health, nutrition and food security in south africa: the role of food...

Health, nutrition and food security with a focus on South Africa : the role of food systems and possible policy responses

David Sanders Emeritus Professor: School of Public Health

University of the Western Cape

DST/NRF Centre of Excellence in Food Security

Peoples Health Movement

A WHO Collaborating Centre for Research and Training in

Human Resources for Health

Outline of Presentation

The extent and significance of nutritional status globally and in South Africa’s health situation

Prevalence, trends and determinants of undernutrition, hunger and food insecurity

Prevalence trends and determinants of overweight/obesity

Dietary factors and the food environment in overweight/obesity and their social and structural determinants

Interventions to address the ‘double burden’ of malnutrition in the context of SDGs

AFRICA and SOUTH ASIA’S CRISIS

Mortality 1 - 4 year olds

Territory size shows the proportion of all deaths of children aged over 1 year and under 5 years old, that occurred there in 2002.

www.worldmapper.org

AFRICA and SOUTH ASIA’S CRISIS TB cases

Territory size shows the proportion of worldwide tuberculosis cases found there.

www.worldmapper.org

Growing inequalities between SSA and HICs

A child born in Sub-Saharan Africa

• In 1970 faced a risk of dying before his or her fifth birthday that was 9 times greater than a child born in an industrialized country.

• In 2015, it was 11 times greater.

WHO Global Health Observatory (GHO) data

THE HEALTH MILLENNIUM DEVELOPMENT GOALS

Between 1990 and 2015 MDG 5: (a) reduce maternal mortality by three quarters and

(b) provide universal coverage of reproductive health services

MDG 4: reduce under-five mortality by two thirds

By 2015

MDG 6: have halted, and begun to reverse, the spread of HIV / AIDS

*United Nations Millenium declaration 2000, signed on to by 189 member states

Despite progress it is insufficient to achieve MDG4 target by 2015; substantial acceleration is required

Achievement of MDG 4 by year, globally and by region, if current trends continue in all countries

Source: UNICEF analysis based on IGME 2013.

Continuing disparities in Africa

• Many regions have reduced disparities in under-five mortality between the poorest and the richest except Sub-Saharan Africa and South Asia

• Under-five mortality rate has declined among even the poorest in all regions

Source: UNICEF analysis based on Pedersen, J., et al., Levels and Trends in Inequity and Child Mortality: Evidence from DHS and MICS surveys', working paper, unpublished, 2013.'

SDG 3

Ensure healthy lives and promote wellbeing for all at all ages

Nutrition – A Key Social Determinant of Health

Leading global risk factors and contributions

to global burden of disease : % DALYs, World

Malnutrition everywhere (Global Nutrition Report 2015)

Malnutrition – the global situation

•Undernutrition is the underlying cause of the death of 2.6 million children each year – one-third of the global total of children’s deaths

•One in four of the world’s children are stunted

•In 2005 22mn children were overweight

•In 2015 2.3bn adults are overweight

700mn are obese

SDG 2

Zero Hunger

End hunger, achieve food security and

improved nutrition and promote

sustainable agriculture

Key Indicators of Food Insecurity Globally

Growing National Food Insecurity

Growing national food insecurity ie dependence on outside sources is demonstrated by the rise in the

number of developing countries that are now food importers - from 74 in 1995-1999 to 89 in 2005-2009

…..

Valdes & Foster, 2012, ICTSD, Geneva

Some Key Structural Factors

Trade agreements and agricultural trade

• Agreement on Agriculture 1994 – opening of markets by reducing tariffs, non-tariff barriers, export subsidies and domestic agricultural support

• Agreement on Application of Sanitary and Phytosanitary Measures

• Technical Barriers to Trade Agreement –

• TRIPs - expanded scope of private property rights on food products, including patents on seeds

0 500 1000 1500 2000

US dollars

Swiss annual subs idy, per cow

Japan annual dairy subs idy, per cow

Per capita annual income, sub-Saharan Africa

Per capita cost of package of essent ial health intervent ions

Per capita annual health expenditure, 63 low income countries

Why should a Swiss cow enjoy a higher income than an African citizen?

Speculation in Commodities: the ‘Food Casino’ This deregulation of commodities derivatives markets in 2000 allowed large institutional investors to

enter commodities derivatives markets.

