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Healthy Eating at a Time of High
         Food Prices
     SANCU - 30 July 2008

 Hettie Schönfeldt, Nicolette Gibson & Hester
                   Vermeulen
  School of Agricultural and Food Sciences



                                                1
Food Based Dietary Guidelines

●Developed from 1998 through joint FAO/WHO
 expert consultation
●Implementation started in 2004
●Based on National Food Consumption
 Survey (NFCS) (1999)
●Corresponds with South African
 Demographic and Health Survey (SADHS)
 (1998)



                                             2
Food Based Dietary Guidelines

●Qualitative statements that express dietary goals in
 terms of foods
●Represent the best consensus of scientific
 knowledge and public health advice currently
 available
●Based on the relationship between diet and disease
●Can be used as educational tools for promoting the
 importance of nutrition to combat the growing double
 burden of malnutrition




                                                        3
Food Based Dietary Guidelines

The FBDG’s are the result of a wide consultative process
  throughout the country, in line with the
  recommendations of the World Health Organisation
  (WHO) and the Food and Agriculture Organisation
  (FAO)
Eleven guidelines where
formulated for healthy
eating for South Africans
older than 7 years


                                                           4
Food Based Dietary Guidelines

The following 1st three guidelines provide
  general health messages to promote a
  healthy lifestyle:

● Enjoy a variety of foods
● Be active
● Drink lots of clean, safe water



                                             5
Food Based Dietary Guidelines

The following food-based dietary guidelines
  help us to plan good mixed meals:

● Make starchy foods the basis of most meals
● Eat plenty of vegetables and fruit every day
● Eat dry beans, split peas, lentils and soya
  regularly
● Chicken, fish, meat, milk or eggs can be eaten
  daily


                                                   6
Food Based Dietary Guidelines

The following dietary guidelines teach us
  about moderation and balance for healthy
  eating:

● Eat fats sparingly
● Use salt sparingly
● Use food and drinks containing sugar
  sparingly and not between meals
● If you drink alcohol, drink sensibly

                                             7
Food Based Programmes




                        8
Canadian Healthy Eating Guidelines




                                     9
Food Groups & Recommended portion sizes




                                          10
Staple foods of South Africa




Cooked white maize porridge, sugar, tea, whole
 milk and brown bread – 5 most often consumed
(NFCS, 2000)
Cereal flours contribute between 50-75% of energy
 intake of populations in sub-Saharan Africa…
and milling refinement of wheat or maize removes
 about two-thirds of the vitamins and minerals
                                                    11
Recommended balanced diet
     “Grocery List”
Bread        1          R5.89
Maize        5kg        R16.99
Soup bones   643g bag   R3.34
Maas         1 carton   R7.39
Milk         2L         R15.99
Spinach      Bunch      R2.99
Carrots      Bunch      R2.99
Tomatoes     1          R1.61
Onion        1          R1.17
Apple        1          R1.49
Potato       1          R2.48
Banana       1          R1.34
Orange       1          R2.04
                        R70.10
                                 12
Recommended balanced diet
                 Current cost per portion
Bread        3 slices                R0.87    3 portions
Maize        500 g cooked            R0.50    5 portions
Soup bones   450g                    R2.44    2 portions
Maas         1 carton                R7.39    2 portions
Spinach      100 g raw (±4 leaves)   R0.66    1 portion
Carrots      1                       R0.32    1 portion
Tomatoes     1                       R1.61    1 portion
Onion        1                       R1.17    1 portion
Apple        1                       R1.49    1 portion
Potato       1                       R2.48    1 portion
Banana       1                       R1.34    1 portion
Orange       1                       R2.04    1 portion
                                     R22.31/day

                                                           13
Recommended balanced diet


ortions:               R22.31/day
                                        •
grains
                                        •
fruits

 & vegies
                                        •
meat
                                        •   14
R7.20



        R7.39


                15
R5.89   R5.92




                16
R6.13


R5.89


             1 bread (R5.89)
                   VS
  1 potato, 1 orange, 1 tomato (R6.13)
                                         17
R1.49




R1.38
                18
Effect of Inflation on food prices
Product                 2006 R/kg*            2008 R/kg**            % Increase
Brown Bread             R4.29                 R5.89                  37%
Tomatoes                R9.38                 R11.99                 28%
Onions                  R6.11                 R6.99                  14.4%
Apples                  R5.23/kg              R8.99                  72%
                        (R7.85/1.5kg)
Potatoes                R2.18/kg              R7.99/kg               267%
                        (R15.17/7kg)
Milk (2L)               R10.27                R15.99                 56%
Oranges                 R3.20/kg              R6.99                  118%
                        (R7.99/2.5kg)

