Programme Director
Dr Shisana, CEO Human Sciences Research Council (HSRC)
Professor Labadarios, Executive Director, Knowledge Systems and Director of the Centre for the Study of the Social and Environmental Determinants of Nutrition
Members of the Centre for the Study of the Social and Environmental Determinants of Nutrition
Honoured guests
Members of the media
Ladies and gentlemen
Of all medicines, food is the oldest, necessary and trusted one. This statement of course includes the satisfaction and pleasure that is associated with eating.
The past three decades have seen extensive and significant developments in the field of nutrition as well as in our lifestyles. The associations between nutrition and disease prevention have been strengthened. Food choices have never been greater, the need to eat "on the move" is increasing and the time we spend on preparing food and eating in a supportive family environment is a diminishing practice.
Few, if any, will doubt the important role of nutrition in disease prevention and treatment. Indeed, lack of food or its consumption in excess is responsible for the wide and deadly, spectrum of nutritional disorders in the developed and developing world today.
The World Health Report 2007 indicated that non-communicable diseases (NCDs), also called chronic diseases of lifestyle, accounted for 60 percent of the estimated 56 million deaths globally, and 47 percent of the global burden of disease. While these diseases were initially mainly limited to higher socio-economic groups in low and middle-income countries, recent evidence suggests that the unhealthy behaviours associated with these diseases are becoming increasingly prevalent in poor communities of resource constraint countries and diseases of lifestyle are becoming more prominent in these communities.
The World Health Report in 2005 highlighted that a few major risk factors accounted for most of the diseases and deaths associated with the major chronic diseases of lifestyle, namely cardiovascular disease (CVD), type two diabetes and certain types of cancer. The major risk factors identified as leading causes of these diseases were high blood pressure, elevated blood fat levels including serum cholesterol levels, overweight and obesity, physical inactivity, tobacco use, and a poor quality diet. Globally, the unhealthy lifestyles associated with chronic diseases of lifestyle were the same. With respect to diet include a high consumption of energy-dense foods that are low in important minerals and vitamins as well as fibre and are high in total fat, saturated fat, trans-fatty acids, free sugars and salt.
On the other side of the spectrum, the world health statistics in 2009 indicate that very large number of children was underweight and that under-nutrition was an underlying cause in more than one third of child deaths. South Africa has not escaped these global trends. South Africa is a middle income country with a variety of living conditions spanning wealthy and middle income suburbs, deprived peri-urban areas, rural farms and under-developed rural areas. Changing social, political and economic factors have resulted in increased urbanisation and changes in diet and health behaviours. Indeed, South Africa has been described as having a "quadruple burden of disease", which includes the conditions associated with under-development, the emerging chronic diseases related to unhealthy lifestyles, HIV and AIDS and injuries.
Studies on dietary intake show that the black African population is undergoing a transition in dietary intake from a traditional high fibre, high carbohydrate intake to a more typically western diet, which has an increased fat and added sugar intake, a lower unrefined carbohydrate intake and an increased intake of animal protein sources, saturated fat and salt. Fruit and vegetable intake is also far below that recommended by the World Health Organisation (WHO). These eating patterns are reflected in the high prevalence of overweight and obesity in the adult and child populations. At the same time stunting and chronic energy deficiency still affect a large number of infants and children in the country.
Since 1994, we have been fortunate to have implemented successfully three national surveys in children which have defined their nutrient and energy intake, micronutrient status, procurement and eating patterns as well as prevalence of under and over nutrition in the country.
The two more recent national surveys, the national food consumption surveys, have shown that there are significant differences between urban and rural areas, and among different age groups.
Overweight is highest in formal urban areas and in one to three year old children. This is an indication that the nutrition transition is underway and that under-nutrition and associated infectious diseases should not be the only health concern for policy makers. The data also indicated that the prevalence of combined overweight and obesity among one to nine year old children is nearly the same as that for stunting in the same age group.
Furthermore, stunting was associated with an increased risk (nearly double) of becoming overweight. This finding suggests that stunting in childhood predisposes children to become overweight or obese when they reach adolescence or adulthood. This association, in its own right, poses a threat for the emergence of chronic disease risk factors when these stunted children become obese adults.
All available reports show that both over and under-nutrition are found in South Africa, with the black population showing the extremes most strongly.
The most recent data on overweight and obesity in adults from Demographic and Health Survey the (DHS) indicated that obesity increased with age until about 35 years in both men and women and declined from about 55 years. A significant proportion of women are obese from about 35 years of age, while more than 20 percent of all women are overweight. For the ethnic groups, obesity is highest in black women and in white men. The prevalence of underweight in adults is far lower than the prevalence of overweight and obesity in males and females.
The reference food consumption surveys together with the DHS have helped shape government policy in a wider context, but more specifically in relation to micronutrients which culminated in the mandatory micronutrient fortification of our staple foods as well as the prevention of the diseases of life style.
Despite the remarkable progress in defining the prevalence of a wide spectrum of nutritional disorders in the country, our policies and interventions need to be more focused and custom designed if they are to be more successful.
Understanding the social and environmental determinants of nutrition has become even more crucial because that is where we as government can intervene to change behaviours in the purchase of food types, in the preparation of food, and in eating a variety of affordable foods and in the amounts that are appropriate.
It is important for us to also monitor the population's food consumption patterns and diseases associated with these patterns. We need to understand, for instance, the socio-cultural determinants of the co-existence of over and under-nutrition in food insecure households. In this regard, we need a road map for nutrition and food security in the country.
The Roadmap will identify a path towards broad based nutrition security for all South Africans. The HSRC has been asked to coordinate this process, as an "honest broker". We see the need for an independent process that draws in key stakeholders for honest and open reflection.
I understand that within the HSRC, this will be a partnership between the Centre for Poverty Employment and Growth, and the new Centre for the Study of the Social and Environmental Determinants of Nutrition. Government is giving this high level priority, recognising the extent of under-nutrition for many South Africans.
The work on the national food consumption surveys is well noted and we encourage this type of work and so are your efforts to set up the South African National Health and Nutrition Examination Survey (SANHANES). The SANHANES will not only extend our knowledge, which is currently restricted to children only, to the whole population in the country but it will also address the need to better define and understand the social and environmental determinants of nutrition.
We need to identify the paths that can practically transpose us from the current status to desired policy end points. We need to know how we can improve on current outcomes in order to improve our current policies. We need to indentify focused, short term interventions that could have quick and high impact.
Your efforts to set up the African Taskforce on Obesity are visionary and will establish a much needed resource centre on knowledge of African diets and foods. It will complement your current research efforts in Zambia, Kenya, Ghana, Seychelles and lead to the improvement of nutrition knowledge and nutritional status of the people of sub-Saharan Africa and regional policy.
Finally, I would like to thank Professor Labadarios for not only being the chairman of our founding and successful national surveys and for serving on many provincial and national nutrition committees since 1994, but also for his vision in creating this unique Centre for the Study of the Social and Environmental Determinants of Nutrition in the HSRC. I would also like to thank the HSRC for adding nutrition to its already excellent work in health, particularly the HIV and AIDS research, the National Health Insurance research and planning work as well as maternal and child health.
I now launch the Centre for the Study of the Social and Environmental Determinants of Nutrition and look forward to working with you together with my other colleagues whose work will also impact on the future research of the centre.
Thank you
Issued by: Department of Health
15 March 2010
Source: Department of Health (http://www.doh.gov.za/)
