Preventing non-communicable diseases: The importance of agro-food policies
Non-communicable diseases (NCDs) are the leading cause of deaths globally and in South Africa. Since 2013, the Department of Health has been implementing a number of legislative and regulatory interventions to reduce the prevalence of known NCD risk factors in the general population. But NCDs remain a challenge. Catherine Ndinda and Dr Sikhulumile Sinyolo write about the importance of agro-food policies for the prevention of NCDs.
Global evidence suggests that unhealthy diets increase the risk of people being affected by NCDs. Fruit and vegetables are important components of a healthy diet, and according to the World Health Organization, the intake of a minimum of 400g of fruit and vegetables per day can reduce the occurrence of chronic diseases such as heart disease, cancer, diabetes and obesity. Yet, South African households consume limited quantities of fruit and vegetables.
The reasons why households have less healthy diets include a lack of access to, and knowledge about, healthy eating, the unavailability and unaffordability of healthy foods, and the power of the global fast-foods culture. For example, if healthy foods are expensive, households resort to the consumption of what is affordable and not necessarily nutritious. Often, these cheaper substitutes are processed foods, which are high in salt and fat content.
The impact of policy
In 2012, Prof Corinna Hawkes, director of the Centre for Food Policy at the City, University of London, and a team of researchers from the UK and Australia, wrote in the journal Food Policy about the link between agricultural policies, obesity and non-communicable diseases. They emphasised that food supply chains, which influence food availability, affordability and acceptability, should be oriented more towards encouraging healthier eating. The fight against NCDs requires policy coherence not only within one sector (the health sector, as is currently the case in South Africa), but also across sectors such as food production, distribution and retailing. But, are the agricultural and food policies geared towards NCD prevention in South Africa? To start with, is there commitment and are there clear policies to tackle NCDs in this country?
Policies to tackle NCDs
A study, which was funded by the International Development Research Centre from 2014 to 2016 found evidence of government commitment to dealing with NCDs since the 1980s. However, efforts in tackling the NCD crisis only gained momentum in the 1990s, after the transition to democracy and the formation of the NCD directorate in the Department of Health.
Although unhealthy diets are not explicitly tackled, several food-related NCD policies were formulated to control unhealthy diets such as those with high salt, high fat and high sugar content. In 2013, the Minister of Health approved the amendment to the Foodstuffs, Cosmetics, and Disinfectants Act, 1972. In terms of the amendment, the country would reduce the salt content in processed foodstuffs such as bread, noodles, potato crisps, processed meat, sausages, read-to-eat-snacks, soup powder, gravy powder and stock cubes. This was because illnesses such as high blood pressure, heart attacks, and vascular dementia were attributed to high salt intake. The taxation of sugar-sweetened beverages was also implemented as a strategy for the control and prevention of obesity.
South Africa’s policies on agriculture, food and nutrition tend to focus on addressing the challenges of hunger and malnutrition. However, most food policies were designed long before NCD policies targeting unhealthy diets came into existence. Furthermore, the food- and nutrition-policies were formulated in isolation from the NCD prevention and control policies. These scenarios pose a challenge to efforts directed at NCD prevention and control.
Trade policies in South Africa also play a central role in determining the type of foods produced and their availability in the local market. For example, the focus on export-oriented agriculture, advocated for because of its potential to create jobs to address the persistently high unemployment levels in the country, can discourage the selling of fruits and vegetables in the local market. For example, 72% of total fruits produced in South Africa is sold in the export market, and only the remainder (28%) is sold locally. Often, the fruits sold in the local market are of lower quality and taste, while the best grades are sold in the export market. This has the potential of putting local consumers off eating fruits and vegetables.
The result is that, while there is increased production of fruit and vegetables in the country, it does not necessarily result in increased local consumption, because of the focus on exports.
Non-communicable diseases refer to medical conditions or diseases that are non-infectious and cannot be passed from person to person. The four main types are cardiovascular diseases (e.g. heart attacks and stroke), cancer, chronic respiratory diseases (e.g. chronic obstructed pulmonary disease and asthma), and diabetes. According to the World Health Organization (2018), non-communicable diseases kill 41 million people each year, which is 71% of all deaths globally. Over 85% of deaths among people aged between 30 and 69 (premature deaths) occur in low-income countries. In South Africa, non-communicable diseases account for 51% of all deaths.
The way forward
Responses to the growing NCD crisis in South Africa should include promoting the consumption of fruits and vegetables. The production, availability, affordability, and consumption of fruit and vegetables is influenced by the agri-food policies. Addressing the food environment is a critical step in dealing with unhealthy diets that contribute to NCDs. Through policy analysis and empirical data collection, a current study on the coherence of agri-food policies with NCD prevention, funded by the International Development Research Centre (Canada) seeks to explore and analyse the extent to which food and nutrition policies align with the national goal of reducing NCDs in the general population.
Authors: Dr Catherine Ndinda, research director in the Human and Social Development research programme, and Dr Sikhulumile Sinyolo, research specialist in the Economic Performance and Development research programme, at the HSRC