Where Food Injustice Wanders Next: South Africa

By Judy Bankman

This blog post originally appeared on the Civil Eats website.

The transnational giants Coke and KFC have increased their presence in urban South AFrica in recent years.

One of the defining landmarks in Johannesburg, South Africa is the Coca-Cola dome: A 19,000-person arena sponsored by the beverage giant. Coke has become increasing popular in South Africa, where an average of 254 Coke products were consumed in 2010. That’s more than the international annual average of 89 per person and quickly approaching the 403 Coke products consumed by the average American.

KFC is also a significant presence in South Africa, with more than 600 locations in the country. Thanks to the increasing availability of soda and fast food, South Africans are developing the chronic diseases associated with the nutrient-poor standard American diet.

As diets around the world are becoming less varied, and more dependent on processed convenience foods, few places demand the attention that South Africa does. As the home to strong historical inequalities and a fierce ongoing battle for racial justice the question arises: What is fueling the adoption of the Western-style diet there? Who is affected the most?

In recent years, South Africans have been migrating from rural areas to urban centers in search of work. Along with more opportunity, life in an urban environment offers easy access to big supermarkets and fast food chains. While access to supermarkets can often be 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, the very ingredients that are tied to diet-related illnesses in the developed world.

Many of those who have recently migrated to urban centers consider their rural diets of unprocessed starches such as pap, high-fiber vegetables, and plant proteins “poverty foods,” and have come to embrace the fried fare and animal protein readily available in commercially dense environments. Meanwhile, steep food and fuel prices make food insecurity a persistent and pressing issue in South Africa.

“Food insecurity” happens 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, using emergency supplies, etc). From 1999 to 2008, access to healthy food has improved in the country’s rural and urban regions. However, the rate of food insecurity remains higher in rural areas: More than 33 percent in 2008 compared to about 20 percent in urban areas.

The Development Bank of Southern Africa (DBSA) found that in 2008, 79 percent of households major cities 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 security; predictably, more money means better access to healthy, safe foods.

While many South Africans go without adequate calories and nutrients, many also deal with a range of “Western,” chronic diseases associated with over-nutrition. The UN 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 is cause for concern for low-income South Africans, many of whom probably did not get enough nutritious food 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, affecting about one third of the population. Among men, whites have the highest obesity rate, at 18 percent.

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, as Distiller told Health 24 recently, some in the nation are bracing for a “diabetes tsunami,” as The International Diabetes Federation estimates that the rate will nearly double by 2030.

Cultural norms in South Africa often favor bigger bodies, especially among women. Thinness has come to be associated with the scourge of HIV that affects about 17 percent of the South African population. In fact, HIV can also be a risk factor for diabetes because antiretroviral drugs can cause glucose intolerance as a side effect. The adoption of the nutrient-poor American-style diet in urban South Africa now means that doctors and patients in the region must be aware of the potential link between HIV and diabetes.

The South African public health community has starting taking 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 that can be added to some processed foods sold in grocery stores. This legislation includes a 50 percent reduction of sodium in bread and comparable reductions inmargarine, soups, and gravies.

Public health professionals hope that with this measure, along with with help from industry, rates of high blood pressure will go down. “Help from industry” is a tricky concept though, as companies’ bottom lines often take precedence over public health or corporate social responsibility. According to Kelly Brownell of Duke University’s Sanford School of Public Policy, “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.

Here in the U.S., obesity rates are much higher among Blacks and Hispanics than among whites. Much has been written about the link between food access (or lack there of) and the entrenched racial inequality present in American cities like Detroit, as grocery stores have closed over the years and convenience stores become the de facto food sources. These trends are not unrelated to what is taking place elsewhere around the globe.

However, in places like South Africa, where healthy indigenous diets remain fresh in many people’s minds, the question remains: Is it possible to leave one’s rural homes, make more money, and enjoy the benefits of urban life without adopting the diet-related illnesses that go with them?

Let’s hope the South African government takes this question to heart.

This post is part of an ongoing series focused on the way the Western diet is impacting the developing world. Previous posts include: Mexico: Public Health, Rising Obesity and the NAFTA Effect and The Little Emperor’s Burger.

The Little Emperor’s Burger

KFC in China

By Judy Bankman

Note: This blog was written by Judy Bankman and Elektra Alivisatos and was originally published onCivil Eats.

When I asked my friend living in China about fast food restaurants there, he responded, “they’re constantly packed with young people.” Though most Chinese know that American fast food is unhealthy and leads to weight gain, the growing trendiness of “Western” fast food among young people in China has contributed to its increased consumption. American franchises such as KFC are thriving. In the U.S., the chain amassed 4,618 locations in 61 years. In China, though, KFC boasted 4,260 locations in only 26 years. China now consumes twice as much meat as the U.S., a whopping 71 million tons per year.

