Province wanting to take NCDs seriously
IOL are reporting the following story:
“Western Cape premier Helen Zille has appointed researchers to find ways for people to lead healthier lifestyles, it was reported on Wednesday.
The Cape Times reported that researchers from the University of Cape Town and the non-governmental organisation, Ideas42, started work in September and would pilot a R1 million project.
The university researchers were from the unit for behavioural economics and neuro-economics.
The Western Cape had higher levels of inactivity, obesity and smoking than the national average, said health department spokeswoman Faiza Steyn.
“Poor choices that lead to ill-health include the misuse of alcohol, smoking, poor diet and insufficient exercise and unsafe sex,” she said.
She said that 60 percent of emergencies treated at provincial hospitals and clinics were the result of medical conditions. Most of these were chronic and many “could be prevented by a healthy diet, exercise and not smoking”.
Zille’s spokesman Zak Mbhele told the newspaper at least R 1 billion was spent by the province each year to treat preventable illnesses and injuries. -” (link)
I am delighted that this is beginning to be escalated beyond rhetoric (The National Department of Health have been discussing this for some time).
Zille alluded to this with her budget speech last month. At the time the response from opposition parties was not positive. (“Zille said that where illnesses could be prevented, citizens must take responsibility for doing so.
“(It must start) with us, right here in this Parliament, going on an eating and exercise regime to bring our weight to normal limits.”
But Cope MPL Mbulelo Ncedana said Zille had insulted the majority of people in the Western Cape with her comments.
“I don’t understand her logic. She has insulted us by saying our eating habits place a burden on the health system,” Ncedana said.” (link)).
I think the problem is really one of articulation of the problem. We need to shift away from talking about NCDs as “Diseases of Lifestyle” or “Diseases of Affluence” and recognise that there are structural drivers behind the choices that people make. Until the structural and personal issues are considered together and given appropriate weighting, Zille is going to have a tough time getting buy in from people and not being accused of being judgmental
The Independent has an eye-catching graphic on rising obesity rates in the UK.
It is accompanied by this article which says the following: “A series of research papers published in The Lancet ahead of next month’s United Nations meeting on non-communicable diseases, which is expected to single out obesity as the world’s greatest challenge, says the drivers of the pandemic have been known for 40 years but governments have turned a blind eye and insisted it is a matter of individual responsibility.
No country in the world was successfully tackling the threat as leaders feared the wrath of electors if they slapped extra taxes on unhealthy foods or restricted car use. But the consequences of doing nothing would be worse, researchers said. Professor Steven Gortmaker, of the Harvard School of Public Health, said assessments of 20 proven interventions for curbing obesity showed that eight would save costs as well as improve health, ranging from a tax on unhealthy food and drink to restrictions on marketing to children and schools programmes to boost healthy eating. Traffic-light labelling to highlight unhealthy foods was among the most effective and cheapest ways of reducing consumption, but more attention was given to drugs and surgery.”
Of course, this is far more easily said than done, particularly when government at all levels is so silo-ed, but evidence is mounting that we are nearing crisis points in so many sectors of the system.
No country in the world was successfully tackling the threat as leaders feared the wrath of electors if they slapped extra taxes on unhealthy foods or restricted car use.
But the consequences of doing nothing would be worse, researchers said. Professor Steven Gortmaker, of the Harvard School of Public Health, said assessments of 20 proven interventions for curbing obesity showed that eight would save costs as well as improve health, ranging from a tax on unhealthy food and drink to restrictions on marketing to children and schools programmes to boost healthy eating.
Traffic-light labelling to highlight unhealthy foods was among the most effective and cheapest ways of reducing consumption, but more attention was given to drugs and surgery.”Absolutely, ensuring food security and an appropriate food system needs to develop out of individuals and communities, NGOs, CBOs etc, Business and Government all recognizing they have a role and responsibility and business in particular needs to be held accountable.
Transfats in South Africa
As you yesterday, South Africa has legislated against Transfats. A maximum of 2% of oil content may now be from transfats and a maximum of 1% of oils in foods claiming to be transfat free.
The Daily Maverick reports on it here: Link
In the article they quote a Pretoria University Nutritionist who notes that while Europe has had such legislation for some time, they have continued to send foods to us that would not be legal there.
The Daily Maverick points to a series of challenges likely to face any operationalising of the legislation.
“That is, if anyone ever challenges those products. The department of health, which could not be reached for comment, doesn’t have the resources to test for such things, and has previously said it will rely on food companies to act honestly. It is perhaps more realistic to expect competitors to police one another, but that leaves consumers without a champion, or even much information. Disclosing the level of trans-fats in food is not yet mandatory, it’s just illegal to have too much.
And that is ignoring one of the primary sources of trans-fats: frying oil that is reused too often. We wouldn’t recommend relying on the local fish ‘n chips shop to do regular testing.”
I think this is key, particularly at the lower end of the market - the non-supermarket sector - where regulation is less effective, where the consumers are more price pressed and so purchasing more heavily processed foods, and where consumers have less information on nutrition and legislation.
USDA Food Environment Atlas
This is an amazing resource put together using a series of data sets (site link)
Fundamentally, geography matters when it comes to thinking about food, health and food security
The cost of healthy foods in South Africa
Business Day report the following: “ It costs on average 69% more to eat healthier food, says a new study on nutrition in SA by specialist researchers.
Low-fat and high-fibre options for food choices are vastly more expensive, says the study, in part explaining SA’s fast- growing epidemic of obesity, especially among black women.
Norman Temple, a researcher at Athabasca University in Canada, and Nelia Steyn at the Human Sciences Research Council (HSRC) in SA determined the extra cost of a healthy diet by comparing six commonly consumed foods with healthier versions.
On a weight comparison, healthier options were between 30% and 110% more expensive. For example, 100g of reduced-fat margarine cost 58% more than the regular variety and wholewheat bread cost 17% more than white bread.
When compared on the basis of the energy provided, healthy options were even more costly. So, fat-free milk was 109% more expensive than full-cream milk and brown rice was 50% more expensive than white rice.” (http://www.businessday.co.za/Articles/Content.aspx?id=139527)
This is no great surprise. It is the same everywhere. But, we have zero-rating on a number of ‘basics’. Which is great, because in our AFSUN survey of Cape Town food security, the poorest tercile of our sampled households were spending an average of 53% of their income on food.
Despite the VAT zero-rating policy there are some problems that prevent the policy really benefiting the most in need.
Watkinson and Makgetla’s 2002 study of the food price crisis noted:”The benefit of V.A.T. zero rating on basic foodstuffs is not being passed on to consumers.
ß There are several inconsistencies in the pricing of bread. Brown bread is V.A.T. exempt, whilst white bread is not. This should mean that brown bread is no more than the price of white bread when 14 per cent is added to the price. However, as Figure 2 shows, only the 700g brown loaf complies, while all others do not. It is not clear which part of the industry chain is responsible for inflating brown bread prices “ (Source)
Then Jansen and Stolz noted in 2009 that poorer households tended to consume more canned vegetables and wealthier households were consuming far of luxurious unprocessed fresh fruit and veg - like fresh cherries, asparagus (all of which require cold storage, by the way). Which of these categories do you think is zero rated?
Finally, the AFSUN work is revealing that low income households are much more dependent on informal markets to access food, which a) are generally more expensive and b) far more limited in the range of foods they sell, with an over-representation of unhealthy food types.
(Source - author’s own. Contact: jane.battersby.lennard at gmail.com)
University of Cape Town