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Local Solutions Can Boost Healthier Food Choices In South Africa

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The crisis in health triggered by cheap food that’s high in fat and sugar is now well documented. Obesity related diseases such as cancer, heart disease and diabetes are rapidly overtaking HIV as the top causes of death in South Africa. A bad diet is a major contributor to this epidemic because people increasingly opt for unhealthier, processed and fast foods.

But how should countries like South Africa go about making sure that people – particularly poor people (where the burden of non-communicable diseases is highest) – have access to healthy food?

Recent research from the Wits School of Public Health, the Health Systems Trust and the University of KwaZulu-Natal sheds fresh light on the problem, showing a proliferation of unhealthy food, particularly in poorer communities.

This demonstrates the need for the government to intervene urgently. One possibility is to create new policies or adapt existing policies to promote the creation of healthy food environments. In particular, local governments have a unique opportunity to intervene.

What food’s available where

The research used a distinction between unhealthy and healthy foods drawn up by the Centres for Disease Control and Prevention. This categorises grocery stores and supermarkets as “healthy” and fast-food restaurants, for example, as “unhealthy”.

The research set out to assess differences in food environment based on socio-economic status. It focused on grocery stores and fast-food restaurants only, with full service restaurants excluded.

The analysis used a tool called the “modified retail food environment index” and show the proportion of food retailers in Gauteng that were “healthy” and what proportion were “unhealthy”.

The results showed how fast-food outlets, and the unhealthy foods they serve, vastly outnumbered formal grocery stores. In November 2016, there were 1559 unhealthy food outlets in Gauteng compared to only 709 healthy food outlets.

Strikingly, the distribution of these outlets are income-based. Most of the poorer wards had only fast-food retailers with no healthy food outlets. Conversely, grocery stores are concentrated in wealthy areas.

The research shows that many wards in Gauteng have high concentrations of unhealthy food – in other words, they have “obesogenic” food environments. This means the type of food available in this environment promote obesity, leaving their residents little choice.

This is a big problem. But it can be fixed.

Changes

One possible strategy is to introduce policies that limit the number of fast-food outlets in communities. But what would these policies look like, and who would implement them?

Local as well as national government structures have the authority to license and control food retailers.

In addition, local governments have extensive powers over planning and zoning. They could be required to consider the impact on the food environment when granting zoning approvals or business licenses.

This would require filling a gap in municipal bylaws. For example, the City of Johannesburg municipality has passed two bylaws regulating informal or street trading and one on spatial planning.

But neither of these link municipal planning obligations to the placement of food retailers. This gap can be filled by explicitly taking saturation or scarcity of different food retailers into account. This could include, for example, creating a zoning exemption or special approval for healthy retailers.

Alternatively, national level policies can better guide implementation at a local level. This would require governments to adapt existing business licensing and planning frameworks to take into account the lack of healthy food retailers in a particular area.

For example, the framework used to grant business licenses is set out in national legislation, the Business Act, but implemented by local governments. This framework might require conditions that are more stringent for food retailers before they set up shop.

Currently, businesses are required to submit a copy of the menu of a food trader and a zoning certificate when applying for a license. This means that municipalities are aware of what kind of retailer is applying for a licence and the nature of their food offerings. Municipalities could use this information to control the number of fast-food retailers in a given area.

Additionally, municipalities could streamline the process for licensing healthy food retailers, making it easier and faster for them to open in areas most in need. By creating a separate, simpler process of approval for healthy retailers, it would potentially encourage more of them to open. Alternatively, they could introduce a certificate of “need exemption”. This system could then allow a waiver of some requirements for a license if that business can demonstrate a need for healthy food retailers in an area.

Local governments have already exercised this kind of power to further public health. Cape Town passed a law that prohibited smoking within a certain distance of doors and open windows.

Municipalities could also put regulations in place that restrict the sale of unhealthy food near schools. In addition, they could incentivise retailers to move to under-served areas. Steps like this are already being explored and are set out in detail by the World Health Organisation guidelines.

Challenges

The research shows that poor South Africans have little choice when it comes to purchasing healthy food in their own neighbourhoods. In addition, municipal governments aren’t doing enough to preserve and improve access to healthier foods.

This must change. There’s a plethora of options to select from if municipalities want to improve their food environments and can facilitate the right to access to healthy foods for the poorest and most vulnerable. A good place to start in South Africa would be Gauteng.

Noluthando Ndlovu, a public health researcher at the Health Systems Trust was a leading member of the research team. -The Conversation

-Karen Hofman: Professor and Program Director, PRICELESS SA ( Priority Cost Effective Lessons in Systems Stregthening South Africa), University of the Witwatersrand

-Safura Abdool Karim: Senior Project Manager, PRICELESS SA ( Priority Cost Effective Lessons in Systems Stregthening South Africa), University of the Witwatersrand

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[IN NUMBERS] Coronavirus Update: COVID-19 In Africa

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While most cases of the COVID-19 coronavirus have been reported in the U.S. , Europe, and China, the virus is spreading rapidly across the African continent.

