The famished road

Nutrition in the Southern African context

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There are serious nutritional challenges in South Africa: huge increases in obesity, problems contingent with changes in diet as rural people move to cities, and early childhood malnutrition, to name a few. A special report on obesity published in South Africa by Lancet in 2011 reported that rapid urbanisation of black people has led to the consuming of more processed, sugar- and salt-laden food. But little work has been done on the links between urbanization, obesity and malnutrition in South Africa.

The number of obese and overweight South African adolescents increased by more than 20% between 2002 and 2008. An added complication to the nutrition debate is the country’s high level of HIV infection – nearly three million people were receiving therapy in 2014. Researchers in the United States found increasing obesity among HIV-positive patients taking anti-retroviral drugs.

The paradox of both under-nutrition and over-nutrition exists in South Africa. At national level, more than half of the female population is either overweight or obese, while millions of children suffer from under-nutrition. South Africa’s 2016 General Household Survey shows 7.4 million people reported experiencing hunger. Although the SA government supplies a support grant to children of unemployed people, usually the money goes to feeding a whole family. As a result, many families survive on cheap energy-dense starchy foods such as maize meal, cooking oil and potatoes which have no nutritional benefits when consumed on their own in excess.

Childhood malnutrition starts early in life in Africa, with the first two years being the most vulnerable period. Chronic malnutrition (stunting) is a bigger problem than endemic acute malnutrition. At national level, 33.3% of South Africa’s pre-school children are Vitamin A deficient, 21.4% are anaemic and 5% suffer from iron-deficiency anaemia.

Population

South Africa’s population consists of five races. The African population of around 43 million is subdivided into eleven ethnic identities. There is a vibrant Indian population of around one and a quarter million, while more than two million mixed-race people who are indigenous to South Africa live mainly in the Cape. White South Africans number around four and a half million, many of whom can trace their descent to the European settlement in the Cape in 1652. The original Cape inhabitants – the San people – inhabited the southern tip of Africa for millennia, according to some historians. Thus eating habits, nutrition, stunting, starvation, obesity and diverse food production levels are part and parcel of a divergent food and nutrition landscape.

Only 35 000 South African commercial farmers provide food for more than 53 million people: one SA farmer feeds 1540 people. French farmers number around 490 000 in a population of 67m: one farmer for 136 people. In Germany, with a population of 82 million and 374 500 farming operations (including forestry and fishing), one farmer feeds 218 people.

Only around 12% of SA’s land is arable, and the country has less than the world average annual rainfall. This rainfall is sometimes erratic, and drought is a sword of Damocles that hangs over South African farming. Yet until a few years ago, the country was a net exporter of food, one of only six in the world.

The quality of South Africa’s agricultural produce is excellent, but it doesn’t reach everyone. South Africa has diverse populations groups and standards of living. The first world sits in juxtaposition with the third world, a situation unique on the planet. Infrastructure is uneven, and food cannot be economically transported to the far corners of the country. Strategies must be developed by the government to ensure that rural black people receive enough nutrition, but this is difficult given that millions live on subsistence agricultural plots.

More than 4000 productive farms were transferred to black people during the SA government’s land redistribution programme but 99% of these went out of production due mainly to lack of support for the new farmers. These farms were handed over to communities with no managerial structures in place, and many of these recipients knew nothing about modern commercial farming and were not supported with backup from the government. They were unable to maintain commercial productivity for various reasons, one being that productive farming in South Africa relies heavily on a high degree of technological input.

Thus nutritional production was the first casualty of this handover, and still is to a great extent. There were too many people on one piece of land. Third-world farming traditions were unable to maintain a modern farm in production.

Scenario

This erratic scenario is not limited to South Africa. In Kenya, scientists found that iron-deficiency anaemia is one of the most common health problems today. In Kenya alone more than 50% of the population suffers from this deficiency. Folic acid is also a nutrient deficiency and women who have low intakes of folic acid are at increased risk of having an infant with neural tube defects.

After the first six months of life, the first solid food babies in Africa receive is a starchy staple such as yams or cassava. Plain porridge made from cereals and tuber flour, though commonly used, is not sufficiently rich in energy. It lacks proteins and essential vitamins.

Thus Africa and South Africa are faced with drastically different social-cultural and economic environments, and the food consumed is not the same throughout the country, as it would be in other more homogenous parts of the world. Most Africans do not eat enough fruit: most rely on one or two staple crops. This uneven situation has significant effect on family nutritional well-being. Cultural influences affect attitudes towards some foods, such as pork.

Urbanization has greatly influenced African feeding habits but not always to their benefit. There is a high consumption of processed foods and snacks, and these “snack” foods have been found to have a high proportion of fat, starch and sugar content.

These new feeding habits have brought a number of life-threatening nutritional disorders to Africa, and especially to South Africa. These include obesity, hypertension, diabetes mellitus, cancer and cardiovascular disorders.

South Africa is now experiencing an obesity epidemic and health issues associated with this are overloading South Africa’s health system. Africa is the region in the world where diabetes is growing fastest. Type 2 diabetes used to be an adult condition and now it is not uncommon to see it in 15-year-olds.

To counteract this severe nutritional health problem, South Africa introduced a sugar tax on 1 April 2018. The level was fixed at 2,1 cents per gram of sugar for each gram above 4g per 100ml of sweetened beverage. The levy excluded fruit juices. The World Health Organisation announced its strong support for the sugary beverages tax.

Twin challenges

South Africa has twin malnutrition challenges: hunger and obesity. Many South Africans go hungry every day, at the same time as obesity rates are rising. This is unsurprising – both are forms of malnutrition and tend to go together. The coexistence of poverty and obesity is a global phenomenon.

Poverty leads to food deprivation and under-nutrition, and research suggests that under-nutrition in early life may play a role in promoting adult obesity. In 2014, over 10 million South Africans, nearly 20% of the country’s population, reported having inadequate food access.

The SA government and NGOs have tried to promote urban and semi-rural food gardens producing vegetables but it is an uphill battle as people tend to eat the traditional food of their forefathers. Too little fruit and vegetables are consumed in South Africa within the black population.

School feeding schemes have had mixed results. Government policies in this regard mean well but there have been serious challenges. The current policy provides only a small amount of food to help relieve child hunger, and there are a number of problems:

Although specific food is allocated, many children only receive “cold” food such as a sandwich and some milkshake supplement. It appears that the children don’t receive all the food that is allocated.

Parents talk of food disappearing from schools and in some cases there has been corruption and theft by people providing the food.

In many cases there is no system of accountability to the parent body. Food distribution is haphazard – parents are not sure what food is distributed and whether it is distributed fairly.

Schools do not always operate properly, closing half way through the morning or not opening at all. During the rainy season roads in rural areas become impassable, meaning the bread truck cannot get through to make deliveries. The milkshakes require water and many schools do not have potable water supplies.

It is clear therefore that proper nutrition for everyone in South and Southern Africa remains out of reach, with serious operational and policy challenges. These are acknowledged however, and many are working seriously towards the goal of nutrition for everyone at the southern tip of the African continent.

Bennie van Zyl, General Manager, TAU SA

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