Low-income black women hardest hit by noncommunicable diseases

Increasing rates of noncommunicable diseases — such as cancer, heart disease, type two diabetes and strokes — have surpassed HIV as the leading cause of death. Not enough of us are talking about it; neither are we politicising food inequality in the way we ought to be.

Low-income black women are disproportionately affected by noncommunicable diseases because of the limited health and nutrition options available to them. This is a structural issue that needs serious policy intervention at the macro level, over and above encouraging and supporting behavioural changes and social norms at the micro level. The South African government must exercise leadership and protect the population against an industry that is poisoning the nation with its unregulated beverage formulas — which have an exorbitant amount of added sugar — among other nutrient-deficient food and drinks we consume.

We cannot “outrun sugary drinks”. This is a fact. Equally, we cannot perpetuate the false and harmful narrative that pathologises the suffering of impoverished communities and the fact that people in these communities are statistically more prone to developing noncommunicable diseases over the course of their lifetimes.

Like most socioeconomic ills, food and health inequality is also deeply gendered. According to the South Africa Demographic and Health Survey, conducted in 2016, 46% of women suffer from hypertension, compared to 44% of men. The same is true for other noncommunicable diseases.

Obesity in South Africa is one side of the food inequality coin. Hunger — and easy access to cheap, unhealthy and poor-quality food options that plague a majority of black families — is the other. Another study, the Living Conditions Survey, also conducted in 2016, found that 52% of adult women live in poverty, compared to 46.1% adult men.

What this means is that the ways in which health and nutrition are understood and marketed need to account for reality, as well as confront all the issues facing the majority of the population in South Africa. Shaming people into joining running clubs, drinking eight glasses of water a day or using healthier recipes when cooking, for example, is not a useful strategy capable of rescuing most people from the dire situation find themselves in. Nevermind that such advice is largely impractical when factoring in the everyday lives of ordinary South African women, who often face high stress levels owing to being burdened with the duty of care beyond just their immediate family members. This care must often be delivered on wages far below the minimum living wage, and must stretch far beyond any measure which can be considered reasonable.

Inequality — a colonial and apartheid legacy — is a monster that torments the lives of those rendered vulnerable owing to a socioeconomic make-up that prioritises the elite and powerful over the overwhelming masses who are impoverished and often navigating multiple intersections of violence and oppression. The relationship between low-income black women and their poor health outcomes is a classic example of how, in a world rife with socioeconomic inequality, our advocacy for any social justice imperative must take seriously the context in which it operates, in both its analysis and interventions.

Ten thousand new cases of diabetes are reported each month in South Africa. To repeat this: 10 000 new cases. Noncommunicable diseases overall account for more than 50% of deaths in the country, according to Statistics South Africa (Stats SA), with diabetes and cardiovascular diseases such as heart attacks being the leading causes of death. This could be avoided if we had the necessary political will to regulate industry and foster far greater food equity. In its 2016 Mortality and causes of death in South Africa: Findings from death notification report, Stats SA highlights how food insecurity and poor access to healthcare continues to make the most vulnerable citizens fall victim to illness and even death.

This is why the Healthy Living Alliance (Heala) is shifting the focus towards the institutions and structures that are effectively responsible: the South African government and the food and beverage industry. Heala is calling for social and political will to back up advocacy efforts towards food justice and equity: the culprits that contribute to the burden of disease must simply be held accountable.

Through its front-of-package labellingcampaign and other advocacy efforts, Heala is advocating for the inclusion of consumer-friendly warnings on the front of food items. This is important, in so far as it contributes towards the regulation of the food industry and holding it accountable for its direct contribution to this epidemic. A junk food tax is another example that could be pursued as a positive measure for ensuring a reduction in the consumption of unhealthy food.

The rise in noncommunicable diseases has also placed a heavy burden on an already poor and malfunctioning public health system. Unfortunately, those people who rely exclusively on public healthcare often do not receive the necessary care and intervention to help them to manage their illnesses well. An overburdened system is simply ill-equipped to provide this. If the government and other institutions of power do not tackle this with the critical insight and urgency it deserves, this situation is headed towards a public health crisis.

There is a direct link between high levels of malnutrition and obesity in South Africa: adults and children who live below the poverty line are likely to be malnourished or living with obesity. The South African National Health and Nutrition Examination Survey found that, in urban areas, 28% of the households were at risk of hunger, while 26% were already experiencing hunger. In rural communities, these statistics hit 32% and 36%, respectively. In South Africa, almost 70% of women and 39% of men are considered overweight or obese. Moreover, 1.6-million South African children are already living with obesity.

Food equity is part of the struggle to realise social justice for all South Africans. We have a food inequality problem in this country and the lack of effective food policy and regulation of the food and beverage industry is one of the primary drivers. But this is not so much a problem of lack: rather, it one of poor regulation, presided over by a government that refuses to act decisively on behalf of its citizens.

The regulation of the food industry is the first step towards tackling food inequality and we must simply insist that the state play its role in this endeavour. Capitalism continues to destroy the environment and sustainable livelihoods, which leads to high levels of human deprivation, hunger and poverty. The government must ensure that it delivers on its mandate to the people by not shying away from holding multinational corporations such as Coca-Cola accountable for their actions.

In our context, an increase in the consumption levels of Coca-Cola products, for example, demonstrates how capital continues to thrive because of the prioritisation of a “market driven” economy over the basic needs of people to survive. The Mexico case illustrates this well. Arguments against regulation (including taxing sugar, for example) that cite only the effect on trade and investment — and, therefore, job losses — are a manipulative tactic taking advantage of the socioeconomic conditions plaguing countries in the Global South.

Advocacy against a 20% “sugary drinks tax” by industry frustrates efforts and positive strategic interventions (including front-of-label packaging). Instead, this allows the industry to continue to get away with murder. Literally. Moreover, it is disappointing to see how easily the government is swayed in slowing down (through effective legislation measures) this impending public health crisis. This includes Heala’s proposed 20% health promotion levy,aka “sugar tax”, which would reduce obesity in more than 220 000 South African adults. The April 2019 victory championed by Heala (an 11% sugar tax), has already produced revenue of about R3-billion for the government.

On October 21 and 22, Heala hosted a #FoodPolicyRoundtable at the Isivivana Centre in Khayelitsha. The two-day workshop brought together civil society organisations, such as the Treatment Action Campaign and the Right to Know Campaign; researchers in the food sector; and entrepreneurs in the alternative food industry, with the specific purpose of unpacking food inequality in South Africa. One of the outcomes was a growing understanding of the links between food inequality and the broader fight for social justice, affirming the need for cross-sectoral strategising and advocacy.

In an effort to hold the government accountable and to continue our advocacy towards ensuring that South Africans have equitable access to health and nutrition, Heala will stage a picket outside Parliament on Monday October 28. The purpose is to pressure the treasury and the department of health to take the lives of South Africans seriously and heed our call for an increase of the health promotion levy from 11% to 20% ahead of the medium-term budget policy statement on Wednesday. This is one of the known effective measures that can curb the high levels of obesity in the South African population.

MJ Motsolo wrote this piece on behalf of the Healthy Living Alliance. The organisation’s vision is to ensure that ordinary South Africans, especially black women and children, have access to equitable health and nutrition as a means of reducing the growing rate of noncommunicable diseases and related deaths. Follow the campaign on social media: @heala_SA on Twitter and Healthy Living Alliance on Facebook.