Yum! Brands, the parent company of KFC, Taco Bell, and Pizza Hut, intends to open20,000 restaurants over the “long term,” according to their Web site. Meanwhile, McDonald’s is expanding in China at the rate of 10 new restaurants per week. These alarming figures reveal how much American fast food culture has already permeated China. And with the burgers and fries come a host of public health consequences.

American fast food chains serve consumers Western-style food products: High in saturated fat, simple carbohydrates, and sugar, with a lot of processing and little nutritional density. In contrast, a traditional rural Chinese diet features plant-based protein, low cholesterol, and some dietary fat. As obesity has become an increasingly common public health concern in the U.S. and other countries, research has shown links between consumption of the Western diet and chronic disease.

For example, a study conducted at the German Institute of Human Health found a link between weight gain and consumption of a Western diet high in processed meats, refined grains, sugar, and potatoes. A 2012 study published in the journal Circulation found that Chinese men and women who consume Western fast food more than twice a week were at higher risk for diabetes and cardiovascular disease. According to Dr. Tsung Cheng at George Washington University Medical Center, “fast food and physical inactivity” are the two most important factors fueling childhood obesity in China.

China’s youth are particularly at risk for developing chronic disease. Like the U.S., China has seen an increase in weight gain and related chronic health conditions among youth. A2012 study in Obesity Reviews Journal compared the risk of chronic disease in China to other countries including the U.S.

The researchers found that approximately 12 percent of Chinese children and adolescents aged seven to 18 were overweight and about 1.7 million children under 18 suffered from diabetes. Additionally, the rate of diabetes among Chinese adolescents aged 12 to 18 was about four times that of American teenagers.

Of course, fast food consumption is only one piece of a larger puzzle. Obesity is a result of both biological and environmental factors, including one’s access to and knowledge about healthy food and one’s family traditions around food. What drives someone to eat fast food is complex, and perhaps in China, this drive is amplified by the one-child policy.

As its name implies, the government’s one-child policy requires families to have no more than one child, barring a few exceptions. Single children are called xiao huangdi, which means “little emperors.” In fact, Wikipedia even has a page devoted to “Little Emperor Syndrome.”

This glorified status within the family structure is often said to create an environment where adults dote upon the child, feeding them whatever foods they desire. Essentially, the single child gets an excessive amount of attention, which often leads to eating a lot of fast food.

Whether the high rates of diabetes and childhood obesity can be blamed on fast food, “Little Emperor Syndrome,” or both, these issues demand serious public health attention. The Chinese government should carefully regulate fast food marketing to children and teens, as well as encourage fitness programming in schools.

The EatSmart@School Campaign, a program run by the Chinese Department of Health, assists primary schools that want to create a more sustainable, healthy food environment. This campaign helps schools establish “healthy eating policies,” in order to increase awareness, and provides online resources including recipes and printable nutrition education materials for teachers and parents.

While these types of campaigns are beneficial and necessary, attitudinal shifts also need to occur in order to effect lasting change in consumption habits. Though it will certainly prove a complex task, the global image of American fast food as a trendy, modern sign of wealth needs to change. In fact, it needs to be reversed completely so that developing countries like China do not fall victim to the same chronic diseases we know so well in the U.S.

Although no country has yet attempted to transform the image of American fast food, perhaps China can take on the challenge. As a nation moving rapidly through an economic and nutrition transition, maybe China will understand the recent links between health and the Western-style diet and begin to reconsider the idealized image of American fast food.

Photo courtesy of Brighter Green

EAST AFRICAN GIRLS’ LEADERSHIP INITIATIVE UPDATE: SUMMER INTERNSHIPS AND HIGHER EDUCATION

By Lauren Berger

Elizabeth with girls from the rescue center

This blog originally appeared on the Brighter Green website

The summer months have proved to be busy and exciting for the Kenyan students in the East African Girls’ Leadership Initiative. Joyce Kakenya Barta has been interning at Lake Elementaita Seasons Hotels and Lodges as a part of the Corporate Social Responsibility section. On her experience she says that:

“I have been involved in community based projects like supporting children homes, environmental cleaning, planting trees, and collecting rubbish. I have recently visited an orphan rescue center that helps HIV positive kids. I am very happy to be working with this community and am learning and getting a lot of experience.”

Joyce also recently heard that she will in fact enroll at Mt. Kenya University studying Journalism and Communications. She will be there for two semesters and then will move onto the diploma/degree level. She is “very excited and happy about this!” and sincerely thanks “SIMOO (a partner organization in Kenya) and other partners for their continuous support and encouragement.”

Elizabeth Kironua Sakuda has been spending her summer working with a project called Ewangan Renewable Energy Center that supplies power to surrounding homes, schools, and businesses through solar and wind energy. She is also helping in the nearby primary school as well as visiting a shelter for girls rescued from forced early marriages twice a week. On her experience she says that:

“Working with the girls [at the rescue center] have made me realize my purpose in community and I am so encouraged to work with [the Maasai] people. Most of the girls in the center are rescued from early marriages that are forced and I have been able to inspire them and they are eager to be where I am now.”

