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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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How Virtual Therapy Apps Are Trying To Disrupt The Mental Health Industry

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Millions of Americans deal with mental illness each year, and more than half of them go untreated. As the mental health industry has grown in recent years, so has the number of tech startups offering virtual therapy, which range from online and app-based chatbots to video therapy sessions and messaging. 

Still a nascent industry, with most startups in the early seed-stage funding round, these companies say they aim to increase access to qualified mental health care providers and reduce the social stigma that comes with seeking help. 

While the efficacy of virtual therapy, compared with traditional in-person therapy, is still being hotly debated, its popularity is undeniable. Its most recognizable pioneers, BetterHelp and TalkSpace, have enrolled nearly 700,000 and more than 1 million users respectively. And investors are taking notice.

Funding for mental health tech startups has boomed in the past few years, jumping from roughly $100 million in 2014 to more than $500 million in 2018, according to Pitchbook. In May of this year, the subscription-based online therapy platform Talkspace raised an additional $50 million, bringing its total funding to just under $110 million since its 2012 inception.

The ubiquity of smartphones, coupled with the lessening of the stigma associated with mental health treatment have played a large role in the growing demand for virtual therapy. Of the various services offered on the Talkspace platform, “clients by far want asynchronous text messaging,” says Neil Leibowitz, the company’s chief medical officer.

Users seem to prefer back-and-forth messaging that isn’t restricted to a narrow window of time over face-to-face interactions. At BetterHelp, founder Alon Matas notes that older users are more likely to go for phone and video therapy sessions, whereas younger users favor text messaging.

“Each generation is getting progressively more mobile-native,” says John Prendergass, an associate director at Ben Franklin Technology Partners’ healthcare investment group, “so I think we’re going to see people become increasingly more accustomed, or predisposed, to a higher level of comfort in seeking care online.”

The ease and convenience of virtual therapy is another draw, particularly for busy people or those who live in rural areas with limited access to therapy and a range of care options.

Alison Darcy, founder and CEO of Woebot, a free automated chatbot that uses artificial intelligence to provide therapeutic services without the direct involvement of humans, says that with Woebot and other similar services, there is no need to schedule appointments weeks in advance and users can receive real-time coaching at the moment they need it, unlike traditional therapy. The sense of anonymity online can also lead to more openness and transparency and attracts people who normally wouldn’t seek therapy.

Along with stigma, the cost of therapy has historically acted as a barrier to accessing quality mental-health care. Health insurance is often unlikely to cover therapy sessions. In most cities, sessions run about $75 to $150 each, and can go as high as $200 or more in places like New York City. Web therapists don’t have to bear the expense of brick-and-mortar offices, filing paperwork or marketing their services, and these savings can be passed on to clients. 

BetterHelp offers a $200-a-month membership that includes weekly live sessions with a therapist and unlimited messaging in between, while Talkspace’s cheapest monthly subscription at $260-a-month, offers unlimited text, video and audio messaging.

But virtual therapy, particularly text-based therapy, is not suitable for everyone. Nor is it likely to make traditional therapy obsolete. “Online therapy isn’t good for people who have severe mental and relational health issues, or any kind of psychosis, deep depression or violence,” says Christiana Awosan, a licensed marriage and family therapist. 

At her New York and New Jersey offices, she works predominantly with black clients, a population that she says prefers face-to-face meetings. “This community is wary of mental health in general because of structural discrimination,” Awosan says. “They pay attention to nonverbal cues and so they need to first build trust in-person.”  

Virtual therapy apps can still be beneficial for people with low-level anxiety, stress or insomnia, and they can also help users become aware of harmful behaviors and obtain a higher sense of well-being. 

Sean Luo, a psychiatrist whose consultancy work focuses on machine learning techniques in mental health technology, says: “This why some of these companies are getting very high valuations. There are a lot of commercialization possibilities.” He adds that from a mental health treatment perspective, a virtual therapy app “isn’t going to solve your problems, because people who are truly ill will by definition require a lot more.”

