One of the defining landmarks in Johannesburg, South Africa, is the Coca-Cola Dome: a 19,000-person arena sponsored by the beverage maker. Coke has become increasingly popular in South Africa, with South Africans drinking an average of 254 Coke products each in 2010. That’s more than the international annual average of 89 Coke products consumed per person, and quickly approaching the 403 Coke products drunk by the average American.
KFC is also a significant presence in South Africa, with more than 600 store locations in the country. Thanks to the increasing availability of soda and fast food, South Africans are eating more and more like Americans, and as they do, they are also developing the chronic diseases associated with the standard American diet.
In recent years, South Africans have been migrating from rural areas to urban centers in search of work. Life in an urban environment brings with it easy access to big supermarkets and fast food chains. While access to supermarkets may sound like a good thing, large chains like Shoprite and Pick ‘n Pay carry mostly packaged foods that contain the processed meat, refined flour and sugar, and artificial preservatives typical of the standard American diet. These are the very ingredients that lead to obesity and diet-related diseases like diabetes. Many South African Blacks who have newly migrated to urban centers consider the unprocessed starches, high-fiber vegetables and plant proteins of their previous rural diets undesirable “poverty foods.” Instead, they have come to embrace the fried foods and animal protein so prevalent in urban environments.
Meanwhile, due to steep food and fuel prices, food insecurity remains a pressing issue in South Africa.
Food insecurity exists when nutritious food is not available or safe for consumption, and when households cannot acquire food in a socially acceptable way (i.e. scavenging, stealing, or using emergency supplies). From 1999 to 2008, food insecurity decreased in both rural and urban regions. However, the rate of food insecurity remains higher in rural areas, at 33.1 percent in 2008, compared to 20.5 percent in urban areas. The Development Bank of Southern Africa (DBSA) found that in 2008, 79 percent of households in the major South African cities of Cape Town, Johannesburg, and Msunduzi, went without food because of a sharp rise in prices. The DBSA also found a direct link between poverty and food insecurity: not surprisingly, more money means better access to healthy, safe foods.
While many South Africans experience under-nutrition, or the inability to consume an adequate number of calories and nutrients, many also deal with a range of “Western” chronic diseases associated with over-nutrition. The U.N. Food and Agriculture Organization (FAO) refers to this phenomenon as the “double burden of malnutrition.” It often occurs in developing countries whose markets have opened their doors to multinational food corporations, and whose domestic public health efforts have been slow to combat hunger.
Dr. Zandile Mchiza, senior scientist of the Medical Research Council of South Africa, has found that early childhood under-nutrition can lead to obesity later in life. This factor is cause for concern for low-income South Africans, many of whom probably did not have enough to eat when they were young. Obesity is a well-known risk factor for diabetes, and 61 percent of South Africans are now considered obese. Black women have the highest rates of obesity, at about one third of the population. Among men, whites have the highest obesity rate, at 18 percent.
Currently, about six percent of the South African population is diabetic, according to Dr. Larry Distiller, founder of the Centre for Diabetes and Endocrinology in Johannesburg. But the International Diabetes Federation (IDF) estimates that this rate will almost double by 2030.
Cultural norms in South Africa often favor bigger bodies, since thinness has come to be associated with the scourge of HIV, which affects about 17 percent of the South African population. Actually, HIV also can be a risk factor for diabetes because antiretroviral drugs can cause glucose intolerance as a side effect. This seemingly paradoxical link demands that healthcare professionals educate themselves and their patients about diabetes risk. This is especially important considering the adoption of an American-style diet in urban South Africa.
The South African public health community has begun to take some steps to encourage healthier eating. Because sodium causes high blood pressure, and high blood pressure is a major risk factor for cardiovascular disease and stroke, the South African government capped the amount of salt in certain processed foods sold in grocery stores. This legislation includes a 50 percent reduction of sodium in bread and comparable reductions in margarine, soups, and gravies.
Public health professionals hope that with this measure, and with help from industry, rates of high blood pressure will decrease. “Help from industry” is a sticky concept, however, as companies’ bottom lines take precedence over public health efforts or corporate social responsibility campaigns. According to Kelly Brownell of Yale University’s Rudd Center for Food Policy and Obesity, “The arresting reality is that companies must sell less food if the population is to lose weight, and this pits the fundamental purpose of the food industry against public health goals.” This is as true in South Africa as in the U.S.
The South African government may want to enact further restrictions on the amount of sugar and saturated fat in processed foods, as well as regulate the ways processed and unhealthy foods are marketed to children on TV and in public schools. While these kinds of domestic policies may decrease consumption of the American-style diet, the biggest challenge for South Africa lies in addressing its “double burden” and working toward food security and food justice for all South Africans, in rural and urban areas alike.