Elizabeth is going to start university in the fall where she will be pursuing a Bachelors of Environmental Studies in Resource Conservation. She is thankful for the “continue help despite the absence of [her] parents” and is thankful for the opportunities the East African Girls’ Leadership Initiative has awarded her.

We are extremely excited for what lies ahead for these young women as they are truly becoming leaders in their communities (and beyond).

Photo courtesy of Daniel Salau

MEXICO: PUBLIC HEALTH, RISING OBESITY AND THE NAFTA EFFECT

Soda bottles in Mexico

By Judy Bankman

Note: this post was originally published on Civil Eats and Food Tank.

On a visit to southern Mexico in 2008, I was shocked to see Coca-Cola billboards dotting rural highways, and roadside tiendas selling bottles of Coke along with local produce. Mexico consumes more gallons of sugary beverages per year than any other country. It’s certainly not coincidental that 9 million people in Mexico are suffering from diabetes.

Mexicans also just surpassed the U.S. as the most obese nation in the world, with an astonishing prevalence rate of 32.8 percent. Mortality rates due to heart attack, diabetes, and high blood pressure have increased significantly along with the spike in obesity rates. The main driver of these troubling health concerns is the energy-dense, nutrient-poor “Western” diet, which has already changed the food landscape in Mexico, pervading areas both urban and rural.

Mexico, like many other developing countries in the global South, is currently going through a nutrition transition. This means it is moving away from a traditional diet high in fruits, vegetables, grains and occasional animal protein, toward a diet that is highly processed, full of animal products, and high in sugar and fat. Nutrition transitions almost always accompany economic transitions. For this reason, countries that are getting wealthier are also starting to eat a more “Western” diet, making them particularly vulnerable to chronic disease.

Rising income is a big factor of changing diets in Mexico and elsewhere. However, trade liberalization also plays a huge role in what food is accessible in developing countries. After NAFTA was implemented in 1994, the number of unhealthy food products from the United States to Mexico increased substantially. A spike also took place in the amount ofraw corn and soy imports: two products used to make highly processed foods and feed livestock.

In 2011, Mexicans consumed 172 liters per capita of Coke, compared to the 1991 pre-NAFTA level of 69 liters per capita. According to the UN Food and Agriculture Organization (FAO), the consumption of animal fat in Mexico increased from about 34.7 grams per capita per day in 1991 to 46.9 grams per capita per day in 2009. A recent study linked these and other resulting dietary changes with an unsettlingly high 12 percent increase in obesity in Mexico between 2000 and 2006. Though obviously an unintended consequence of NAFTA, this shows that trade can actually impact public health.

Interestingly, a review of literature indicates that the closer you are to the US (geographically and culturally), the higher your risk of obesity. For example, a 2011 study at the University of California, Los Angeles, found that Mexican children living in households with close or extended family members migrating to the United States for work had a higher chance of becoming overweight or obese than children without migrant networks.

A 2012 study showed that a higher degree of familiarity with US culture, measured by frequency of TV watching in English, was associated with greater obesity risk among Mexican children in Baja California. Although the prevalence of abdominal obesityamong adults over 20 in all Mexican states is relatively high (between 61.4 percent and 82.9 percent), the two states with the highest rates, Sonora and Tamaulipas, border the United States.

By contrast, the two states with the lowest rates of abdominal obesity, Oaxaca and Chiapas, are located in very south of Mexico, farthest from the United States. This fact is remarkable: sheer proximity to the United States has a bearing on diet and obesity rates.

Although statistics paint a bleak picture, the Mexican government has taken some steps to address the emerging public health threats within its borders. In 2010, the Mexican government under then-president Felipe Calderón enacted the Ley Antiobesided, or anti-obesity law.

This required physical education in public elementary and middle schools and restricted the amount of calories, salt and fat in foods sold in public schools. Mexican public health officials have criticized this law, however, because it doesn’t ban the consumption of processed food, rather it restricts how processed food is sold and marketed in schools.

All of this leads to the question, how can a country like Mexico go through a nutrition transition without jumping from under-nutrition to over-nutrition? For sure, the solutions need to be multi-faceted. Perhaps a law banning processed food sales entirely from public schools would reduce how much of it students eat during the day. Forward-thinking policy would also subsidize local fruit and vegetable growers and connect them with schools, both supporting local economies and encouraging healthy eating habits among school-aged children.

Although rewriting trade agreements, i.e., NAFTA, would prove a complex and difficult task, it would be in the best interest of Mexico’s public health to reject or revise future trade agreements that allow – or encourage – such an astronomical flow of corn, soy, and meat and dairy products into its market.

Photo courtesy of Judy Bankman