The confirmed worldwide cases for the virus have surpassed a million with the current figure being at 1,286,294.

The increase in new reported cases around the world has led the World Health Organization (WHO) to declare the coronavirus a global pandemic.

The death toll continues to rise globally, and is currently at 70,344.

Italy leads with 15,887. Spain is second with 13,055 . The U.S. is third with 9,620. France is fourth with 8,078, and the UK is fifth with 4,934.

China, where the virus originated from, maintains that its death toll is at 3,331.

The figure of the global recoveries stands at 271,867.

Here are the numbers in Africa:

Country Confirmed Cases Confirmed DeathsConfirmed Recoveries
Algeria1,32015290
Angola1422
Benin2215
Botswana61
Burkina Faso3451790
Burundi3
Cameroon658917
Cabo Verde (Cape Verde)711
Central African Republic (CAR)8
Chad9
Congo4552
Cote d’Ivoire (Ivory Coast)261337
Democratic Republic of the Congo (DRC)154183
Djibouti599
Egypt117358247
Equatorial Guinea161
Eritrea29
Eswatini (formerly Swaziland)9
Ethiopia4424
Gabon2411
Gambia412
Ghana214531
Guinea1215
Guinea-Bissau18
Kenya14244
Liberia1333
Libya181
Madagascar722
Malawi412
Mali4751
Mauritania612
Mauritius22777
Morocco1,1137176
Mozambique101
Namibia163
Niger1841013
Nigeria232533
Rwanda1044
Senegal226292
Seychelles10
Sierra Leone6
Somalia71
South Africa 1,6551195
South Sudan1
Sudan1222
Tanzania2213
Togo52322
Tunisia574225
Uganda52
Western Sahara4
Zambia3913
Zimbabwe91

Note: The numbers will be updated as new information is available.

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This Entrepreneur Built Tent Floors After Hurricane Katrina. Now He’s Building A Pop-Up Coronavirus Hospital

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EverBlock Systems designed the nurses stations and patient pods inside this pop-up coronavirus ... [+] EVERBLOCK SYSTEMS

Arnon Rosan manufactures giant Lego-like building blocks, which can be converted into furniture or walls for offices, classrooms, and military training operations. They’ve been used to build a life-sized ice castle in New York City’s Bryant Park and a 17-foot-tall menorah in Washington, D.C. But now his company, EverBlock Systems, is sending truckloads of plastic blocks and interlocking wall units from New York to Louisiana to build a temporary hospital for coronavirus patients.

“We don’t wish for disaster, certainly,” Rosan says of the virus sweeping the country. “But we’re happy to be able to respond with something that we know people need and solves the problem quickly and efficiently.” 

State and federal governments and health systems across the United States are scrambling to find space to treat patients as coronavirus cases have quickly overwhelmed emergency rooms and ICUs. Convention centers and arenas from Los Angeles to Philadelphia are being transformed into temporary hospitals, as are outdoor spaces, such as New York City’s Central Park.Today In: Healthcare

The one thing all these places have in common? “They have enough room to set up safe and appropriate working environments for the medical staff … and the equipment and supplies that are needed,” says Dr. Irwin Redlener, Director of the National Center for Disaster Preparedness at Columbia University. 

For his part, Rosan is busy working to fulfill an order to build 2,000 patients pods and 130 nurses stations for the field hospital under construction inside the Ernest N. Morial Convention Center in New Orleans.

Louisiana-based Dynamic Construction Group, the primary contractor on the hospital project, tapped EverBlock on March 26 to provide its products. At that point, Rosan had a head start: there were nearly a thousand wall panels and 60,000 blocks in his company’s warehouse ready to load onto the 53-foot trucks that would take them down to New Orleans. But he’ll need to provide a lot more. Rosan estimates the total project will require close to 6,000 panels and 150,000 blocks. In addition to 13 full-time employees, he’s recently hired 9 temporary workers to help scale up production at the company’s manufacturing facility and warehouse in the Bronx. 

“We’re being asked to deliver a year’s worth of product in one month,” says Rosan. Though his usual orders have dried up, he’s already expecting EverBlock’s revenues to more than double from an expected $7.5 million to more than $20 million by the end of this year. The convention center contract alone will likely come in well above $10 million, he says. 

This isn’t Rosan’s first time supplying material for disaster relief projects. His previous company Signature Systems Group, which he founded in 1999, manufactured temporary floor and roadway systems that could gain access to remote sites, such as oil rigs. Rosan says he supplied modular floors for tents used by the National Guard following Hurricanes Katrina, Ike and Sandy. He also worked on the flooring for a tent project for the World Food Programme in Haiti after the earthquake. 

