As South Africa strives to respond to, and recover from, the COVID-19 pandemic and other existing health crises, the state must rethink how it prioritizes the use of public health resources. Scholars have cited these health crises as “four colliding epidemics,” where HIV and tuberculosis; maternal, new-born, and child health; violence and injury; and noncommunicable diseases (NCDs) co-exist. Consequently, COVID-19 has exacerbated these health burdens while highlighting inequities within the country’s health system. The current health needs of South Africans far exceed the capacity of the health sector, placing immense pressure on limited public health resources that are expected to serve 84% of the population. As the state has redirected much of its resources to the pandemic, trade-offs are inevitable when trying to build a recovery plan.
For instance, the growing NCDs burden has taken center stage as a major public health concern, rapidly becoming the leading cause of mortality in the country, estimated to account for 57.7% of annual deaths. However, the NCDs epidemic is complex, as there are many underlying determinants and contributing risk factors. Unhealthy diets — characterized as the intake of energy-dense foods high in sugar, salt and fat — are one of the major risk-factors linked to many NCDs. This is largely due to the increasing availability and affordability of ultra-processed, energy-dense foods and the broader obesogenic environment that promotes the consumption of such foods. While other forms of malnutrition, such as food insecurity and hunger, have plagued South Africa for decades, the transitioning socioeconomic landscape and reliance on the formal food sector have resulted in an unprecedented increase in rates of overweight, obesity, and diet-related NCDs. This is partly a result of major food corporations who are responsible for perpetuating unhealthy diets through the production, distribution, and advertisement of these ultra-processed foods, contributing toward the creation of an obesogenic environment.
South Africa presents a complex food crisis. While the country is considered food secure at a national level because it produces enough food to feed the population, it is considered food insecure at a household level because millions of people are unable to access this food — indicating that the food crisis is ultimately an issue of equity. Moreover, the situation was worsened by the nationwide lockdown, where people were further limited by not being able to physically access food markets, compounded by severe financial hardship, as roughly three million jobs were lost within the first three months of the pandemic. Subsequently, people were forced into making unhealthy food choices, as price hikes were widespread and ultra-processed foods continue to be the most affordable option for families.
South Africa needs to reconsider how it prioritizes a more resilient food system, along with the socioeconomic infrastructure to ensure it can be sustained to support the many, not just the few. Consideration should be given to the prevention of diseases and the promotion of health by targeting risk factors, such as the consumption of unhealthy food, as well as making provision for access to healthier food choices. To this end, principles of food justice provide useful recommendations on how to respond to issues of food and nutrition insecurity and deep-rooted systemic barriers, such as gender, racial, classist, and economic divisions which hinder access to healthy, nutritious, and culturally appropriate foods. This is closely linked to ideals of food sovereignty, which is defined as “the right of peoples to healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems.” Together, these movements aim to address both socioeconomic barriers to accessing food and also make provisions for the importance of self-sustainability.
Additionally, the principles of food justice and sovereignty also provide an avenue for demanding accessible information on food, nutrition, and the importance of a healthy diet. The current food environment and widespread access to ultra-processed food means that people are largely unaware of the ingredients in their food, or the health implications thereof. However, as states also have an obligation to respect, protect, and fulfill the right to health, this includes putting measures in place to reduce the availability, accessibility, and affordability of unhealthy foods. This can be achieved by introducing legislative, policy, and regulatory measures — such as marketing restrictions to children and front-of-pack labelling guidelines — to reduce the consumption of unhealthy foods and to enable consumers to make informed choices about the food they eat.
Furthermore, South Africa is committed to international and regional human rights standards, and their Constitution entrenches the right to food in Section 27 (1)(b), 28 (1)(c), and 35 (2)(e), making the right to food a justiciable and enforceable right. However, there have been many obstacles to realizing this right because there is no national framework to determine the extent to which departments are responsible, nor is it clear which national body will oversee the implementation of this right. Such omissions make it hard to bring forward legal challenges. This has also resulted in policy incoherence, with over 60 fragmented food and nutrition security policies, with very little impact on the ground. Still, the state has made some progress in adopting measures aimed at addressing diet-related risk factors, by regulating limits on the content of certain foodstuffs, such as sodium levels, and through fiscal measures such as the Health Promotion Levy on sugar sweetened beverages, along with regulating the labelling and advertising of some unhealthy food products. Unfortunately, the activities of the food and beverage industry have largely remained unregulated, and they have successfully employed strategies to delay the adoption and implementation of these measures. Nevertheless, South Africa’s failure to adopt a national legislative framework and the piecemeal approach it has taken to enforce existing regulatory measures are inadequate to meet its obligations to respect, protect, and fulfill these rights.
Consequently, as South Africa strives to respond to a number of public health crises and faces grave socioeconomic challenges, the state must explore solutions beyond the traditional discourse. There is a need for political will and the prioritization of preventative measures to be taken, with consideration of the broader food and health environment. These solutions should include understanding how people access and acquire food, and how this process can be improved to ensure equitable and sustainable access to healthy, nutritious food. Interventions undertaken by the state should focus on responding to the lack of access to resources and skills needed to eliminate the burden of reliance on food markets and ultra-processed foods, as well as improving the regulation of the production, distribution, and advertisement of foodstuffs to better consumer knowledge and behavior in the local context. Therefore, food and nutrition interventions should ensure equitable and sustainable practices across all relevant state sectors, along with private sector stakeholders who continue to influence and dominant the food system.
To this end, legislative and policy considerations on food and nutrition should be better aligned with population-specific challenges, and South Africa should be held accountable in its efforts to continually create healthier environments. Therefore, addressing underlying inequities should be at the center of every intervention and recommendation. Ultimately, South African should adopt and implement interventions that ensure the realization of the right to food in an equitable, dignified, and sustainable manner.