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Hunger Summit

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The document discusses the high cost of a healthy diet in South Africa and potential solutions. It provides an example daily balanced diet plan and cost at current food prices, which is over 3 times the amount typically available to spend per person per day for many South Africans. The document proposes two potential solutions: 1) A food stamp program to increase availability and affordability of nutritious foods for low-income households and 2) Development of an affordable "balanced budget basket" of foods meeting daily nutritional needs sold at reduced prices in retail stores.

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The cost of a healthy diet Hettie Sch旦nfeldt, Nicolette Gibson & Hester Vermeulen School of Agricultural and Food Sciences 1
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
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
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
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
Food Based Dietary Guidelines The FBDGs 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
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
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
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
Food Based Programmes 10
Canadian Healthy Eating Guidelines 11
Food Groups & Recommended portion sizes 12
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
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 (賊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
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
THE REALITY daily nutritionally adequate diet R22.31 VS R5.33 available per person per day 16
Recommended balanced diet ortions: R22.31/day grains fruits & veggies Have available R5.33 meat 17
R7.20 R7.39 18
R5.89 R5.92 19
R6.13 R5.89 1 bread (R5.89) VS 1 potato, 1 orange, 1 tomato (R6.13) 20
R1.49 R1.38 21
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
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
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
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
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
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
Recommended intake: 10 000 kJ/day 28
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
What should be done? Food Security 30
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
Thank You nicolette.gibson@up.ac.za 012 361 2333 32
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 33
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
http://www.fns.usda.gov/fsp/ 35
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
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
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) 38
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 1遜 cup yogurt etc 2 portions meat and meat alternatives > 賊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 39

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Hunger Summit

  • 1. The cost of a healthy diet Hettie Sch旦nfeldt, 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 FBDGs 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
  • 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 (賊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
  • 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
  • 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 33
  • 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
  • 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) 38
  • 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 1遜 cup yogurt etc 2 portions meat and meat alternatives > 賊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 39