What’s driving sub-Saharan Africa’s malnutrition problem?

A staple daily diet for millions of South Africans is this traditional porridge, known as “pap”, made from mielie-meal (ground maize). Reuters/Siphiwe Sibeko

Sub-Saharan Africa has the highest level of food insecurity in the world. An estimated 220 million people lack adequate nutrition. The nature of the problem is shifting rapidly, with overweight status and obesity emerging as new forms of food insecurity while malnutrition persists. But continental policy responses do not address this changing reality.

Food insecurity is the outcome of being too poor to grow or buy food. But it’s not just any food. According to the United Nations’ Food and Agriculture Organisation’s [definition]((http://www.who.int/trade/glossary/story028/en/), people need:

… sufficient, safe, nutritious food to maintain a healthy and active life.

Current policy focuses on alleviating undernutrition through increased production and access to food. It does not focus on the systemic issues that inform the food choices people make. This may result in worsening food insecurity in the region.

The thinking around food security in Africa is stuck, even though there are calls for a more nuanced understanding of the problem. The common thought is that the food insecure are poor, hungry people who don’t have the means to grow or buy enough food.

The other misconception is that obese people are overweight or unhealthy because of what they eat; that they are at fault for making bad choices. This leads us to believe that people need nutrition education to help them make better choices, and that they deserve a healthy portion of blame if they make poor ones.

Both understandings are wrong. Food insecurity is driven by the economics and the geographies of the food system.

A poverty related obesity epidemic

In the region, 33% of adults are overweight and a further 11% are obese. The levels of diet-related non-communicable diseases are rising as a result of rapid urbanisation, the urbanisation of poverty and rapidly changing food systems.

Obesity affects both rich and poor people. In the developed world obesity rates are levelling off. But they continue to climb in the developing world. This has significant developmental outcomes. In 2010 overweight status and obesity caused about 3.4 million deaths, 3.9% of years of life lost and 3.8% of disability-adjusted life-years – a calculation of the number of years of life lost to ill health, disability or early death.

Obesity rates have not doubled and tripled in recent decades because people have spontaneously and collectively started to make bad food choices.

The poor eat badly because it makes economic sense for them to do so. South Africa’s food system, for example, is one in which corporate power is concentrated. The system is dominated by “Big Food” – large commercial entities that control the food market. The South African experience mirrors global trends in which food markets have been deregulated and liberalised.

For example, the liberalisation of trade has opened up imports of highly processed, cheap food, and large private companies that sell highly processed foods are able to exert pressure on national governments. This has handed power over nutrition to food processors and retailers.

Healthier alternatives like low-fat foods are generally more expensive than less healthy options because they are “value padded” with sugars and refined carbohydrates. At the same time, the price of fresh produce has increased at a faster rate than that of processed foods.

This economic logic is reinforced by marketing and advertising that sends conflicting health messages. For example, soft drink companies or fast-food chains associate themselves with sports events and healthy lifestyles; and schools advocate healthy eating but also have on-site tuckshops that sell junk food.

Poor people also have limited access to storage and refrigeration, which affects their options.

What the response should be

Blaming the poor for a logical response to a systemic problem is not helping the situation, and nutrition education alone will not change what people eat.

Governments must shift their attention from the individual to the system when considering why people eat what they eat. Governments must also consider the effects when good food policy is overridden by economic growth imperatives that support a food system dominated by highly processed foods.

South African Finance Minister Pravin Gordhan recently announced that the country will implement a tax on sugar-sweetened beverages from 2017. The sugar industry argues that this will harm businesses and negatively affect the poor. It is, in part, correct.

Regulation of unhealthy foods without corresponding incentivisation of healthier foods is regressive. Likewise, if issues like access, storage, refrigeration and transport are not addressed, efforts to moderate food choice through pricing will only be an additional tax on the poor. It will not remedy food insecurity of either kind.

Food insecurity in Africa needs to be understood in the context of the wider food system, as well as in the way that food connects to economic and other practices. There needs to be a radical reconfiguration of food security policy that moves away from focusing on production and household poverty alleviation to consider the nature and dynamics of the food system.

Failure to do so will simply accelerate the transition from one form of food insecurity to another.