The shuffling of health ministers in recent years has left policy and legislation to regulate processed food manufacturing and retailing in equally messy disarray. 

Public health lawyer Safura Abdool Karim said South Africa has, since the exit of Aaron Motsoaledi as health minister in 2019, seen a backsliding in prioritising regulations to compel manufacturers and retailers to reduce or eliminate unhealthy ingredients in their food and beverage offerings and to change how these products are marketed to consumers. 

“We have gone from being world leaders in legislation to lagging behind,” said Abdool Karim, who is also a consultant at PRICELESS SA in the Wits School of Public Health. She was a panellist at Wednesday’s Daily Maverick webinar titled Delay, Dilute, Delegitimise — how the food industry shapes what you eat and what you weigh.

She said South Africa had made “pioneering” strides since 2011 in legislating to effectively ban trans fats in foodstuff and reduce salt and sugar in processed food. But the past three years have seen weakened political will, inaction and growing industry and labour resistance.

“The huge loss of political will has also come with a shift in focus to the likes of Covid-19 and NHI, but we are also talking about policies that have been stalled from before Covid-19 or NHI. Another challenge is that non-communicable diseases are different to many other health crises in that it faces very strong opposition. For example, since 2004 there has been no opposition to HIV treatment or TB treatment, but with food regulation there is strong opposition from labour and industry because they have deeply vested interests,” she said.

Without legislation and commitment to legislate and regulate appropriately, she says industry turns conveniently to the “delay, dilute and delegitimise” tactics that downplay the public health crisis of a rise in non-communicable diseases (like cardiovascular diseases, cancers, obesity and diabetes). These are linked to overconsumption of foods that are unhealthy and offer poor nutrition.

Consumers remain in the dark about what exactly is in the food they eat. A lack of transparency and accountability from industry also remains the status quo and the public health bill keeps edging upwards.

The treatment of diabetes already costs taxpayers billions, webinar host and journalist Zukiswa Pikoli said. Global Health Action reported on a 2018 study that found it costs taxpayers about R3-billion a year to treat people who have diabetes in South Africa. By 2030, it is estimated that about 4.5 million people who will be reliant on public sector healthcare will have type 2 diabetes, translating to a projected annual bill above R35-billion. 

Independent strategic health journalist and editor Laura Lopez Gonzalez said a proposed moratorium on the increases in the sugar tax — ostensibly to give the sugar industry a boost through a reprieve — could last at least until 2023. 

She said: “So you have had almost no change, basically only a small increase that’s inflation-related — so essentially the tax levy [that came into effect in 2018] keeps getting weaker.”

Lopez Gonzalez said: “Industry narratives lean on the issue of job losses [if the sugar tax is increased] but rarely ever are the health impacts included in those job calculations — like what it costs to companies, what it cost to workers, what it costs society at large.”

Underpinning issues such as raising the sugar tax came down to human rights, Pikoli said. “There is a very real toll on people’s lives and taking people out, other than in economic fallout. It’s important that when we talk about food justice, that it actually is denying people the right to life — it’s what it boils down to.”

The panellists also said that the issue of nutritional literacy was another distraction that shifted the onus for choosing healthier food options on to individual consumers. 

Lopez Gonzalez said a 2013 study on nutrition scored South Africans’ nutritional literacy at just 5/10. The context of the low score though, she said, needed to be better understood.

“There are definitely gaps in nutritional literacy, but if you have no option for buying food, you can be as literate as you want about what you shouldn’t be eating; it doesn’t mean that you can choose — it’s a false choice… there’s also a shaming narrative of individuals who get sick or are overweight like it’s their bad choices alone, but this is something that we need to unpack,” she said. 

Abdool Karim reiterated this point in an interview after the webinar. She said: “It is not about individuals’ discretionary use of a food, but it’s about what is hidden in the foods that have been formulated in such a way that we consume much more sugar, salt and fat than we realise.

“You can have three teaspoons of sugar in your coffee; that isn’t the problem — it’s the 13 teaspoons of sugar in a bottle of Coke that you don’t know you’re consuming that is the problem,” she said.

Added to this, she said, was that food systems had become monopolised, giving rise to a mighty corporate lobby that also allowed big business to get off the hook.

“We have incredibly localised and concentrated food systems and food supply chains. Four companies control 80% of the food production in South Africa. In the grocery retail market, it’s also four companies that control 80% of formal grocery outlets. So clearly, there is this very close link between monopolisation or concentration of the food supply and choice,” Abdool Karim said. 

For her, pushback and pressure must come from civil society and consumers to turn around an epidemic of non-communicable disease.

“Civil society and consumers need a voice and need to ask why government is failing people and not protecting them from getting sick 10 or 20 years into the future. There should be warning labels on unhealthy food items. And we need to know what is being hidden from us.”

The way forward, she and Lopez Gonzalez said, required multipronged strategies. It included more awareness and education and more research to quantify the costs of not curbing the industry with legislation. It extended too to support for informal food systems such as small-scale farmers and traders and even supporting the likes of linking schools to food garden projects to ensure school nutrition programmes were healthier. 

“It’s incredibly complex. And we need to use every tool in our arsenal,” Abdool Karim said. MC/DM