Food for all: The need to measure healthy eating in SA
Ensuring that everyone consumes a nutritious diet for a healthy life is a fundamental socioeconomic and human right entrenched in the South African constitution. However, realising this right is difficult without appropriate information. We need reliable facts about the extent to which people consume balanced diets, writes Dr Peter Jacobs, who investigated recent data on nutritional intake in South Africa.
South Africa’s 1996 constitution protects and promotes the right to food for all, but is silent on the right to adequate nutrition. Yet, the common understanding is that Section 27 incorporates the right to a nutritious diet for a healthy life, and this understanding has been entrenched in the government’s recent National Policy on Food and Nutrition Security.
Communities, civil-society actors and academics have questioned the extent to which South African authorities are succeeding in realising this fundamental human right. At the conceptual level, does a food production or balanced dietary-intake approach guide policy? At the level of fiscal expenditure, to what extent is government spending improving the food and nutrition status of people? In terms of metrics and methodologies, how useful are the information-collection instruments and indicators for identifying malnourished populations, especially children in poor households? We need to think through and link how the concept of food- and nutrition-security informs the design and implementation of policy, state funding and corresponding measurement tools.
A global priority
Realising the right to adequate food and nutrition has evolved into a global priority. It is entrenched in the United Nation’s Sustainable Development Goals (SDGs), with its emphasis on restructuring how agro-food systems work to achieve food- and nutrition-security for all. The SDGs also call for drastic cuts in food waste and global greenhouse gas emissions generated by dominant systems of food production, distribution and consumption.
For several years before the SDGs came into effect in 2016, India and Brazil had already taken exemplary steps towards adequate food and nutrition. Their governments have pioneered overarching food- and nutrition-security legislation, coupled with fit-for-purpose action plans. In the adopted laws, comprehensive and holistic approaches to food- and nutrition-policy have displaced the old focus on agricultural output. This integrated approach shows in how these countries govern their food- and nutrition-policy interventions. It is evident in a shift from reliance on agricultural ministries to broad-based stakeholder involvement in grassroots execution and coordination of action plans, ranging from health-care facilities to civil-society actors.
The National Policy that South Africa adopted in 2014, seems to follow these global trends, at least partially, in its strategic intent. In addition to prioritising the availability of, and access to, enough food for zero hunger – a condition when a person consumes the quantity of food consistent with dietary energy requirements – the policy also promotes healthy diets, which is synonymous with balanced nutrition and ending hidden hunger.
Measuring healthy eating
What evidence is there to show that this policy is beginning to help improve the food- and nutrition-security status of the population? It is hard to answer this question without suitable indicators and measurement tools. However, regular measurement of access to diverse foods for healthy diets is costly and poses technical difficulties widely examined in the literature. Table 1 summarises the strengths and limitations of prominent sources relied upon in policy and research circles. No single survey collects information on every dimension of food- and nutrition-security for each member of the population. Moreover, the surveys vary so much in their respective designs and frequency of use. These methodological problems do not allow for exploiting their complementary strengths.
In terms of popular use, the General Household Survey overshadows the rest, mainly because it covers almost every dimension of food- and nutrition-security. But, despite its popularity, its shortcomings include not collecting any data on food prices, nutritional awareness and nutrient intake.
Statistics for 2012 to 2017 show that just over one-fifth of South African households did not have enough money to satisfy their food needs. The trend was consistent with evidence of bygone years: food insecurity was more pervasive in rural areas, as a substantially higher share of rural households were unable to buy enough food, as reported in Table 2. Using the same food access and affordability yardstick, the number of food-insecure urban households increased from 1,71 million (17,72%) to 2,15 million (19,02%) households during this period. A deepening level of money-metric poverty is not the only explanation for nutritious food becoming unaffordable to more households. Structural causes of food-cost inflation are compelling drivers of this food-affordability crisis. Export-oriented farmers, food-processing corporations and supermarket monopolies control the agro-food value chain. Weak institutional governance of the food system allows them to collude and manipulate food prices to maximise corporate profits as repeated bread and dairy price scandals reveal.
Strategies to avoid hunger
When people are unable to secure enough nutritious food, their instinctive reaction is to limit their vulnerability to extreme hunger or starvation. Typical responses include skipping meals, eating smaller meals, cutting the varieties of foods consumed or a combination of these coping responses.
The logic behind these strategies makes sense: to stretch the available food until the next uncertain meal. Reduced food variety, as reported in Table 3, mirrors trends highlighted above and points to hidden hunger (undernutrition plus obesity) becoming more acute. Compromising dietary diversity in a context marked by excessive consumption of ultra-processed starches, meat, fats and sugars works against efforts at combatting child malnutrition (stunting, wasting and obesity) and other diseases of lifestyle associated with empty calories. Malnourished consumers in South Africa do not benefit from an entrenched food regime that exports the best quality agro-foods and imports ultra-processed foods.
South Africa is far from realising the global aspiration of securing nutritious food for all. The country needs to couple direct state assistance for food and nutritionally insecure households with substantial investments in better-quality information collection, processing and dissemination tools.
Once-off yearly surveys cannot properly measure the diversity of foods accessed and consumed. It is crucial that researchers also measure nutritional status and awareness of the nutritional content of foods. This shift in thinking needs to begin with an integrated and dynamic approach to the political economy of food- and nutrition-security that goes beyond the narrow limits of counting total food output.
Author: Dr Peter Jacobs, research director in the HSRC’s Economic Performance and Development research programme
End Note: This summary draws on an invited presentation delivered at a seminar of the Legal Resources Centre to explore prospects for litigation on realising the right to adequate food and nutrition.