In 2013, he sold Signature Systems Group to a private equity firmand was looking for something new to keep busy. He declined to disclose the deal price, but said at the time of the sale, the company had around $90 million in revenue. His current company began as a side project — the idea for developing the company’s giant blocks came from his kids. But when customers began to realize their potential, the company took off. 

“People seem to just engage and resonate with this concept of ‘Wow this oversized building block. I can build anything,” he recalls.

Inside the Ernest N. Morial Convention Center in New Orleans. 
EVERBLOCK SYSTEMS

EverBlock is delivering the walls and blocks that make up the tented structures in which patients will sleep. Each pod is an individual chamber that will have its own ventilation duct to ensure that patients with different viral loads are kept separate. Dynamic Construction is working on the ventilation, electrical and all of the other construction components needed to make the temporary hospital function. 

“These beds will be for patients who are not fragile. They don’t need to be on a ventilator, they don’t need an ICU bed, but they still need to be hospitalized,” Louisiana’s Democratic Governor Jim Bel Edwards said earlier this week at a press conference outside the convention center. While the original plan had been to care for 1,000 patients at the facility, Edwards had to quickly double that number a few days later in response to the surge in patients. The goal now is to have 1,000 beds set up by early next week and the full 2,000 beds by April 20. 

“My philosophy is when these things happen, you have to react in real time,” Rosan says. “That’s something that we’re just really good at — that quick rallying of resources to make it happen.”

Katie Jennings, Forbes Staff, Healthcare

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Surge Of Smartphone Apps Promise Coronavirus Tracking, But Raise Privacy Concerns

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Topline: A pan-European team of researchers announced Wednesday their plan to release a smartphone app that would notify users if they’ve been exposed to someone infected with coronavirus, the latest example of tech-driven coronavirus solutions that have also raised concerns about user privacy.

  • A European project called Pan-European Privacy Preserving Proximity Tracing is working toward releasing a coronavirus tracing app in the next week that would use anonymous Bluetooth technology to track when a smartphone comes in close range with another, so if a user were to test positive for coronavirus those at risk of infection could be notified.
  • Contact tracing, or determining people who may have been exposed to someone with a virus, is an established aspect of pandemic control and was used effectively to tackle coronavirus in countries like China, Singapore and South Korea in the form of smartphone tracking.
  • University of Oxford researchers and the U.K. government are working on a similar project— but unlike other smartphone tracking systems, the British version in development would be based on voluntary participation and bet on citizens inputting their information out of a sense of civic duty.
  • The U.S. government is in talks with companies like Facebook FB and Google GOOGL and other tech companies about tracking if users are social distancing using large amounts of anonymous, aggregated location data— this information is less precise, and more likely to anticipate outbreaks rather than pinpoint individuals who have been exposed to the virus.
  • 1.5 million Israelis have voluntarily downloaded a mobile app that alerts users if they’ve come into contact with someone with coronavirus— but Prime Minister Benjamin Netanyahu has still ordered that potential coronavirus carriers have their phones monitored, a controversial move the government says is necessary, as the 17% of the population using the app is not enough to fight off the pandemic.  
  • Moscow , on a city-wide lockdown since Monday, announced Wednesday that a new phone app that will officials to track the movements of people diagnosed with coronavirus in the capital city would be launched on Thursday, saying the government will lend a smartphone to anyone unable to download the app.

Crucial quote: “We’re exploring ways that aggregated anonymized location information could help in the fight against [coronavirus]. One example could be helping health authorities determine the impact of social distancing, similar to the way we show popular restaurant times and traffic patterns in Google Maps ,” Google spokesman Johnny Luu told the The Washington Post. He made sure to note it “would not involve sharing data about any individual’s location, movement, or contacts.”

Key background: Private and public entities alike are looking for ways to fight off coronavirus as the pandemic continues. On Wednesday, there were more than 900,000 confirmed cases worldwide and nearly 50,000 deaths.Officials told The New York Times NYT that The National Health Service, Britain’s centralized national health system, is trusted by citizens— and paired with the strong data privacy laws in place, said they think people would agree to join the effort to share their private information to help trace infections. However, American tech firms are reported to still be skeptical about sharing substantial data with the U.S. government ever since Edward Snowden revealed the NSA was collecting information from the firms clandestinely. 

Surprising fact: The information tech companies have access to data that sheds light on Americans’ behavior in light of the coronavirus pandemic. According to a Facebook analysis, restaurant visits fell about 80% in Italy and 70% in Spain— while Americans only stopped eating out at a rate of 31%.

Carlie Porterfield, Forbes Staff, Business

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