COST OF A HEALTHY DIET Most South Africans cannot afford to eat well

The cost and inaccessibility of healthier food choices are forcing the greater majority of South Africans into an unhealthy lifestyle, find NORMAN J TEMPLE and NELIA P STEYN.
For most South Africans, a healthy diet is unaffordable, costing on average 69% more than the unhealthy food choices they make presently. While there are several barriers between the general population and a healthier diet, cost is an important factor for South Africans in gaining access to healthier food.
Studies in the US and France have shown that refined cereals and foods with added sugar and fat are cheap sources of energy, but that they are typically low in nutrients, unlike healthy foods like meat, fish, vegetables and fruit. This means people with low incomes select a relatively less healthy diet with a low content of several micronutrients and a high energy density.
Moreover, foods with a high energy density appear to cause spontaneous overeating and may be an important factor in the high prevalence of obesity in people of low socioeconomic status.
Nutrition in South Africa
These findings are relevant to nutrition in South Africa. As a developing country, average incomes are much lower than in highly developed countries. South Africa has a high prevalence of under- and over-nutrition, including a fast-growing epidemic of obesity, especially among women.These problems are most concentrated in the black population, where poverty is widespread and malnutrition common. In a study to determine the extra cost of a healthy diet, the prices of six commonly consumed foods were compared with that of healthier versions. A clear trend was seen for the healthier foods to be more expensive, typically 10% to 60% more on a weight basis, while the cost premium for healthier foods was considerably greater when prices were compared based on rands per mega-joule. The study found that healthier foods were 30% to 110% more expensive. On average, the healthier diet costs 69% more.

In real terms, the cost of a healthier diet was R36 more per meal (or about R1 090 per month) for a family of five. Based on a 2005–2006 survey, households whose income is exceeded by just more than half the population, the increased expenditure on food of R1 090 represents 57% of total household income. This percentage decreases to about 30% for those whose household income is exceeded by one-third of the population.

Availability of choices



Studies in the US and other countries have reported that low-income areas often lack a supermarket with a wide selection of healthy food. Instead, people shop in small food stores where prices are higher and there are fewer healthier food choices. A similar scenario prevails in South Africa, where the small food stores in small towns offer limited healthy choices.

Implications for government policy



Recommendations need to be carefully crafted, especially when most people in the target population have a low income.


Asking people to switch from enjoyable foods to a combination of more expensive foods and cheap foods is likely to receive a lukewarm response. And because of the cost, a strategy of changing the national diet using health promotion is likely to achieve only limited success.


Overcoming this barrier will probably require a drop in food prices, in turn requiring government intervention in accessibility and with taxation and subsidies. Another strategy is to ensure healthy food choices are made in school meals or other sponsored nutrition programmes.

Summary of an article published in Nutrition (2011).

Dr Norman J Temple is a researcher at the Centre for Science at Athabasca University, and Dr Nelia P Steyn is a chief research specialist in the Population Health, Health Systems and Innovation programme, HSRC.