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14 April 2021 | Story Dr Chantell Witten | Photo Supplied
Dr Chantell Witten is from the Division of Health Professions Education.

A decade ago, Rob Nixon, a professor in the humanities and environment studies at Princeton University in the US, introduced the concept of slow violence in the context of climate change and environmentalism, explaining slow violence as violence that occurs gradually and out of sight, a violence of delayed destruction that is dispersed across time and space, an attritional violence that is typically not viewed as violence, at all. While profound, Professor Nixon’s concept of ”out-of-sight violence” and ”violence of delayed destruction” was challenged by Professor Thom Davies from the University of Nottingham in the UK who urged scholars to instead ask the question: ”out of sight to whom?” He argued that structural inequality mutated into noxious instances of immediate slow but pervasive violence by those who have endured toxic landscapes and unhealthy physical environments.

Reflecting on the impact of COVID-19 in the context of persistent hunger in South Africa’s cities, Dr Gareth Haysom from the University of Cape Town, challenged us as society to recognise the ”slow violence“ of hunger and food insecurity that are also often “experienced in private, incremental and accretive ways that are often invisible”. But as urged by Professor Davies, the question of child hunger and malnutrition in South Africa is really, to whom is this hunger and malnutrition invisible?

Malnutrition and its debilitating consequences have been studied and known about as far back as the 1950s. In 1976, Stoch and Smyth from the then Child Psychiatric Unit and Department of Paediatrics and Child Health at the University of Cape Town reported on a 15-year developmental study conducted from 1955 to 1970 on the effects of severe undernutrition during infancy on subsequent physical growth and intellectual functioning on coloured children from the Cape Flats concluded that the effects of severe undernutrition during infancy on subsequent brain growth and intellectual development confirmed gross retardation of intellect in the undernourished group when compared to the controls. Furthermore, the study concluded that given the abnormal performance of the control group that there was much evidence to suggest that the controls were also suboptimal in terms of nutritional status and intellectual functioning. This means that in general the nutritional status of coloured children on the Cape Flats was poor. Fast forward to 2021, and child nutrition in South Africa is still sub-optimal.

South Africa’s nutrition indicators have worsened

The most recent data from 2016 National Demographic Health Survey showed that 27% of children under the age of five years are stunted or too short for their age. This equates to more than 1.5 million children whose health and development is compromised and who have a lower chance of reaching their full potential even into their adult years. While many countries of the same economic development status have improved their nutrition indicators, South Africa’s nutrition indicators have worsened. South Africa has been identified as one of the countries with high levels of multiple forms of malnutrition manifested in high levels of stunting, childhood obesity and multiple micronutrient deficiencies, the most notable being vitamin A deficiency. These multiple forms of malnutrition cast a long shadow of ill-health and delayed development. of children, robbing them of quality of life and years of life in their childhood and their adult years. Malnutrition has a double cost on quality of life and additional health costs consuming resources that could have been spent on better food.

The right to have access to sufficient food is embedded in Section 26 and 27 of our Constitution and the right to adequate nutrition for children is stipulated in section 28. The Bill of Rights enshrined in the Constitution states that “every citizen has a right to have access to sufficient food, water and social security” and that “the State must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of this right”. Before the onslaught of COVID-19, we as health and social care professionals, have been acutely aware that a significant number of South Africans do not have access to sufficient food and go hungry on a daily basis. Malnutrition is well-documented in South Africa and unfortunately is progressively getting worse.

SA has not prioritised children or the realisation of their human rights to food and nutrition

Better nutrition can only be achieved when food and care are available to young children but in the context of rising food prices, limited maternal support and a difficult psychosocial environment, mothers are not able to provide their children with a health-enabling environment. Our high levels of stunting and obesity levels reflect the chronic situation of poor-quality and inadequate diets coupled with poor caring practices. While these poor dietary practices are often individualised and focused on mothers, there are many systemic and structural barriers for families to access affordable and nutritious diets. The food environment is shaped by a profit-centred food system that comes at the cost of people’s health and well-being. Children have always being the prime focus of the food industry, from the promotion of maternal supplements to improved maternal nutrition for the developing foetus, to the promotion of infant formula as a convenient and easy-to-use alternative to breastfeeding, to the manipulative marketing of foods for and to children.

Child nutrition has become a global tracking indicator for both human and economic development. Sadly, our lack of progress over the past 20 years clearly illustrates that we, as a country, have not prioritised children or the realisation of their human rights to food and nutrition. The findings of the 2020 Child Gauge gives us, as a country, the opportunity to stop the violations of children’s rights and to end the slow violence of child malnutrition.

News Archive

Media: Sunday Times
2006-05-20

Sunday Times, 4 June 2006

True leadership may mean admitting disunity
 

In this edited extract from the inaugural King Moshoeshoe Memorial Lecture at the University of the Free State, Professor Njabulo S Ndebele explores the leadership challenges facing South Africa

RECENT events have created a sense that we are undergoing a serious crisis of leadership in our new democracy. An increasing number of highly intelligent, sensitive and committed South Africans, across class, racial and cultural spectrums, confess to feeling uncertain and vulnerable as never before since 1994.

