Hunger Summit Presentation

1. The cost of a healthy diet
Hettie Schönfeldt, Nicolette Gibson & Hester
Vermeulen
School of Agricultural and Food Sciences
1

2. The African Situation
Africa is the only continent where the
nutrition situation has deteriorated in
recent decades
•Since 1990 the number of undernourished people in
Africa has increased by nearly 20%
•Under nutrition is a major risk factor and contribute to 28%
of deaths in Africa
2

3. South Africa
● Population of 46 million people
● Majority SA households live in poverty with limited food variety
(mainly staples) available in the home
White maize porridge, brown bread, sugar, milk & tea (NFCS, 1999)
● 30.9 % preschool children stunted (Short for their age)
vs.
● 56.2% of the adult population overweight or obese
(Demographic and Health Survey, 2003)
● Rapid urbanization and acculturation
Current Provinces of South Africa with Provincial Capitals
Province boundaries
International boundaries
● Double burden of disease often evident within same
LIMPOPO
LIMPOPO
 Pie te rs burg
 Pie te rsburg
 Ne ls pruit
 Ne ls pruit
households, and often even within the same individual
GAUTENG
GAUTENG
M m abatho
Mm abatho
Mm
Johanne s burg 
Johanne sburg  MPUMALANGA
MPUMALANGA
SWAZILAND
SWAZILAND
NORTH WEST
NORTH WEST
FREE STATE
FREE STATE
 Upington
 Upington
KWAZULU-NATAL
KWAZULU-NATAL
 Bloe m fonte in
 Bloe m fonte in
NORTHERN CAPE LESOTHO
LESOTHO  Pie te rm aritzburg
 Pie te rm aritzburg
NORTHERN CAPE
EASTERN CAPE
EASTERN CAPE
 Bis ho
 Bis ho
WESTERN CAPE
WESTERN CAPE
 Cape Tow n
Cape Tow n
3

0 100 200 Map produced by the Health GIS Centre,
Medical Research Council of SA (2004)
kilometers
Data Source: Municipal Demarcation Board

4. Recent SA Health and Nutrition Developments to
combat malnutrition
1. Food Based Dietary Guidelines
2. Food Fortification and Supplementation
Program
● Iodization of salt
● Vitamin A supplementation
● Food Fortification Program
4

5. 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
5

6. 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
6

7. 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
7

8. 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
8

9. 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
9

10. Food Based Programmes
10

11. Canadian Healthy Eating Guidelines
11

12. Food Groups & Recommended portion sizes
12

13. 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
13

14. 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
14

15. South Africa Financial demographics
●Half of the 10 to 11 million households in South Africa can
be classified as low-income households
– Have less than ZAR800 per month to spend
(Prahalat & Hart, 2006)
●Most households have 5 members:
– ZAR5.33 /person /day to meet all needs
●Substantially lower than the international poverty line
indicator of US$1.25/day (ZAR11.13)
15

16. THE REALITY
daily nutritionally adequate diet
R22.31
VS
R5.33
available per person per day
16

17. Recommended balanced diet
ortions: R22.31/day
•
grains
•
fruits
& veggies
Have available •
R5.33
meat
• 17

18. R7.20
R7.39
18

19. R5.89 R5.92
19

20. R6.13
R5.89
1 bread (R5.89)
VS
1 potato, 1 orange, 1 tomato (R6.13)
20

21. R1.49
R1.38
21

22. Cooked white maize porridge, brown bread, sugar,
tea, whole milk and– 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
22

23. General Food Fortification and Supplementation
Program in 2003
National Food Fortification Program includes the compulsory addition
of 8 micronutrients to all maize meal and wheat flours
The fortification cocktail and the addition rates based on National Food
Consumption Survey (NFCS), 1999 & South African Vitamin A
Consultancy Group Survey (SAVACG), 1994
33,3% of SA children (6-71 months) are vitamin A deficient (SAVACG, 1994)
1 in 2 children consume less than half the recommended level for
vitamin A, riboflavin, niacin, vitamin B6, folic acid, calcium, iron and zinc
(NFCS, 1999)
23

24. Food Fortification Program (2003)
Envisaged Results?
Vitamin A and Fe fortification in maize meal and
wheat flour over 5-years could:
1. Prevent one out of four childhood deaths
2. Lower maternal deaths by one third
3. Increase the working capacity of the labour force
by up to 40%
4. Raise the population IQ by 10 to 15 points
5. Increase the GDP by 5% at a cost of 0.3%
6. Alleviate the iron deficiency cost, which is
predicted to be near US$1-bn/year (SA DoH)
24

25. Food Fortification Program (2003)
●Successful?
– National Food Consumption Survey fortification
Baseline (2005) performed 2 years after NFFP was
implemented
– Findings:
> 2 out of 3 children and 1 out of 4 women had a
poor vit A status
> 1 out of 7 children and 1 out of 5 women had
poor iron status
> 45% of children had inadequate zinc status
Indicate increases in deficiencies when compared to
previous data – regardless of fortification
25