*National Agricultural Marketing Council – Food price trends July 2005 – July 2006
**As purchased July 2008                                                             19
The SU-LSM segments

Proportion of SA population and average monthly
             income (SAARF, 2008)




                                                                                                 Average household income (R'000)
                     18.0                                                                   25
                     16.0
% of SA population




                     14.0                                                                   20
                     12.0
                                                                                            15
                     10.0
                      8.0
                                                                                            10
                      6.0
                      4.0                                                                   5
                      2.0
                      0.0                                                                   0
                            1     2      3     4       5   6     7      8    9     10

                            % of SA Adult population       Average monthly income (R'000)
                                                                                                                                    20
The LSM segments
           Dynamics in the SA adult consumer market
                        (SAARF, 2008)
    40.0

                -29%
    35.0


    30.0                  +6%       +26%
                                                                2001
    25.0                                                        2002
                                                                2003
    20.0
%




                                                                2004
                                                                2005

    15.0
                                                +28%            2006
                                                                2007

    10.0


     5.0


     0.0
           LSM 1-3        LSM 4-5    LSM 6-8    LSM 9-10

                                                           21
The impact of inflation

                                  R 2,000        12.8%                                                                                                                     13.0%
                                                                                                                                                          R 1,840
                                  R 1,800
                                                                                                                                                                           11.0%




                                                                                                                                                                                   Additional spending as share of income
                                  R 1,600
Additional spending (R/hh/year)




                                  R 1,400                                                                                                                                  9.0%

                                                                                                                    R 1,159             R 1,208
                                  R 1,200
                                                               7.2%                                R 1,100                                                                 7.0%

                                  R 1,000                                     R 945
                                                          R 863                   5.7%
                                                                                                        5.0%                                                               5.0%
                                   R 800
                                            R 692                                                                          4.0%
                                   R 600                                                                                                                                   3.0%
                                                                                                                                               2.2%
                                   R 400
                                                                                                                                                                           1.0%
                                   R 200
                                                                                                                                                                0.7%

                                     R0                                                                                                                                    -1.0%
                                            Decile 1      Decile 2            Decile 3             Decile 4          Decile 5     Average deciles 6 - Average decile 9 -
                                                                                                                                          8                 10

                                                                     Additional spending (07/08)        Additional spending / Income (07/08)




                                                                                                                                                                                                                            22
Food Coping Strategies

1.  Eat less preferred food
2.  Borrow food
3.  Buy food on credit
4.  Gather wild food
5.  Consume seed stock
6.  Send members to eat elsewhere
7.  Send members to beg
8.  Limit portion size
9.  Restrict consumption in favour of children
10. Feeding working members at the expense of non-working
    members
11. Ration money to buy ready to eat food
12. Skip the entire day without meals
                                                            23
Effect of Inflation

Cooked maize meal porridge – assume income stays the
same
 Scenario                                 Cooked             Estimated       Share of     Energy
                                          Portion size (g)   portion costs   daily        contributio
                                                             (R)             income (%)   n (kJ)
 Typical – base line                      532                0.70            14.0         2420.6
 29 % inflation June 06 to June 07        382                0.61            12.2         1736.8
 5.4% inflation June 07 to June 08        361                0.60            11.9         1643.0
 3.2% Projection June 08 to June 09       350                0.60            11.9         1590.4

“Typical” portion:
            Provides only 37.8% of energy, 25.7% of protein and 20.1% of vit A needs

After 2 years:
            Provides only 25.7% of energy, 17.4% of protein and 17.4% of vit A needs


                                                                                                        24
Recommended intake: 10 000 kJ/day

                                    25
View on Africa

Africa is the only continent
where the nutrition
situation has deteriorated
in recent decades

• 206 million people in Africa are iron deficient
• 86 million are affected by iodine deficiency
• 31 million are deficient in vitamin A

It emphasize slow pace of progress in intervention efforts
against micro-nutrient deficiencies in Africa (FAO and
WHO)
                                                             26
At a glance: South Africa is a developing country

● Population of 46 million people of which 79% are black
  Africans
● Majority of South African households live in poverty with
  a limited variety of foods (mainly staples) available in
  the home
● 30.9 % preschool children stunted
● 56.2% of the adult population was recorded overweight
  or obese (Demographic and Health Survey, 2003),
    ● highest prevalence of obesity in females
● Double burden of disease within same household - due
  to rapid urbanization and acculturation

