Sanhanes-1 Study

SA land of the fat and the hungry

South Africa is a paradoxical land of the fat and the hungry, where poor food choices are piling on the kilos without staving off rumbling stomachs, according to the new South African National Health and Nutrition Examination Survey (Sanhanes-1), published this week by the Human Sciences Research Council (HSRC).

“People buy what they can afford. And mostly it is food that is dense in energy but poor in micronutrients,” said the HSRC’s Prof Demetre Labadarios, one of the survey’s principal investigators, speaking at the launch of the survey in Pretoria on Tuesday August 6.

“We don’t have sufficient diversity in our diets and rely on one or two food groups, like mielie meal pap, from which we get most of our calories,” he said.

Two-thirds of women and a third of men were either overweight or obese, yet a quarter of South African households experienced hunger, the Sanhanes-1, found.

The survey, funded by the Department of Health and the United Kingdom’s Department for International Development (DFID), is the first of its kind conducted in South Africa, and is similar to health and nutrition examination surveys (NHANES) carried out on a regular basis in countries like the United States, Japan, China, Canada and countries in Europe.

SANHANES is designed to assess the health and nutritional status of adults and children, providing a snapshot of the shape, size and nutritional status of the nation, and is intended to help policy makers craft better strategies for managing diseases associated with diet, weight and lack of exercise.

The survey is unique in that it combines interviews in households with physical examinations in mobile clinics and blood analysis in laboratories.

More than 25,000 people completed questionnaires, 12,000 agreed to a physical examination and 8,000 had blood tests, making it the largest survey of its kind to date in SA.

A third of men and half of women aged between 18 and 40 failed a basic fitness test administered by the researchers, with people living in formal housing in urban areas faring slightly worse than their counterparts in informal and rural areas.

Health Minister Aaron Motsoaledi said the survey findings made for uncomfortable reading, as it signalled a potentially large increase in the number of people with noncommunicable diseases, such as diabetes and hypertension in years to come.

One of the most striking findings was that seven out of 10 women had a waist circumference of more than 88cm, a threshold that points to an increased risk of metabolic disorders such as diabetes. “If drastic steps are not taken in the next decade or two health … budgets won’t cope,” said Motsoaledi.

The health system was already struggling to cope with 2-million HIV patients visiting facilities each month for chronic medication and could not manage millions more patients in need of regular medicine for non-communicable diseases, he said.

The minister took a dig at the food industry, saying if it did not start making healthier products it would have no one left to sell to.

But he also acknowledged the structural issues in the economy that made healthier food more pricey than items that offered more nutrition. “There is a worldwide struggle to make healthy food cheaper,” he said, noting that a carton of milk was more expensive than a tin of Coke or Sprite.

The Sanhanes-1 survey found adult smoking had halved since 1993, falling from a prevalence of 32% to 16.4% last year. But it found twice as many people (30%) were exposed to smoking in the environment, prompting the researchers to call for a total ban on smoking in public places.

Half the households surveyed reported that no one drank alcohol, but in those where alcohol was consumed a significant minority (17%) reported misuse.

Motsoaledi said the government had already restricted tobacco and alcohol use, but said further controls were needed. Tobacco had contributed nothing but death and cigarettes “should only exist in a museum”.

He said the government was “marching forward” with its law to discourage the advertising of alcoholic beverages.

“We are not doing this because we want to be a nanny state. We just want to save our country from impending doom.”

Source: BDLive, HSRC

Food, glorious food

With the release of the South African National Health and Nutrition Examination Survey, Mark Heywood of Section27, examines the issue of one of the most fundamental human rights: food.

These are some of the facts that [Sanhanes-1] unearths:

  • 26% of our population experience hunger
  • an additional 28.6% are “living at the risk” of being hungry
  • 28% of “rural formal” and 37% of “rural informal” households are “experiencing hunger”, particularly in the Provinces that are our rural bread and food baskets

By far the most influential factor in determining an individual’s choices when purchasing food is not nutrient content (14.1% of women shoppers consider this, as opposed to 7.3% of men), but rather the price of the food item (64.5% of women shoppers consider this factor).

What do these statistics mean? They mean that there are a hell of a lot of people out there who experience the pangs of hunger, and many of them live around you, in cities and townships, not just in rural areas. Hunger is both a physical and mental deprivation…

In radio discussions after the report was publicised a high level of ignorance was displayed about the impact of poverty on food habits. Many callers questioned (sometimes with genuine ignorance and at other times with what appears to be ill-concealed judgment about the unhealthy choices made by the poor) how we could be a country that exhibits both obesity and malnourishment at the same time. The answer, obviously, is that poor people generally have bad diets.

“Allow not nature more than nature needs” and people buy what they can afford and what fills their empty stomachs, if not their nutritional requirements: cheap but filling starch-based staples and fast food that are greasy, fatty, sugary and salty. All this contributes to both obesity and malnutrition. It also contributes to ill-health and provides just reason for the minister of health to want to regulate fast food manufacturers as well as alcohol, which plays a good role in dulling hunger and a bad role in diverting money that could be spent on food….

Daily Maverick: Read the full article

Visit the HSRC website for full details of the survey