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. 

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Far from the stark images of famine in the 1990s, the idea of ‘hidden hunger’ emerged, and with it the concept of the double burden of disease. Namely the combined effects of having both too little to eat and eating too much of the wrong things (a topic covered in detail in Daily Maverick’s new Food Justice podcast). Epidemiologists positioned this as the cumulative health impacts of stunting and impeded cognitive development, combined cardiovascular diseases, hypertension and obesity. Economists positioned this as the compounding impacts of stunted human potential associated with hunger, and the astronomical costs on the healthcare system associated with being overweight or obese. Wits researchers put the cost to South Africa’s health system at R33-billion a year — 15% of government healthcare expenditure. Raj Patel, one of the world’s leading thinkers on the topic of food justice wrote a book on the topic titled ‘Stuffed and Starved’. You get the idea.

The lost decade of the Zuma era didn’t help. We all know this story, but the collapse of many state functions paired with astronomic unemployment and high food price inflation, has been a tragedy for the food insecure.  

The result? 

Extensive school feeding programmes, government grants and strong social ties have been critical saving graces, helping to keep South Africa from outright famine. And hunger is as prevalent as ever. 

However, as we spend more time in its dark company, we get to understand the less obvious impacts of hunger a little better. Just as we did with the idea of malnutrition and ‘hidden hunger’, the food systems researchers are on the brink of another conceptual leap which will appear to the urban poor as an obvious statement of what’s already common knowledge: Food insecurity is not simply an issue that affects the body. Hunger is having a devastating effect on mental health in South Africa. 

We have spoken for many years about the double burden of disease. We need to start talking about the triple burden, because the double-burden framing has missed the critical dimension of mental health in hunger studies. A growing number of community activists are trying to raise the alarm about the links between chronic hunger and the mental health crisis in South Africa. This includes depression, suicide and gender-based violence. 

While researchers have been urging planners and policymakers to consider the double burden of disease as they develop policy to grapple with hunger in Africa’s growing cities, our emerging research collaborations with food activist organisations like Fact, suggest that this needs to be reframed to the triple burden of disease, to include the dimension of mental health within our wider understanding of the impacts of hunger in our cities.   

Depression, shame, anger and anxiety are, after all, bodily afflictions, like diabetes — just ask the undertakers. DM/MC

Dr Luke Metelerkamp is a research associate at TMG’s Urban Food Futures Programme.

16 October is World Food Day and Maverick Citizen will be publishing articles throughout the week in commemoration of this which will culminate in a special newsletter on Friday 14 October.