                                                              27
Prevalence of vitamin A deficiency in South Africa
            Children 6 - 71 months

                                                               43.5
 45
                                   38
 40
                                                33     32                33.3         W Cape
 35                         31.1
                                                                                      N Cape
 30                                     26.8
                    23.5                                                              Gauteng
 25     21                                                                            E Cape
             18.5
 20                                                                                   KZN
 15                                                                                   F State
 10                                                                                   Mpumal
                                                                                      N West
  5
                                                                                      Limpopo
  0                                                                                   SA
     pe ap
           e
                   ng ape     Z N       te    al   st     po         A
                                       a         e               S
  C
   a     C    ut
                 e
                       C     K     S
                                     t
                                           pum W       po                SAVACG Survey Report,
       N    a        E           F             N      m                  1995
W          G                             M         Li
                                                                                                 28
Prevalence of Anaemia and Iron Deficiency in South Africa
                   Children 6 - 71 Months
               Haemoglobin < 11 g/dl             Ferritin < 12ug/l

     SA                9.8%                   21.1%
Limpopo                    11%
                                                                  34.2%
 N West              8.1%
                                                 24.5%
Mpumal                      11.5%                     27.7%
 F State            6.8%          17.1%
    KZN                      13.4%
                         10.4%
 E Cape         5%                     20.6%
Gauteng               9.2%       16.3%
 N Cape                    10.9%              21.5%
 W Cape                               16.4%
                                                         28.6%
           0    5     10         15      20      25      30       35      40
                                                              SAVACG Survey Report, 1995
                                                                                           29
NATIONAL FOOD CONSUMPTION SURVEY (1999)

     Micronutrient intake of children 1-9 years

     Zinc
Vitamin A
     Iron
       B6
Riboflavin
   Niacin
  Thiamin
Folic Acid

         0%     20%     40%     60%     80%       100%
                  % Consuming < 67% RDA
                                                         30
South African Children under-5 yrs

Mortality rate:
●Rural Areas = 7.12%
●Urban Areas = 4.32%
              (SADHS, 1998)


●Stunted for age = 30.9%
●Underweight for age = 9.6%
          versus
●Overweight for age = 9.3%
                         (NFCS, 1999)

                                             31
Food inflation in South Africa - Nutrition
                   implications

●Future Implications:
  – Already nutrition dilemma with low vit A, Fe, prot and kJ intake –
    with decrease in portion sizes = continual decrease
  – Fortification programs not calculated based on such low
    consumption values
  – Households could, due to inflation, move significantly closer to
    FAO “Hunger threshold” of 1 260kJ/day
  – High risk of food diversity declining even more
●Future Priorities
  – Planning for adequate staple foods at affordable prices
  – Possibility of Government Food stamps


                                                                         32
Parallel activities


●Nutrition Communication Initiative by the
 Consumer Goods Council of SA
 Response to the publication of the new draft regulation for food
  labeling and advertising by the DoH. Highlighted the need to
  build greater capacity in the field of nutrition and to play an
  active role in the provision of nutrition education to South
  African consumers
 –Agreed that Food Based Dietary Guidelines
  form the basis
 –Development of a Food Guide as a 1st step


