A balanced food basket approach to monitor food affordability in South Africa

Abstract

The public health landscape in South Africa today is characterised by a double-burden of nutritional challenges. Under-nutrition is prevalent, as is evident from the high levels of childhood stunting that are reported. Deficiencies of micro-nutrients such as vitamin A and iron continue to be prevalent in children, females and vulnerable groups. Simultaneously overweight and obesity among adults and children together with an associated increase in the occurrence of non-communicable diseases (NCDs) such as diabetes and cardiovascular disease are increasing steadily to epidemic levels. With approximately 40% of the population living under the International Poverty Line and approximately a quarter of the population not able to obtain enough food to fulfil their daily energy needs, poverty and food insecurity are harsh realities in many South African households. The ability of a household to make healthy food choices is, among other factors, affected by food affordability. Food affordability is determined by household income relative to the cost of purchased food items. In recent years, food affordability in South Africa has been under increased pressure due to the following factors: household income-growth barely keeping track with inflation, rising unemployment, as well as high and ever increasing food prices. The pressure on lower income households is particularly profound, forcing such households to use about a third of total expenditure for food purchases. In this study, a multi-disciplinary approach was used (including principles of nutrition, economics and consumer behaviour sciences) to develop models to measure the cost and affordability of healthy eating in South Africa at a national level and on a socio-economically disaggregated basis. The healthy food basket model was primarily based on the South African Food-based Dietary Guidelines, typical food consumption patterns, household demographics and official urban retail food prices monitored by Statistics South Africa. Food affordability is a major challenge, with 60% of the population unable to afford the Moderate-cost Food Basket which provides greater nutritional diversity. The more economical Thrifty Healthy Food Basket (approximately 30% less expensive) is only affordable to approximately half of the South African population. A four member household earning two minimum wages has to spend a third of total expenditure on food to be able to afford this basket, while the typical food expenditure share of such households is usually lower (approximately 24%), thus confirming the pressure on households to afford healthy eating. In future the models of healthy eating also present possibilities for further expansion (e.g. these models can be refined to study different geographical areas or different household structure typologies). Compared to national nutritional recommendations, the study found that the intakes of whole-grain starch-rich foods, lean meat, fish, eggs, dairy, fruit, vegetables and legumes were low. Inadequate intake was generally more severe among lower income households. Less-affluent households spend a large proportion of their food budget on starch-rich staples, fats / oils and sugar-rich foods, but allocate insufficient resources to animal-source foods, legumes, fruit and vegetables. This study also identified that excessive intakes of refined and processed starch-rich food options, sugar-rich foods and fats / oils were common across all income groups and increased with socio-economic status. These findings confirm the reality of the nutrition transition in South Africa. The contribution of this research to estimate the socio-economically disaggregated consumption of animal-source foods (meat, fish and eggs) and starch-rich foods (maize meal, bread, rice and potatoes), provides valuable insights into differences in food intake across the socio-economic spectrum of South Africa. A complex combination of interventions is required to promote healthy eating patterns in South Africa. In addition to legislative measures (e.g. salt and sugar reduction legislation), consumer education (across the socio-economic spectrum) should focus on science-based practical solutions and provide advice on making healthy and budget-conscious food choices. In addition, it is also important to design and implement policy actions to improve the affordability and availability of healthy food options for the various socio-economic groups, in diverse geographic locations in South Africa. The improvement of food affordability is a key component in moving closer to achieve the Sustainable Development Goal of the United Nations “to end hunger, achieve food security, improve nutrition and promote sustainable agriculture”. Furthermore, improving household food and nutrition security (including addressing issues pertaining to healthy food consumption and affordability), through public and private sector actions, is one of the enabling milestones in the National Development Plan 2030. The monthly costing of the food basket models which were developed in this study and analyses thereof should be used as policy analysis tools to act as a practical, scientific basis for the food security debate in South Africa. These tools are, in fact, already published on a quarterly basis in the public domain. In future the models of healthy eating also present possibilities for further expansion (e.g. these models can be refined to study different geographical areas or different household structure typologies).