Morgan Stanley estimates that the number of outstanding

contracts in maize futures increased from 500,000 in

2003 to almost 2.5 million in 2008.

Already in 2006, Merrill Lynch estimated that

speculation was causing commodity prices to trade

at 50 per cent higher than if they were based on fundamental supply and demand.

De Schutter, Olivier (2010). “Food Commodities Speculation and Food Price Crisis”, United Nations Special Rapporteur on The Right to Food, Briefing Note 2, September 2010. World Economy, Ecology and Development (WEED) (2008). “Food Speculation: The Main Factor of the Price Bubble in 2008”, p.11, www2.weed-online.org/uploads/weed_food_speculation.pdf.

Karmjeet Sekhon, project manager for Indian food company Karuturi Global,

with crops in Ethiopia's Gambella province. Photograph: John Vidal for the Guardian

Ethiopia has sold

leases to 3.6 million

hectares of its best

farmland to foreign

companies

yet relies on 700,000

tonnes of emergency food

aid each year

‘Land Grabs’: the new colonialism More than 200m hectares claimed between 2000

and 2010, the majority in sub-Saharan Africa

What is the impact and prevalence of undernutrition in South Africa among

children?

Leading causes of premature mortality in 2013: • HIV/AIDS (15.5%) • TB (12.4%) • Lower respiratory infections (8.3%) • Diarrhoeal diseases (5.7%) • Cerebrovascular disease (4.6%) • Hypertensive heart disease (3.3%) • Ischaemic heart disease (3.3%) • Diabetes mellitus (2.8%) • Road injuries (2.6%) Massyn N, Peer N, Padarath A, Barron P, Day C, editors. District Health Barometer 2014/15. Durban: Health Systems Trust; October 2015

Food security

• Food security exists when all people at all times have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.

• This definition has been identified with the four dimensions of food security: availability, access, stability and utilisation. It embodies the food and care-related aspects of good nutrition (Committee on World Food Security 1996,

2012)

• Food insecurity can be chronic, temporal, temporary or cyclical

Table XX: Dimensions of deprivation and inequality in South Africa

Dimensions of deprivation Children in poorest 20%

of households

Children in richest 20%

of households

Income poverty*

100% 0%

Child hunger*

28% 3%

Inadequate water*

54% 9%

Inadequate sanitation*

47% 9%

Overcrowding*

28% 5%

Educational throughput†

46% 17%

Clinic far from home*

46% 25% Source: Statistics South Africa (2011) General Household Survey 2010. Analysis by Katharine Hall, Children’s Institute, UCT. * See Part 3: Children Count – The numbers for more information on these indicators.

† Proportion of children aged 16 – 17 who have completed compulsory schooling (grade 9).

Child poverty in South Africa remains extremely high. In 2010, six out of every 10 children lived in households with an income of less than R575 per person per month. Stark racial disparities persist, with 67% of African children living in poor households compared to only 4% of White children

Statistics South Africa (2011) General Household Survey 2010

Double Burden

Non-communicable Diseases, overweight and obesity in South Africa

Leading causes of premature mortality in 2013: HIV/AIDS (15.5%) TB (12.4%) Lower respiratory infections (8.3%) Diarrhoeal diseases (5.7%) Cerebrovascular disease (4.6%) Hypertensive heart disease (3.3%) Ischaemic heart disease (3.3%) Diabetes mellitus (2.8%) Road injuries (2.6%) Massyn N, Peer N, Padarath A, Barron P, Day C, editors. District Health Barometer 2014/15. Durban: Health Systems Trust; October 2015

Figure 2. Diabetes prevalence based on 1985 WHO criteria presented by age categories for men

and women in 1990 and 2008/09.

Peer N, Steyn K, Lombard C, Lambert EV, et al. (2012) Rising Diabetes Prevalence among Urban-Dwelling Black South Africans.

PLoS ONE 7(9): e43336. doi:10.1371/journal.pone.0043336

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0043336

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0043336

Determinants of ‘Overnutrition’ in South Africa

Consumption of sweet beverages and confectionery

Compared with a worldwide average of 89 in 2010

South Africans consumed 254 Coca-Cola

products per person per year, an increase from

around 130 in 1992 and 175 in 1997.

In 2010, up to half of young people were reported to

consume fast foods, cakes and biscuits, cold drinks,

and sweets at least four days a week.

