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18 June 2020 | Story Dr Chantell Witten | Photo Supplied
Dr Chantell Witten.

On 26 March 2020, the President declared a national lockdown in response to the COVID-19 pandemic as it started to emerge in South Africa. Since then and several weeks into the lockdown, Statistics South Africa (2020) has provided evidence which many intuitively knew would be more devastating to households than the coronavirus itself – loss of income and the negative effects that follow hunger. Stats SA reported that the percentage of respondents receiving no income increased from 5,2% before the lockdown to 15,4% by the sixth week of the national lockdown. Given that the majority of South Africans depend on the informal labour market, such as informal traders and casual workers, this lack of income would hit millions of households. Furthermore, Stats SA also reported a decrease in formal wage/salary earners for the same period, from 76,6% before the national lockdown to 66,7% by the sixth week of national lockdown.

While South Africa is food secure at national level, millions of households are food insecure. According to the United Nations Food and Agriculture Organization’s (FAO) 1996 definition of food security, this simply means that there is not enough food at all times for all the people in a household to have physical and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.  In short, people are hungry and at greater risk for ill health – physically, emotionally, and spiritually.  A hungry man is an angry man. Likewise, a hungry nation is an angry nation.

In July 2019, the measurement of extreme poverty – the food poverty line (FPL) – was raised to R561 (using April 2019 prices) per person per month, which was up from R547 last year. This is the amount of money that Stats SA calculates an individual requires “to afford the minimum required daily energy intake” of 2 100 calories per day. Before the onset of the COVID-19 pandemic, South Africa already had a precarious food and nutrition situation, especially for young children. South Africa’s child stunting levels – an indication of chronic and long-term food insecurity – increased from 21% in 2008 to 27% in 2016.  With COVID-19 and the subsequent lockdown, child malnutrition rates are expected to increase. Stunting not only affects a child’s health, making them more susceptible to disease and infection, but also impairs their mental and physical development – meaning that children who suffer from stunting are less likely to achieve their full height and cognitive potentials as adults.  

What can we do to address this food situation or prevent it from worsening?
The 2020 Global Nutrition Report recognises and asserts that inequality and globalisation are major drivers of food insecurity. As individuals and as collectives, we need to continue to advocate for and support calls to continue raising the child support grant to help households stay above the poverty line.  Millions of households in South Africa are supported by social grants; in solidarity, we need to appreciate the safety net that these social grants provide to vulnerable households. Advocate for and support initiatives to safeguard child health and nutrition, including efforts to promote, protect, and support breastfeeding in neonatal care, postnatal care, and ongoing support to breastfeeding mothers.  Breastfeeding remains the most cost-effective health intervention for infants and young children, supporting optimal growth and development and providing long-term health benefits into adulthood. Advocate for and support initiatives to coordinate sustainable food support to vulnerable households, including, among others, food distribution, food vouchers, onsite feeding, home gardening, and tax-free food baskets.  These efforts would be our collective solidarity to support and protect vulnerable households as we enter the global economic recession as a result of COVID-19.

How can we protect our households’ food and nutrition security? 
COVID-19 brings with it much uncertainty and many unintended negative effects.  While we seek out strategies to support mental well-being and emotional resilience, we also need to remain physically healthy.  Good nutrition is fundamental to good health and well-being. South Africa has a set of ten healthy eating guidelines that promote the principles of eating more unprocessed foods, eating more vegetables and fruit, reducing the use of fats and oils and reducing the intake of sugar and salt.  Good nutrition starts with good food and sometimes good food can cost more, so it is important to use your food budget wisely.  The food budget includes food eaten at home, as well as funds spent on food eaten outside of the home, eating take-outs, foods bought online, and food eaten away from home.  Planning your meals in advance and sticking to a food plan will limit opportunities to spend money on items that are not on the plan; planning ahead also means you can take advantage of good prices, especially as food prices are on the increase and will continue to increase. Bulking up when prices are low and on special, making use of combo buying, e.g. buy three and pay for two, and buying directly from food producers such as co-ops, all help to save money in the long run.  Meat, fish, and especially seafood are the most expensive food items; rather use eggs, chicken, and less expense meat cuts for your meals.  Legumes such as dried beans, peas, and soya are less expensive with great nutritional value.  Explore these less-known group of foods with many great health benefits, such as no fat, more fibre, and lots of vitamins and minerals.

In an effort to eat more fresh vegetables and fruit, starting a home garden is a great family challenge and a definite way of keeping food costs low. And as we navigate the new normal post-COVID times ahead, let us keep mealtimes and meal preparation a fun family activity. Discovering new foods and new tastes can be as exciting as travelling to a new place.  Stay safe, stay healthy! 

Opinion article by Dr Chantell Witten, Division of Health Professions Education, University of the Free State.


News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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