COVID-19 has had a devastating impact on people with obesity and noncommunicable diseases such as diabetes. The pandemic has underlined the importance of the food environment and healthy food intake. It has shown the urgent need for effective policies to make sure that everyone can get enough nutritious food - and particularly in sub-Saharan Africa.
In Africa, nearly 70% of diabetes cases are undiagnosed. Of these, 90% are type 2 diabetes cases. Obesity is a key risk factor for developing type 2 diabetes. Between 1975 and 2016, southern Africa saw the world's highest proportional increase in child and adolescent obesity - an alarming 400% per decade.
Ultra-processed foods and sugary drinks contribute to rising rates of obesity and diet-related diseases. Unhealthy, processed foods are now frequently consumed in low- and middle-income countries. This is largely due to the low prices, food types, availability and marketing strategies employed by large corporations. Healthier food options are relatively expensive and unaffordable in low- and middle-income countries. This influences people to steer away from healthier options. Companies market these convenient, palatable, yet unhealthy foods aggressively, and aim their marketing at children. It's not always possible to choose healthier products, especially in rural areas.
Supplying ultra-processed products is very profitable for the companies concerned. These products have low production input requirements, a high retail value and an extended shelf life. Often the responsibility for preventing noncommunicable disease is put on individuals. But the corporate food industry creates a food environment that gives rise to obesity.
COVID-19 has brought new urgency to the need to repair food systems that put profits before public health.
A recent report by the organisation Global Health Advocacy Incubator highlights how food and beverage corporations used the COVID-19 pandemic as an opportunity to promote their ultra-processed foods to vulnerable populations around the world.
The report includes over 280 examples from 18 countries of the food industry undermining healthy food policy efforts. This was done through lobbying to classify (unhealthy) ultra-processed foodstuffs as "essential products" during the pandemic. They also improved their brand image through providing financial and other support to needy communities, frontline workers, food banks, and small businesses while still marketing unhealthy products and pushing against healthy food policies.
A shift in the food system is urgently required. Interventions to achieve this must include policies that promote healthier food choices. These include imposing taxes on food that is high in sugar, salt or saturated fat (unhealthy fat); regulating food labels; and restricting marketing of unhealthy products. Policies must also support people in making healthier food choices, for example through subsidies.
Healthy food policies to consider
Globally, there has been a push for healthy food policies to curb the obesity pandemic. African countries have been slow to adopt policies like these. But South Africa introduced a Health Promotion Levy in 2018. It aims to give manufacturers an incentive to reduce the sugar content of drinks. It also seeks to discourage excessive consumption by increasing the price of these products. Mexico imposed a tax on sugar sweetened drinks in 2014. This has resulted in a 6% reduction in purchases of sugary drinks and replacement with untaxed beverages (predominantly plain water) - specifically among lower income households who likely have poorer health outcomes.
The implementation of the tax is an acknowledgement that corporates have manufactured conditions that cultivate malconsumption resulting in poor nutrition and noncommunicable disease.
Governments should also introduce labelling that helps consumers to identify food with high quantities of salt, saturated fat or sugar. Chile introduced a set of linked policies, including warning labels and marketing controls. The result was that companies reformulated products to improve their health profiles.
But taxes and labelling interventions won't be enough to stem the tide of obesity and noncommunicable diseases. Food policies must also make healthy food more accessible.
Subsidies can lower the price of healthy foods. This will help put healthy food within reach of poorer people. Prices can be changed through a combination of taxes on unhealthy products and subsidies on healthier alternatives. In Finland, a subsidy of milk protein rather than milk fat resulted in more consumption of low fat milk and a reduction of cardiovascular diseases over time. A fruit and vegetable subsidy in the US Special Supplemental Nutrition Program for Women, Infants, and Children led to increased - and sustained - fruit and vegetable intake.
The way forward
The best policies are those that create positive changes in the food, social and information environments. A policy cannot be adopted in isolation; for the biggest impact they need to be part of a set of mutually reinforcing and supporting actions. Chile is one country that has taken steps like this to create an enabling environment.
Countries in sub-Saharan Africa should regulate the food industry better to protect against industry interference that harms the population. Policies that restrict marketing to children, provide clear labelling and tax unhealthy foodstuffs should be the start. The revenue raised from these taxes could be used to subsidise the cost of healthy foods.
Rina Swart, Professor, University of the Western Cape; Makoma Bopape, Lecturer in Department of Human Nutrition and Dietetic, University of Limpopo, and Tamryn Frank, Researcher, University of the Western Cape