Carbonated drinks are now the third most commonly

consumed food/drink item among very young urban

South African children (aged 12–24 months)—less

than maize meal and brewed tea, but more than

milk . Hawkes C. (2002), Coca-Cola Company (2010)

Theron et al (2007), Reddy et al. (2010)

‘I am scared of exercising because I will lose

weight and people may think that I have

HIV/AIDS.’

‘People who boil food are not civilised. Fried food

is attractive and tasty such as “Kentucky Fried

Chicken”. If your neighbour boils food people say

she is still backward because the food does not

taste nor look attractive’

Chopra M, Puoane T. Diabetes Voice 2003; 48: 24–6.

Societal Factors in Obesity

Structural Factors in Obesity

Retail and Trade

Packaged Food Sales in South Africa

The largest ten packaged food companies account for 51.8% of total packaged food sales.

This is greater than the global average (globally in 2007, ten companies accounted for around 26%

of the processed foods market).

Euromonitor International, ETC Group (2008)

From a Nestlé press release:

Vevey, February 21, 2008 “Popularly positioned products (PPPs). Products aimed at lower income consumers in the developing world, will continue to grow strongly in 2008 and beyond. Nestlé PPPs, which mostly consist of dairy products, Nescafé and Maggi culinary products, grew by over 25% to reach around CHF 6 billion in sales in 2007. The overall market for such products in Asia, Africa and Latin America is estimated at over CHF 80 billion.”

Trade import from world to SA

Data from Dept of Trade and Industry SA

(graphs made with Excel)

Bread, pastry, cakes, biscuits and other bakers wares

0

100000000

200000000

300000000

400000000

500000000

600000000

700000000

800000000

900000000

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Val

ue

(Ran

d)

Department of Trade and Industry SA

Pasta (uncooked, cooked or prepared)

0

100000000

200000000

300000000

400000000

500000000

600000000

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Department of Trade and Industry SA

Source: DTI

trade database

Rapid growth of supermarkets in South Africa

• Supermarkets now share at least 50-60% of food sales in South Africa, with the majority of this growth occurring after 1994

• In a recent study, nearly two-thirds of households in a rural area in South Africa were now buying their food at supermarkets

Number of households in two rural areas in Transkei, Eastern Cape going to supermarkets

Xume Luzie Total

Percent of total

78.4% 50.0% 64.8%

Source: D'Haese, Marijke, and Guido Van Huylenbroeck. "The rise of supermarkets and changing expenditure patterns of poor rural households case study in the Transkei area, South Africa." Food Policy 30 (2005): 97-113.

0%

10%

20%

30%

40%

Japan U.S. South Africa

Percent increase:

1999- 2005

Source: Euromonitor International, 2007

Growth in Supermarket Food Sales

Expansion of Supermarkets in Cape Town

Battersby, AFSUN

The consequences…

• Rural consumers pay almost R6 more than urban consumers for the same food basket. The poor households spent 33% of their income on food, compared to 11% for the non-poor

• Healthier foods typically cost between 10% and 60% more when compared on a weight basis (R per 100g) and between 30% and 110% more when compared based on the cost of food energy (R per 100 kJ)

• Children from the most food insecure households are

most at risk of under-nutrition whilst adult women in the same households are often most at risk of obesity (NFCS 1999, 2005; SANHANES 2012)

Supermarket shopping and obesity in Kenya

SUMMARY

In South Africa, as in other jurisdictions, ‘‘Big Food’’ (large commercial entities that dominate the agricultural, food and beverage environment) is becoming more widespread and is implicated in unhealthy eating.

Big Food in South Africa involves South African companies, some of which have invested in other (mainly, but not only, African) nations, as well as companies headquartered in North America and Europe.

SUMMARY

These companies have developed strategies to increase the availability, affordability, and acceptability of their foods in South Africa. These include price-fixing and aggressive marketing and advertising.

The South African government should act urgently to mitigate the adverse health effects in the food environment in South Africa through education about the health risks of unhealthy diets, regulation of Big Food, and support for healthy foods.