                                                                    33
Thank you for your attention




                               34

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Nicollettes Presentation

  • 1. Healthy Eating at a Time of High Food Prices SANCU - 30 July 2008 Hettie Schönfeldt, Nicolette Gibson & Hester Vermeulen School of Agricultural and Food Sciences 1
  • 2. Food Based Dietary Guidelines ●Developed from 1998 through joint FAO/WHO expert consultation ●Implementation started in 2004 ●Based on National Food Consumption Survey (NFCS) (1999) ●Corresponds with South African Demographic and Health Survey (SADHS) (1998) 2
  • 3. Food Based Dietary Guidelines ●Qualitative statements that express dietary goals in terms of foods ●Represent the best consensus of scientific knowledge and public health advice currently available ●Based on the relationship between diet and disease ●Can be used as educational tools for promoting the importance of nutrition to combat the growing double burden of malnutrition 3
  • 4. Food Based Dietary Guidelines The FBDG’s are the result of a wide consultative process throughout the country, in line with the recommendations of the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO) Eleven guidelines where formulated for healthy eating for South Africans older than 7 years 4
  • 5. Food Based Dietary Guidelines The following 1st three guidelines provide general health messages to promote a healthy lifestyle: ● Enjoy a variety of foods ● Be active ● Drink lots of clean, safe water 5
  • 6. Food Based Dietary Guidelines The following food-based dietary guidelines help us to plan good mixed meals: ● Make starchy foods the basis of most meals ● Eat plenty of vegetables and fruit every day ● Eat dry beans, split peas, lentils and soya regularly ● Chicken, fish, meat, milk or eggs can be eaten daily 6
  • 7. Food Based Dietary Guidelines The following dietary guidelines teach us about moderation and balance for healthy eating: ● Eat fats sparingly ● Use salt sparingly ● Use food and drinks containing sugar sparingly and not between meals ● If you drink alcohol, drink sensibly 7
  • 9. Canadian Healthy Eating Guidelines 9
  • 10. Food Groups & Recommended portion sizes 10
  • 11. Staple foods of South Africa Cooked white maize porridge, sugar, tea, whole milk and brown bread – 5 most often consumed (NFCS, 2000) Cereal flours contribute between 50-75% of energy intake of populations in sub-Saharan Africa… and milling refinement of wheat or maize removes about two-thirds of the vitamins and minerals 11
  • 12. Recommended balanced diet “Grocery List” Bread 1 R5.89 Maize 5kg R16.99 Soup bones 643g bag R3.34 Maas 1 carton R7.39 Milk 2L R15.99 Spinach Bunch R2.99 Carrots Bunch R2.99 Tomatoes 1 R1.61 Onion 1 R1.17 Apple 1 R1.49 Potato 1 R2.48 Banana 1 R1.34 Orange 1 R2.04 R70.10 12
  • 13. Recommended balanced diet Current cost per portion Bread 3 slices R0.87 3 portions Maize 500 g cooked R0.50 5 portions Soup bones 450g R2.44 2 portions Maas 1 carton R7.39 2 portions Spinach 100 g raw (±4 leaves) R0.66 1 portion Carrots 1 R0.32 1 portion Tomatoes 1 R1.61 1 portion Onion 1 R1.17 1 portion Apple 1 R1.49 1 portion Potato 1 R2.48 1 portion Banana 1 R1.34 1 portion Orange 1 R2.04 1 portion R22.31/day 13
  • 14. Recommended balanced diet ortions: R22.31/day • grains • fruits & vegies • meat • 14
  • 15. R7.20 R7.39 15
  • 16. R5.89 R5.92 16
  • 17. R6.13 R5.89 1 bread (R5.89) VS 1 potato, 1 orange, 1 tomato (R6.13) 17
  • 19. Effect of Inflation on food prices Product 2006 R/kg* 2008 R/kg** % Increase Brown Bread R4.29 R5.89 37% Tomatoes R9.38 R11.99 28% Onions R6.11 R6.99 14.4% Apples R5.23/kg R8.99 72% (R7.85/1.5kg) Potatoes R2.18/kg R7.99/kg 267% (R15.17/7kg) Milk (2L) R10.27 R15.99 56% Oranges R3.20/kg R6.99 118% (R7.99/2.5kg) *National Agricultural Marketing Council – Food price trends July 2005 – July 2006 **As purchased July 2008 19
  • 20. The SU-LSM segments Proportion of SA population and average monthly income (SAARF, 2008) Average household income (R'000) 18.0 25 16.0 % of SA population 14.0 20 12.0 15 10.0 8.0 10 6.0 4.0 5 2.0 0.0 0 1 2 3 4 5 6 7 8 9 10 % of SA Adult population Average monthly income (R'000) 20
  • 21. The LSM segments Dynamics in the SA adult consumer market (SAARF, 2008) 40.0 -29% 35.0 30.0 +6% +26% 2001 25.0 2002 2003 20.0 % 2004 2005 15.0 +28% 2006 2007 10.0 5.0 0.0 LSM 1-3 LSM 4-5 LSM 6-8 LSM 9-10 21
