On a recent trip to South Africa, I often heard it said that low-income groups have “good access to bad food and bad access to good food”. While the wealthier people can afford a variety of vegetables, fruits, nuts and lean meats, nutritious food is either too expensive or simply not sold in local shops in poorer areas.
What people living in poorer areas of South Africa do have access to is cheap, highly processed food that is rich in sugars, fat and salt but missing many essential nutrients. Calories are entering the local food systems, but in the wrong form. As a result, low-income urban areas in South Africa areas are increasingly seen as “food swamps”.
The consequences are clear: in South Africa, levels of childhood overweight are spiralling
People living in these poorer communities face a whole raft of additional barriers to eating healthily. Small crises come along that undermine their efforts. The increasing cost of electricity and its unreliable supply means it’s not always easy or cheap to prepare food at home; storage of fresh foods can be a challenge without refrigeration; poor transport connections mean people often have to leave home at 4 am to get to work on time; and unexpected expenses can blow a whole month’s carefully planned food budget. The stress of these barriers is often too much and many people are simply too worn out to be active or to prepare healthy food from scratch.
The consequences are clear: in South Africa, levels of childhood overweight are spiralling. Childhood obesity has increased to 13 per cent, more than twice the global average and the highest in the Eastern and Southern African Region.
Not eating enough nutritious foods and eating too many unhealthy foods in early years prevents children from growing properly. UNICEF’s State of the World’s Children 2019 report found that 1 in 3 children are not growing well and 2 in 3 young children do not receive the right combination and diversity of foods for optimal nutrition. Over 75 per cent of overweight children now live in middle-income countries – this is not a “high income country issue”, it’s a sustainable development issue.
As a result, UNICEF is scaling up work on the prevention of childhood overweight and obesity. I recently travelled to Cape Town to kick off an exciting new community-based project that aims to understand how we can better empower vulnerable urban communities to eat healthily.
For this project, UNICEF is partnering with the African Centre for Cities, Stellenbosch University and the Centre for Food Policy at City University of London to learn from the situation in two low-income communities in the Western Cape: Masiphumelele (affectionately known as “Masi”) and Zweletemba.
Previous work with these communities has shown that residents often speak of trying to eat healthily and be physically active but feel their environment prevents it. Local and national government have been making efforts to help people eat better, but the patchwork of policies does not appear to be reaching its full potential. Efforts such as nutrition education, extra money given to poor families to support their children, or programmes designed to help feed infants and toddlers better, while well-intentioned and essential, appear insufficient in the face of multiple and complex barriers.
In Masi and Zweletemba we will identify promising solutions by listening to people in urban settings who experience the problems we are talking about. We will talk to low-income families who have young children, walking with them around their neighbourhoods to understand their daily routines and find out what influences the foods they eat, and what could change that.
We will discuss the ways the government tries to help and ask whether they know about it or are benefitting from the intended support. Asking what might make a difference to their lives could offer some interesting and inspiring new solutions. We will also map local environments to understand how food marketing and selling methods influence how people eat.
This work is happening in South Africa, but I believe it will have regional and global relevance, providing insights to better support countries on overweight and obesity prevention. More needs to be done to create an enabling environment for vulnerable communities, but what combination of policies and interventions will do it best?
Overweight and obesity affect some of our most vulnerable children in struggling communities
On World Obesity Day, it is important to remember that overweight and obesity affect some of our most vulnerable children in struggling communities. Far from being the result of laziness, ignorance or irresponsible decisions on the part of children or their caregivers, it largely results from a vicious combination of financial, social and physical barriers that prevent communities from eating well. Caregivers often understand the importance of good nutrition and eating well. They are clear, too, on the barriers to healthy nutrition. Let us work together to lower these barriers and to ensure that every child, young person and woman has the nourishing diet they need at every moment of life to meet their full potential.
Jo Jewell is a Nutrition Specialist at UNICEF Headquarters focusing on the prevention of overweight and obesity.