Macro Structural Determinants of ‘Obesogenic’ Food Environments

Regionally

Source: DTI

trade database

Regional trade and investment policies in SADC since 1990

• early 1990s: ongoing liberalization associated with multilateral trade negotiations

• 1996: SADC trade agreement signed

• 1997-2003: South Africa strengthens investment policy and signs 22 Bilateral Investment Agreements

• 1999: South Africa signs bilateral agreement with European Union (EU)

• 2000: SADC trade protocol comes into effect; Government of South Africa strengthens support for regional export and investment

• 2002: new Southern Africa Customs Union Agreement completed

• 2007: Interim Economic Partnership Agreement concluded between EU and Botswana, Lesotho, Namibia, Swaziland and Mozambique

• 2008: SADC Free Trade Area completed (except for Angola, Democratic Republic of the Congo, Seychelles)

“… trade policy that actively

encourages the unfettered

production, trade, and

consumption of foods high in

fats and sugars to the

detriment of fruit and vegetable

production is contradictory to

health policy …” (p 10)

It is important therefore that

ministers of health, supported

by the ministry, are strongly

equipped to play such a

stewardship role within

government”(p 111)

2. Investment (including FDI)

TNCs and countries

Of the 100 governments and corporations with the highest annual revenues in 2014, 63 were corporations and 37 were governments.

CIA World Fact Book https://www.cia.gov/library/publications/the-world-factbook/fields/2056.html Fortune Global 500 http://fortune.com/global500/

Strengths of SDGs

• SDG drafters argue that eliminating poverty will require more than charity — it will require reducing inequality, combating climate change, strengthening labor rights, eliminating Western agricultural subsidies, and so on.

• So.. SDG process much more comprehensive and focus more on equity

Big Question

Can SDGs be attained in the current context

of neoliberal globalisation?

SDG 8

Decent Work and Economic Growth

- Promote sustained, inclusive and

sustainable economic growth, full and

productive employment and decent

work for all

AFRICA and SOUTH ASIA’S CRISIS

GDP wealth

Territory size shows the proportion of worldwide wealth, that is Gross Domestic Product based on exchange rates with the US$, that is found there.

www.worldmapper.org

Chen S, Ravallion M, World Bank; 2012

Poverty on the Rise

Source: World Bank Data Set

0

10

20

30

40

50

60

70

2002 2003 2004 2005 2006 2007 2008 2009 2010

Taxes in USD trillions

Govt expenses in USD trillions

Global GDP USD trillions

Value of GDP less taxes USD trillions

Value of GDP less govt expenses in USD trillions

In 2002, there was USD 24 trillion

in untaxed, private wealth

By 2010, this had swollen to USD

44 trillion

SDG 8

Decent Work and Economic Growth

- Promote sustained, inclusive and

sustainable economic growth, full and

productive employment and decent

work for all

Weaknesses of SDGs

• “planet Earth and its ecosystems are our home” and underscores the necessity of achieving “harmony with nature.” It establishes a commitment to hold global warming below a 2° Celsius increase, and calls for “sustainable patterns of production and consumption.” The goals include the restoration of water-related ecosystems, a halt to the loss of biodiversity, and an end to overfishing, deforestation, and desertification.

https://www.jacobinmag.com/2015/08/global-poverty-climate-change-sdgs/

Weaknesses of SDGs

• Yet despite this growing realization, the core of the SDG program for development and poverty reduction relies precisely on the old model of industrial growth — ever-increasing levels of extraction, production, and consumption. And ..at least 7 percent annual GDP growth in least developed countries and higher levels of economic productivity across the board. In fact Goal 8, is devoted specifically to export-oriented growth, in keeping

with existing neoliberal models. https://www.jacobinmag.com/2015/08/global-poverty-climate-change-sdgs/

Weaknesses of SDGs

• Of all the income generated by global GDP growth between 1999 and 2008, the poorest 60 percent of humanity received only 5 percent of it. Given the existing ratio between GDP growth and the income growth of the poorest, it will take 207 years to eliminate poverty with this strategy, and to get there, we will have to grow the global economy by 175 times its present size.


Weaknesses of SDGs

• Indeed, we would need at least 3.4 Earths to sustain this level of production and consumption — and that’s assuming that the already-high-income countries slow their present rates of growth to zero, which they show no sign of doing.