  • 22. The impact of inflation R 2,000 12.8% 13.0% R 1,840 R 1,800 11.0% Additional spending as share of income R 1,600 Additional spending (R/hh/year) R 1,400 9.0% R 1,159 R 1,208 R 1,200 7.2% R 1,100 7.0% R 1,000 R 945 R 863 5.7% 5.0% 5.0% R 800 R 692 4.0% R 600 3.0% 2.2% R 400 1.0% R 200 0.7% R0 -1.0% Decile 1 Decile 2 Decile 3 Decile 4 Decile 5 Average deciles 6 - Average decile 9 - 8 10 Additional spending (07/08) Additional spending / Income (07/08) 22
  • 23. Food Coping Strategies 1. Eat less preferred food 2. Borrow food 3. Buy food on credit 4. Gather wild food 5. Consume seed stock 6. Send members to eat elsewhere 7. Send members to beg 8. Limit portion size 9. Restrict consumption in favour of children 10. Feeding working members at the expense of non-working members 11. Ration money to buy ready to eat food 12. Skip the entire day without meals 23
  • 24. Effect of Inflation Cooked maize meal porridge – assume income stays the same Scenario Cooked Estimated Share of Energy Portion size (g) portion costs daily contributio (R) income (%) n (kJ) Typical – base line 532 0.70 14.0 2420.6 29 % inflation June 06 to June 07 382 0.61 12.2 1736.8 5.4% inflation June 07 to June 08 361 0.60 11.9 1643.0 3.2% Projection June 08 to June 09 350 0.60 11.9 1590.4 “Typical” portion: Provides only 37.8% of energy, 25.7% of protein and 20.1% of vit A needs After 2 years: Provides only 25.7% of energy, 17.4% of protein and 17.4% of vit A needs 24
  • 25. Recommended intake: 10 000 kJ/day 25
  • 26. View on Africa Africa is the only continent where the nutrition situation has deteriorated in recent decades • 206 million people in Africa are iron deficient • 86 million are affected by iodine deficiency • 31 million are deficient in vitamin A It emphasize slow pace of progress in intervention efforts against micro-nutrient deficiencies in Africa (FAO and WHO) 26
  • 27. At a glance: South Africa is a developing country ● Population of 46 million people of which 79% are black Africans ● Majority of South African households live in poverty with a limited variety of foods (mainly staples) available in the home ● 30.9 % preschool children stunted ● 56.2% of the adult population was recorded overweight or obese (Demographic and Health Survey, 2003), ● highest prevalence of obesity in females ● Double burden of disease within same household - due to rapid urbanization and acculturation 27
  • 28. Prevalence of vitamin A deficiency in South Africa Children 6 - 71 months 43.5 45 38 40 33 32 33.3 W Cape 35 31.1 N Cape 30 26.8 23.5 Gauteng 25 21 E Cape 18.5 20 KZN 15 F State 10 Mpumal N West 5 Limpopo 0 SA pe ap e ng ape Z N te al st po A a e S C a C ut e C K S t pum W po SAVACG Survey Report, N a E F N m 1995 W G M Li 28
  • 29. Prevalence of Anaemia and Iron Deficiency in South Africa Children 6 - 71 Months Haemoglobin < 11 g/dl Ferritin < 12ug/l SA 9.8% 21.1% Limpopo 11% 34.2% N West 8.1% 24.5% Mpumal 11.5% 27.7% F State 6.8% 17.1% KZN 13.4% 10.4% E Cape 5% 20.6% Gauteng 9.2% 16.3% N Cape 10.9% 21.5% W Cape 16.4% 28.6% 0 5 10 15 20 25 30 35 40 SAVACG Survey Report, 1995 29
  • 30. NATIONAL FOOD CONSUMPTION SURVEY (1999) Micronutrient intake of children 1-9 years Zinc Vitamin A Iron B6 Riboflavin Niacin Thiamin Folic Acid 0% 20% 40% 60% 80% 100% % Consuming < 67% RDA 30
  • 31. South African Children under-5 yrs Mortality rate: ●Rural Areas = 7.12% ●Urban Areas = 4.32% (SADHS, 1998) ●Stunted for age = 30.9% ●Underweight for age = 9.6% versus ●Overweight for age = 9.3% (NFCS, 1999) 31
  • 32. Food inflation in South Africa - Nutrition implications ●Future Implications: – Already nutrition dilemma with low vit A, Fe, prot and kJ intake – with decrease in portion sizes = continual decrease – Fortification programs not calculated based on such low consumption values – Households could, due to inflation, move significantly closer to FAO “Hunger threshold” of 1 260kJ/day – High risk of food diversity declining even more ●Future Priorities – Planning for adequate staple foods at affordable prices – Possibility of Government Food stamps 32
  • 33. Parallel activities ●Nutrition Communication Initiative by the Consumer Goods Council of SA Response to the publication of the new draft regulation for food labeling and advertising by the DoH. Highlighted the need to build greater capacity in the field of nutrition and to play an active role in the provision of nutrition education to South African consumers –Agreed that Food Based Dietary Guidelines form the basis –Development of a Food Guide as a 1st step 33
  • 34. Thank you for your attention 34