26. Food fortification
● Most nutrients are added to contribute 25% of RDA in 200g
raw product
– Translates into 370g brown bread
– Dependent on consistency of porridge: 530g stiff porridge &
1450g soft porridge
● 2005 study indicated that the average daily intake of maize
porridge was 532g/person (345 stiff, 124 soft, 83 crumbly), while
brown bread intake was only about 150g/person/day
(Duvenhage & Schonfeldt, 2007)
Effect of inflation on portion size?
26

27. Current consumption patterns
1. Limited amount of money available to spend on food results in a
very limited food basket
2. Increase in food prices results in decrease in portion sizes
Average portion consumed (g)
Studies Ethnic Groups Maize Bread Milk Sugar
Adult Food Consumption studies
1983– 2002 All 848 165 204 27
Lebowa Study 1991 Black, rural, 10yrs+ 858 153 40.6 19.7
Dikgale study 1998 Black, rural, 19yrs+ 891 121 121 26.8
THUSA Bana Study 1996 – 1998 Black, urban + rural,10yrs+ 532 115 72.4 20.5
Duvenage Study 2005 Black, informal urban,20yrs+ 532 150 56 22
27

28. Recommended intake: 10 000 kJ/day
28

29. Food inflation in South Africa - Nutrition
implications
●Already nutrition dilemma with low vit A, Fe, prot and kJ
intake – with decrease in portion sizes = continual
decrease
●High risk of food diversity - promoted by dietary
guidelines - to decline even more
●Fortification programs are not calculated based on these
low consumption values
●Households could, due to inflation, move significantly
closer to FAO “Hunger threshold” of 308kCal / 1 260kJ
per day
29

30. What should be done?
Food
Security
30

31. Possible solutions
Combined effort between government and private sector
1. Food Stamp system (Retail & Government)
> Awarded free to those most in need (affordability)
> Increase availability of certain nutritionally adequate foods
to the poor
2. Development of an in-store balanced food basket
(Retail & Producers)
> Provides a balanced diet in one basket / bag (nutritionally
adequate) (different content depending on the retailer)
> At a reduced price (affordability)
> In the shops where the poor consumer would anyway
purchase staple foods (availability)
31

32. Thank You
nicolette.gibson@up.ac.za
012 – 361 2333
32

33. 1. Food Stamp Program
● The USDA Food Stamp Program
– Federal assistance program that provides food to low income people
living in the US
– Most food stamp benefits are now distributed using
Electronic Benefit Transfer (EBT) cards but for most of its history the
program has used paper vouchers
● Stamps used to purchase any prepackaged edible foods regardless of
nutritional value (for example soda and candy could be purchased on food
stamps)
● Both consumer and retailer needs to apply for eligibility to receive / accept
these EBT cards
● Screening tools are available on the web – to screen for eligibility for food
stamps
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34. 1. Food Stamp Program
● Consumer application for Food Stamps must be made at local
Food Stamp Office
– Criteria
> earnings
> rent or mortgage
> utility bills
> child support
> day care expenses
> medical bills (if you are 60 or older, or disable)
> Child support payments
● Store Eligibility
– must sell food for home preparation and consumption and meet at least one of
the criteria below
> Offer for sale at least three different varieties of food in each of the following
four staple food groups, with perishable foods in at least two categories, on a
daily basis: Bread & Grains, Dairy, Fruits & Vegetables, Meat, Poultry, Fish
> At least 50% of the total sales (e.g., food, non-food, services, etc.) at your
store must be from the sale of staple food
34

35. http://www.fns.usda.gov/fsp/ 35

36. 2. Balanced Budget Basket
●Basket / bag containing low cost produce
providing all the nutrients required per
person per day
●Set at a constant low price with variable
contents suiting the retailer and the
supplier
36

37. Balanced Budget Basket
●Providing a bag / basket containing foods containing all the
nutrients required per person per day
●Variety of products based on the 5 food groups and portions
●Could use surplus perishables that would normally not be
sold / removed from the shelves
●Does not need to contain the same products every day –
only maintain the requirement:
– Provide 8 portions starches
– Provide 8 portions fruit and veg
– Provide 2 portions meat and meat alternatives
– Provide 2 portions dairy and alternatives
– Should be sold at a constant reduced price (e.g R10)
37

38. Proposal
●Available all year round at retailer
●Containing the most inexpensive products to retailer as
bought from the producer for that day / week
●Does not need to be the best and highest quality
produce
– Could be that which other wise would have been removed from
shelf and not sold (e.g. with marks)
– E.g windfalls program for apples in England
●Each basket may be different, as long as it contains the
required
– E.g indivdual: 8prt starches, 8prt veggies & fruit, 2prt meats
and 2prt dairy
– OR family pack (For four ppl)
– OR weekly basket (For either)
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39. Balanced Budget Basket
●Will contain the most affordable options:
– 8 portions starch
> 500g starch, (e.g. half bread 350g + 150g raw maize meal)
– 2 portions dairy
> 100g cheese OR container maas OR 250 ml canned milk
OR 500ml milk OR 500 ml sour milk or 1½ cup yogurt etc…
– 2 portions meat and meat alternatives
> ±200g made up from Soup bones (greater weight needed)
OR oval OR gizzards OR eggs (2 eggs) OR legumes OR
nuts etc…
– 8 portions fruits and vegetables
> 800g made up of a variety of the most affordable fruits and
vegetables including at least one vitamin A rich vegetable
and one green vegetable
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