South Africa’s triple burden of disease — hunger and its hidden links to our mental health crisis

I was at the checkout in my local supermarket last weekend when a line from a weekend paper caught my eye:

“With gang violence and social economic issues having a cold grip on communities, undertakers have noticed an influx of young people's bodies”

These are the times we live in. As food prices continue to soar to all-time highs and hunger comes knocking where do you turn? Mark Heywood was on point in DM last year when he quoted 32-year-old Russel Makhubela who was reported to have said “What’s the use of collecting firewood because at the end of the day we will have nothing to eat tomorrow” before he went on to poison himself and his family. 

A tragic human face, to an all too common story. Unlike famine situations, in which whole regions face a shared traumatic experience as a result of factors so clearly beyond their control, those who suffer hunger in South Africa often do so in shame and silence, stranded on islands of suffering just beyond the shopping mall: Able to see the shopping isles bursting with food and smell the aromas of other’s cooking, but still be faced with the painful humiliation of failing to put food on your family’s table.    

For a long time, food insecurity meant famine. Emaciated bodies, on the brink of death, in desperate need of emergency food aid. This was India in the 1970s, Ethiopia in the 1990s, and the DRC today. This was not our reality, and so the privileged in power told themselves that they had bigger issues to worry about than what people ate. 

Then things started to change, and South Africa started to take a closer look at the issue of hunger in our towns and cities. This was, in part, driven by those concerned with educating the next generation of ‘born free’ South Africans. Educators realised that they couldn’t teach a hungry child. What we discovered was shocking. In South Africa, the rate of stunted children (low body size for age) is going up, (from 24% in 2004 to 27% in 2016) and millions of South Africans grapple with hunger as part of their daily reality. 

Over this period, in South Africa, as in much of the world, populations were urbanising, and supermarkets and highly processed foods were becoming central pillars in people’s diets. Urbanites, but especially the urban poor, were fending off hunger by cutting down on dietary diversity and filling up in the cheapest way they could: on bulk carbs and sugars. Foods with almost no nutritional value. Regulators responded, by mandating nutritional fortification of staples such as bread and maize meal, but otherwise left the private sector to do what it does best: grow profits by externalising costs. And grow they did. The proportion of food sold through big supermarkets increased from 10% in the 1990s to around 85% today. Fast food outlets and sugar intake followed close behind and by 2012 South Africans were consuming 254 Coca-Cola products per year — three times the global average. This shift in diets forced us to change the way we think about food insecurity as we tried to make sense of the fact that obesity and hunger were now both so prevalent.