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Hunger Summit Presentation
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1
The cost of a healthy diet
Hettie Schönfeldt, Nicolette Gibson & Hester Vermeulen
School of Agricultural and Food Sciences
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
3
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LESOTHOLESOTHOLESOTHOLESOTHOLESOTHOLESOTHOLESOTHOLESOTHOLESOTHO
SWAZILANDSWAZILANDSWAZILANDSWAZILANDSWAZILANDSWAZILANDSWAZILANDSWAZILANDSWAZILANDNORTH WESTNORTH WESTNORTH WESTNORTH WESTNORTH WESTNORTH WESTNORTH WESTNORTH WESTNORTH WEST
MPUMALANGAMPUMALANGAMPUMALANGAMPUMALANGAMPUMALANGAMPUMALANGAMPUMALANGAMPUMALANGAMPUMALANGA
GAUTENGGAUTENGGAUTENGGAUTENGGAUTENGGAUTENGGAUTENGGAUTENGGAUTENG
FREE STATE FREE STATE FREE STATE FREE STATE FREE STATE FREE STATE FREE STATE FREE STATE FREE STATE
WESTERN CAPEWESTERN CAPEWESTERN CAPEWESTERN CAPEWESTERN CAPEWESTERN CAPEWESTERN CAPEWESTERN CAPEWESTERN CAPE
LIMPOPOLIMPOPOLIMPOPOLIMPOPOLIMPOPOLIMPOPOLIMPOPOLIMPOPOLIMPOPO
KWAZULU-NATALKWAZULU-NATALKWAZULU-NATALKWAZULU-NATALKWAZULU-NATALKWAZULU-NATALKWAZULU-NATALKWAZULU-NATALKWAZULU-NATAL
NORTHERN CAPENORTHERN CAPENORTHERN CAPENORTHERN CAPENORTHERN CAPENORTHERN CAPENORTHERN CAPENORTHERN CAPENORTHERN CAPE
MmabathoMmabathoMmabathoMmabathoMmabathoMmabathoMmabathoMmabathoMmabathoJohannesburgJohannesburgJohannesburgJohannesburgJohannesburgJohannesburgJohannesburgJohannesburgJohannesburg
NelspruitNelspruitNelspruitNelspruitNelspruitNelspruitNelspruitNelspruitNelspruit
UpingtonUpingtonUpingtonUpingtonUpingtonUpingtonUpingtonUpingtonUpington
BloemfonteinBloemfonteinBloemfonteinBloemfonteinBloemfonteinBloemfonteinBloemfonteinBloemfonteinBloemfontein
Cape TownCape TownCape TownCape TownCape TownCape TownCape TownCape TownCape Town
BishoBishoBishoBishoBishoBishoBishoBishoBisho
PietersburgPietersburgPietersburgPietersburgPietersburgPietersburgPietersburgPietersburgPietersburg
PietermaritzburgPietermaritzburgPietermaritzburgPietermaritzburgPietermaritzburgPietermaritzburgPietermaritzburgPietermaritzburgPietermaritzburg
EASTERN CAPEEASTERN CAPEEASTERN CAPEEASTERN CAPEEASTERN CAPEEASTERN CAPEEASTERN CAPEEASTERN CAPEEASTERN CAPE
Map produced by the Health GIS Centre,Medical Research Council of SA (2004)
Data Source: Municipal Demarcation Board
Current Provinces of South Africa with Provincial Capitals
Province boundaries
International boundaries
● Population of 46 million people● Majority SA households live in poverty with limited food
variety (mainly staples) available in the homeWhite 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
● Double burden of disease often evident within same households, and often even within the same
individual
South Africa
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
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
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
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
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
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
10
Food Based Programmes
11
Canadian Healthy Eating Guidelines
12
Food Groups & Recommended portion sizes
13
Recommended balanced diet “Grocery List”“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
R70.10R70.10
14
Recommended balanced diet Current cost per portionCurrent 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/dayR22.31/day
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)
16
THE REALITY
daily nutritionally adequate diet
R22.31VS
R5.33 available per person per day
17
Recommended balanced diet
Portions:•8 grains•8 fruits & veggies•2 meat•2 dairy
R22.31/dayR22.31/day
Have available R5.33
18
R7.20R7.20
R7.39R7.39
19
R5.89R5.89 R5.92R5.92
20
1 bread (R5.89) VS
1 potato, 1 orange, 1 tomato (R6.13)
R5.89R5.89
R6.13R6.13
21
R1.38R1.38
R1.49R1.49
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
23
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)
General Food Fortification and Supplementation Program in 2003
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 deaths2. Lower maternal deaths by one third3. Increase the working capacity of the labour force
by up to 40%4. Raise the population IQ by 10 to 15 points5. 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)
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
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?
27
Current consumption patterns
Studies Ethnic GroupsAverage portion consumed (g)Maize Bread Milk Sugar
Adult Food Consumption studies 1983– 2002 All 848 165 204 27Lebowa Study 1991 Black, rural, 10yrs+ 858 153 40.6 19.7Dikgale study 1998 Black, rural, 19yrs+ 891 121 121 26.8THUSA Bana Study 1996 – 1998 Black, urban + rural,10yrs+ 532 115 72.4 20.5Duvenage Study 2005 Black, informal urban,20yrs+ 532 150 56 22
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
28
Recommended intake: 10 000 kJ/day
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
30
What should be done?
Food Security
31
Possible solutions
Combined effort between government and private sector1. Food Stamp system (Retail & Government)>Awarded free to those most in need (affordability) >Increase availability of certain nutritionally adequate foods
to the poor2. 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)
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
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
35http://www.fns.usda.gov/fsp/
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
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)
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)
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