Olivier de Schutter UN Special Rapporteur on the Right to Food

March 2012

Felicity Lawrence, The Guardian, 9 March 2012

Key actions

Education and training imperatives for nutrition and food workforce

A desired workforce structure

Delisle et al, Capacity-building for a strong public health

nutrition workforce in low-resource , Bull WHO (in press)

Delisle et al, Capacity-building for a strong public health

nutrition workforce in low-resource , Bull WHO (in press)

Research imperatives for nutrition and food workforce

Overview of some research gaps

Robust, representative data on adult diets

Foods procured and reasons for such procurement

Suppliers of commonly consumed foods – both obesogenic and healthy foods

Policies and market factors structuring the food environment

Policy instruments available to influence (an improved) food environment

Additional research needed

Review School Nutrition Programme and other public provisioning of food (eg prisons, hospitals, ECD centres etc) for

Quality of diets

Cost of nutrients

Impact on nutrition knowledge

Impact on school attendance

Employment generation in food supply and preparation (and potential)

Additional research needed

•The impact of improved sanitation on childhood nutritional status

• Levels of awareness (and attitudes) of nature and trends in food environment amongst health workers and general population

• Information, education and media messages to children (schools, advertising boards, TV etc)

•Options to optimise use of CSG for improved diets eg vouchers etc

•Evaluation of communal physical activity eg park runs

Advocacy imperatives for nutrition and food workforce

Interventions to Combat Stunting and ’Overnutrition’

•Promote breast feeding and regulate formula milk

•Promote cheap, nutrient-dense weaning foods

•Campaign for improved sanitation

•Raise awareness of deteriorating food environment amongst health workers and general population

•Review local government policies and regulations around vending eg in and around schools and advertising, especially to kids.

•Restructure School Nutrition Programme a la Brazil and invest in community infrastructure for sport, recreation and improved personal safety


•Analyse pricing incentives/disincentives to tax unhealthy and subsidise healthy foods

•Review trade policy and FDI especially wrt food

• Civil society needs to be strengthened to challenge inequitable macroeconomic regime and inappropriate policies through evidence-based advocacy and social mobilisation

THANK YOU!






•Work with other researchers and policymakers to review local government policies and regulations around vending eg in and around schools and advertising, especially to kids.


•Review School Nutrition Programme and invest in community infrastructure for sport, recreation and improved personal safety

•Work with political economists to analyse pricing incentives/disincentives to tax unhealthy and subsidise healthy foods

•Work with political economists to review trade policy, especially wrt food trade

• Work with civil society to challenge inequitable macroeconomic regime and inappropriate policies through evidence-based advocacy and social mobilisation

Olivier de Schutter UN Special Rapporteur on the Right to Food

March 2012

Felicity Lawrence, The Guardian, 9 March 2012






•Review local government policies and regulations around vending eg in and around schools and advertising, especially to kids.

•Restructure School Nutrition Programme a la Brazil and invest in community infrastructure for sport, recreation and improved personal safety


•Analyse pricing incentives/disincentives to tax unhealthy and subsidise healthy foods

•Review trade policy, especially wrt food trade

• Civil society needs urgently to challenge inequitable macroeconomic regime and inappropriate policies through evidence-based advocacy and social mobilisation

Goal 3: Ensure healthy lives and

promote wellbeing for all at all ages TARGETS

3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births

3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births

3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases


promote wellbeing for all at all

ages

3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being

3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol

3.6 By 2020, halve the number of global deaths and injuries from road


promote wellbeing for all at all ages

3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, ..and the integration of reproductive health into national strategies and programmes

3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all

3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and


promote wellbeing for all at all ages

3.10 Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate

3.11 Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health,


promote wellbeing for all at all

ages

3.12 Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States

3.13 Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of

Imagine a stroll by the river …

You notice a movement in the water, it is a baby, drowning!

… then another infant, half-submerged, floats down in the water struggling for life

… followed by 5, 10 more -- and more and more and more

You become very good at saving drowning children, develop new methods & technology, teach others, attend international conferences

but more and more and more and more come struggling down …

Photo: L Reynolds

Social determinants – diagram Source: Western Cape Burden of Disease Reduction Project (2007)

South Africa

Child PIP found

60% of children

were underweight

and a third were

severely

malnourished

Prepared foodstuffs: sugar vs.

vegetables/fruit/nuts

0

1E+09

2E+09

3E+09

4E+09

5E+09

6E+09

7E+09

8E+09

9E+09

1E+10

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

SUGARS AND SUGAR CONFECTIONERY PREPARATIONS OF VEGETABLES, FRUIT, NUTS OR OTHER PARTS OF PLANTS

Sugar vs. vegetable/fruit/nuts

(raw and prepared)

