Obesity: no choice in SA

BIAS: POOREST AREAS HAVE FAST-FOOD OUTLETS BUT NO GROCERY STORES

1 559 unhealthy food outlets in Gauteng, 709 healthy ones in 2016.

Obesity-related diseases such as cancer, heart disease and diabetes are rapidly overtaking HIV as the top causes of death in South Africa. Bad diets are a major contributor to this epidemic.

But how should countries like South Africa ensure that people, particularly the poor, among whom the burden of noncommunicable diseases is highest, have access to healthy food?

Recent research by the Wits School of Public Health, the Health Systems Trust and the University of KwaZulu-Natal showed a proliferation of unhealthy food, particularly in poorer communities.

This demonstrates the need for the government to intervene urgently. One possibility is to create new policies or adapt existing ones to promote healthy food. In particular, local governments have a unique opportunity to intervene.

The research used a distinction between unhealthy and healthy foods drawn up by the Centres for Disease Control and Prevention. These categorised grocery stores and supermarkets as “healthy” and fast-food restaurants, for example, as “unhealthy”.

The research set out to assess differences in food environment based on socioeconomic status. It focused on grocery stores and fast-food restaurants only, with full-service restaurants excluded. The analysis used a tool called the “modified retail food environment index” and showed the proportion of food retailers in Gauteng that were “healthy” and what proportion were “unhealthy”.

The results found that fast-food outlets, and the unhealthy foods they serve, vastly outnumbered formal grocery stores. In November 2016, there were 1 559 unhealthy food outlets in Gauteng compared with just 709 healthy food outlets.

Most of the poorer wards had only fast-food retailers with no healthy food outlets. Conversely, grocery stores were concentrated in wealthy areas.

The research shows that many wards in Gauteng have a high concentration of unhealthy food – in other words, they have “obesogenic” food environments. This means the type of food available in these environments promotes obesity, leaving their residents little choice.

This is a big problem. But it can be fixed. One possible strategy is to introduce policies that limit the number of fast-food outlets in communities. But what would these policies look like, and who would implement them?

Local, as well as national, government structures have the authority to license and control food retailers.

In addition, local governments have extensive powers over planning and zoning. They could be required to consider the impact on the food environment when granting zoning approvals or business licences.

This would require filling a gap in municipal bylaws. For example, the City of Joburg municipality has passed two bylaws regulating informal or street trading and one on spatial planning. But neither of these link municipal planning obligations to the placement of food retailers. This gap can be filled by explicitly taking saturation or scarcity of different food retailers into account. This could include, for example, creating a zoning exemption or special approval for healthy retailers.

Alternatively, national level policies can better guide implementation at a local level. This would require governments to adapt existing business licensing and planning frameworks to take into account the lack of healthy food retailers in a particular area.

For example, the framework used to grant business licences is set out in national legislation, the Business Act, but implemented by local governments. This framework might require conditions that are more stringent for food retailers before they set up shop.

Currently, businesses are required to submit a copy of the menu of a food trader and a zoning certificate when applying for a licence. This means municipalities are aware of what kind of retailer is applying for a licence and the nature of their food. Municipalities could use this information to control the number of fast-food retailers in a given area.

Additionally, municipalities could streamline the process for licensing healthy food retailers, making it easier and faster for them to open in areas most in need.

By creating a separate, simpler process of approval for healthy retailers, it would potentially encourage more of them to open.

Alternatively, they could introduce a certificate of “need exemption”.

This system could then allow a waiver of some requirements for a licence if that business can demonstrate a need for healthy food retailers in an area.

Local governments have already exercised this kind of power to further public health. Cape Town passed a law that prohibited smoking within a certain distance of doors and open windows.

Municipalities could also put regulations in place that restrict the sale of unhealthy food near schools. They could incentivise retailers to move to underserved areas. Steps like this are already being explored and are set out in detail by the World Health Organisation guidelines.

There’s a plethora of options if municipalities want to improve their food environments and can facilitate the right to access healthy foods for the poorest and most vulnerable. A good place to start in South Africa would be Gauteng.

Karen Hofman: Professor and programme director of Priceless SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the Witwatersrand.

Safura Abdool Karim: Senior project manager Priceless SA.

Republished from TheConversation.com

A plethora of options if municipalities want to improve food environments.