too will have increased risk of diabetes, heart disease, stroke and a number of cancers. Such non-communicable diseases are now among the top causes of death in the country at around 40%. At the same time, the prevalence of overweight and obesity is close on 58% for men and 71% for women.

The accumulated losses to South Africa’s GDP from 2006 – 2015 from diabetes, stroke and coronary heart disease alone are estimated at R27 billion. According to Genesis, an economics-based consulting firm, non-communicable or lifestyle diseases already account for nearly 40% of healthcare spend in Gauteng. They estimate that by 2030 this spend will reach R19.2 billion per year.

Today (16 October) is World Food Day, a day intended to draw attention to food and nutrition security across the globe. In South Africa, our issue is less about food production – despite the food insecurity of some households, we do produce enough food to feed our population – and more about diets which are healthy not only for humans, but also for the environment.

South Africa’s highly industrialised food system not only drives stunting, obesity and other non-communicable diseases, it’s also driving a major environmental crisis; including escalating biodiversity loss, deforestation, desertification and soil degradation, water scarcity and declining water quality.

As both Refilwe and Tshepo’s stories attest, addressing these goes beyond individual behaviour around food choices. Food choices are driven by broader food environments including availability and physical access, affordability, promotion, advertising, demand and information as well as food quality and safety issues.

In order to see transformative change, we need to take a systemic view of understanding all the possible interconnections and feedback loops so that, in intending to problem-solve, we do not create other unintended consequences. We need to foster interventions that are multifaceted, multi-sectoral, multi-impactful and transformational. We need to leverage the growing willingness to engage collaboratively and take concrete actions. And we need to ensure that health-related actions are strategic, aligned, well implemented with strong outcomes and robust accountability.

Last year, the Southern Africa Food Lab and WWF South Africa, embarked upon research into the role of the food industry in improving its impact on human and environmental health. The research, funded by the WWF Green Trust, involved engagement with representatives of  sector bodies, business initiatives, food manufacturers, retailers, food producers, suppliers, NGOs, government departments and academia, as well as researchers and consultants.

The resultant report, An Appetite for Collaboration, suggests that while more effective government policy and regulatory intervention are critical to addressing some of the systemic issues driving food choices, in the absence of an enabling policy environment, it is incumbent upon those involved in the food sector, as drivers of dietary change, to consider their responsibility in engendering nutrition-related health challenges. Although there is a potential role for collaborative industry initiatives based on a perceived willingness to engage and take concrete actions, much more is needed. Many of the health-related actions lack strategic intent, implementation is often patchy, and outcomes are typically weak with insufficient accountability. This raises questions about a concerted drive by civil society and consumers to demand this change and to exert pressure on both the state and food companies.

The Food Lab is now in the process of launching further initiatives to comprehensively address the impacts of the food system experienced by the majority of South Africans and will be hosting a National Dialogue titled Food as Nexus between Health, Economy & Environments – Challenges and Opportunities for Governance on 31 October towards this end.

Dr Scott Drimie is Director of the Southern Africa Food Lab, which is housed at the University of Stellenbosch.