When indomitable optimists confess to having a sense of things unhinging, the misery of anxiety spreads. We have the sense that events are spiralling out of control and that no one among the leadership of the country seems to have a definitive handle on things.

There can be nothing more debilitating than a generalised and undefined sense of anxiety in the body politic. It breeds conspiracies and fear.

There is an impression that a very complex society has developed, in the last few years, a rather simple, centralised governance mechanism in the hope that delivery can be better and more quickly driven. The complexity of governance then gets located within a single structure of authority rather than in the devolved structures envisaged in the Constitution, which should interact with one another continuously, and in response to their specific settings, to achieve defined goals. Collapse in a single structure of authority, because there is no robust backup, can be catastrophic.

The autonomy of devolved structures presents itself as an impediment only when visionary cohesion collapses. Where such cohesion is strong, the impediment is only illusory, particularly when it encourages healthy competition, for example, among the provinces, or where a province develops a character that is not necessarily autonomous politically but rather distinctive and a special source of regional pride. Such competition brings vibrancy to the country. It does not necessarily challenge the centre.

Devolved autonomy is vital in the interests of sustainable governance. The failure of various structures to actualise their constitutionally defined roles should not be attributed to the failure of the prescribed governance mechanism. It is too early to say that what we have has not worked. The only viable corrective will be in our ability to be robust in identifying the problems and dealing with them concertedly.

We have never had social cohesion in South Africa — certainly not since the Natives’ Land Act of 1913. What we definitely have had over the decades is a mobilising vision. Could it be that the mobilising vision, mistaken for social cohesion, is cracking under the weight of the reality and extent of social reconstruction, and that the legitimate framework for debating these problems is collapsing? If that is so, are we witnessing a cumulative failure of leadership?

I am making a descriptive rather than an evaluative inquiry. I do not believe that there is any single entity to be blamed. It is simply that we may be a country in search of another line of approach. What will it be?

I would like to suggest two avenues of approach — an inclusive model and a counter-intuitive model of leadership.

In an inclusive approach, leadership is exercised not only by those who have been put in some position of power to steer an organisation or institution. Leadership is what all of us do when we express, sincerely, our deepest feelings and thoughts; when we do our work, whatever it is, with passion and integrity.

Counter-intuitive leadership lies in the ability of leaders to read a problematic situation, assess probable outcomes and then recognise that those outcomes will only compound the problem. Genuine leadership, in this sense, requires going against probability in seeking unexpected outcomes. That’s what happened when we avoided a civil war and ended up with an “unexpected” democracy.

Right now, we may very well hear desperate calls for unity, when the counter-intuitive imperative would be to acknowledge disunity. A declaration of unity where it manifestly does not appear to exist will fail to reassure.

Many within the “broad alliance” might have the view that the mobilising vision of old may have transformed into a strategy of executive steering with a disposition towards an expectation of compliance. No matter how compelling the reasons for that tendency, it may be seen as part of a cumulative process in which popular notions of democratic governance are apparently undermined and devalued; and where public uncertainty in the midst of seeming crisis induces fear which could freeze public thinking at a time when more voices ought to be heard.

Could it be that part of the problem is that we are unable to deal with the notion of opposition? We are horrified that any of us could be seen to have become “the opposition”. The word has been demonised. In reality, it is time we began to anticipate the arrival of a moment when there is no longer a single, overwhelmingly dominant political force as is currently the case. Such is the course of history. The measure of the maturity of the current political environment will be in how it can create conditions that anticipate that moment rather than seek to prevent it. We see here once more the essential creativity of the counter-intuitive imperative.

This is the formidable challenge of a popular post-apartheid political movement. Can it conceptually anticipate a future when it is no longer overwhelmingly in control, in the form in which it is currently, and resist, counter-intuitively, the temptation to prevent such an eventuality? Successfully resisting such an option would enable its current vision and its ultimate legacy to our country to manifest in different articulations, which then contend for social influence. In this way, the vision never really dies; it simply evolves into higher, more complex forms of itself. Consider the metaphor of flying ants replicating the ant community by establishing new ones.

We may certainly experience the meaning of comradeship differently, where we will now have “comrades on the other side”.

Any political movement that imagines itself as a perpetual entity should look at the compelling evidence of history. Few movements have survived those defining moments when they should have been more elastic, and that because they were not, did not live to see the next day.

I believe we may have reached a moment not fundamentally different from the sobering, yet uplifting and vision-making, nation-building realities that led to Kempton Park in the early ’90s. The difference between then and now is that the black majority is not facing white compatriots across the negotiating table. Rather, it is facing itself: perhaps really for the first time since 1994. Could we apply to ourselves the same degree of inventiveness and rigorous negotiation we displayed leading up to the adoption or our Constitution?

This is not a time for repeating old platitudes. It is the time, once more, for vision.

In the total scheme of things, the outcome could be as disastrous as it could be formative and uplifting, setting in place the conditions for a true renaissance that could be sustained for generations to come.

Ndebele is Vice-Chancellor of the University of Cape Town and author of the novel The Cry of Winnie Mandela

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