0

1E+09

2E+09

3E+09

4E+09

5E+09

6E+09

7E+09

8E+09

9E+09

1E+10

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

SUGARS AND SUGAR CONFECTIONERY

ALL VEGETABLES, FRUIT, NUTS OR OTHER PARTS OF PLANTS (RAW OR PREPARED)

Market Sizes - Historic - Retail Value RSP - R mn - Current Prices

Category 2004 2005 2006 2007 2008 2009

Packaged food 69475 74462 78929 84062 92671 101192

Source: Packaged Food: Euromonitor from trade sources/national statistics Source: Packaged Food: Euromonitor from trade sources/national statistics

Prevalence of stunting among children under 5 yr in countries with national prevalence of 30% or higher. 2009 or later

Reanalysis DHS and MICS data.

Countdown 2015

Stunting tends to be

much more common

in rural areas

Weaknesses of SDGs

Goal 8 is peppered with progressive-sounding qualifications: the growth should be inclusive, should promote full employment and decent work, and we should endeavour to decouple growth from environmental degradation. But these qualifications are vague, and the real message that shines through is that GDP growth is all that ultimately matters


Weaknesses of SDGs • Right now global production and consumption levels

are overshooting our planet’s capacity by about 50 percent each year. Yet the SDGs’ proposed solution to this problem is superficial: reduce food waste, make resource use more efficient, and “encourage companies, especially large and transnational companies, to adopt sustainable practices.” These proposals explicitly avoid ..reduced consumption by the world’s wealthy and regulating corporate extraction.


Priority Actions Needed (1)

• Develop comprehensive approaches that address social determinants of (ill) health through healthy public policies and intersectoral action. This will inevitably entail confronting corporate interests.

Priority Actions Needed (2)

• Promote increased public expenditure on health services and reduce role of private sector

Researching the obesogenic food environment,

its drivers and potential policy levers in South

Africa and Ghana (2017-9)

Aim

To better understand the changing nature of food marketed in poor communities in South Africa and Ghana, the drivers of these changes and the potential policy levers available to improve the healthfulness of the local food environment.

Objectives

What are the range, quality and cost of foods acquired by poor consumers and stocked in the retail outlets most used by poor consumers in both an urban area/peri-urban area and deep rural area (supermarkets, spazas, vendors and fast food outlets) and where are they located?

How do poor and vulnerable consumers make decisions about where (when and why) to obtain food?

Objectives

Who are the key suppliers of highly processed and fast foods, and fruit and vegetables? What are the policies, economic and regulatory considerations, and market and industry dynamics, both national and supra-national,that drive availability of key commodities within these food groups?

What are the potential policy levers available in different sectors and at different levels of government to improve the availability and accessibility of healthy food choices in the local food environment

Researching the obesogenic food environment,

its drivers and potential policy levers in South

Africa and Ghana (2017-9)

Aim

To better understand the changing nature of food marketed in poor communities in South Africa and Ghana, the drivers of these changes and the potential policy levers available to improve the healthfulness of the local food environment.

Objectives

What are the range, quality and cost of foods acquired by poor consumers and stocked in the retail outlets most used by poor consumers in both an urban area/peri-urban area and deep rural area (supermarkets, spazas, vendors and fast food outlets) and where are they located?

How do poor and vulnerable consumers make decisions about where (when and why) to obtain food?

Objectives

Who are the key suppliers of highly processed and fast foods, and fruit and vegetables? What are the policies, economic and regulatory considerations, and market and industry dynamics, both national and supra-national,that drive availability of key commodities within these food groups?

What are the potential policy levers available in different sectors and at different levels of government to improve the availability and accessibility of healthy food choices in the local food environment

Inequalities on the Rise

• High net worth individuals, the 24 million of us with liquid assets of between $1 and $50 million.

• ‘Ultra’ high net worth individuals, the 80,000 whose liquid assets exceed $50 million.

• And then there are the 1,200 global billionaires.

• 8.5 million people (1/10th of 1%) own 84% of total global personal wealth.

Sources: Credit Suisse, 2010, 2011

Henry, The Price of Offshore Revisited, 2012

0

50

100

150

200

250

300

350

400

450

500

Where are the world's billionaires

http://royal.pingdom.com/2011/03/11/world-

billionaire-stats-charts/

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