Relying on digital therapy platforms might also provide a false sense of security for users who actually need more serious mental-health care, and many of these apps are ill-equipped to deal with emergencies like suicide, drug overdoses or the medical consequences of psychiatric illness. “The level of intervention simply isn’t strong enough,” says Luo, “and so these aspects still need to be evaluated by a trained professional.

Ruth Umoh, Diversity and Inclusion Writer, Forbes Staff.

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No Seat At The Global Table For Indigenous African Cuisine

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Gastronomic tourism based on African food could easily increase and create new value chains that unlock billions in untapped wealth for the continent, but what is stopping us?


Food and tourism are an integral part of most economies, globally. Food is undeniably a core part of all cultures and an increasingly important attraction for tourists. To satisfy their wanderlust, contemporary tourists require an array of experiences that include elements of education, entertainment, picturesque scenery and culinary wonders.  The link between food and tourism allows destinations to develop local economies; and food experiences help to brand and market them, as well as supporting the local culture and knowledge systems.

 This is particularly important for rural communities, where 61% of sub-Saharan Africans live, according to the World Bank last year. These communities have often felt the brunt of urbanization, which has resulted in a shift away from rural economies. If implemented effectively, Africa could get a piece of the gastronomic tourism pie, which was worth $8.8 trillion last year, according to the World Travel & Tourism Council.

World-renowned chef Nompumelelo Mqwebu and author of her self-published cookbook, Through the Eyes Of An African Chef. Picture: Motlaban Monnakgotla

However, there is currently very little public information to pique the interest of tourists about African food. World-renowned South African chef Nompumelelo Mqwebu sought to remedy this with her self-published cookbook, Through the Eyes Of An African Chef.

“I think where it was very clear to me that I needed to do something was when I went to cooking school. I trained at Christina Martin School of Food and Wine. I thought I was actually going to get training on South African food and, somehow, I assumed we were talking indigenous food.

 “I was shocked that we went through the whole year’s curriculum and we didn’t cover anything that I ate at home; we didn’t cover anything that my first cousins, who are Sotho, ate in Nelspruit (in South Africa’s Mpumalanga Province); we didn’t cover anything that would come from eSwatini, which is where my mother is from,” Mqwebu says.

By self-publishing, she has ultimately contributed to a value chain that has linked local food producers and suppliers, which includes agriculture, food production, country branding and cultural and creative industries.

“I am a member of Proudly South African, not only my business, but the book as well. Part of the reason is that the cookbook was 100% published in South Africa. So, everybody who worked on the cookbook, and printing, was all in South Africa, which is something quite rare these days because authors have their books published abroad.”

The Proudly South African campaign is a South African ‘buy local’ initiative that sells her cookbook on their online platform as its production adheres to the initiative’s campaign standards. Self-publishing has allowed Mqwebu to promote her book for two years and to directly communicate with her audience in a way she thought was best, while exposing her to a vast community of local networks. She recalls her first step towards creating her own body of work.

Amadumbe gnocchi. Picture: Nompumelelo Mqwebu and Nicole Louw Photography

“I was in culinary school when I wrote the recipe for amadumbe (potato of the tropics) gnocchi. We were making gnocchi and I thought, ‘so why aren’t we using amadumbe because it’s a starch?’ and when I tasted it, I thought, ‘this could definitely work’. I started doing my recipes then.

 “And there was talk about, ‘we don’t have desserts as Africans’. I did some research and found we ate berries, we were never big on sugar to begin with. That’s why I took the same isidudu (soft porridge made from ground corn) with pumpkin that my grandmother used to make and that became my dessert. “I also found that when I went to libraries looking for indigenous recipes, I couldn’t really find something that spoke to me as a chef. I found content that looked like history books. It was not appealing. It was not something, as a chef, I could proudly present to another chef from a different part of the world, so I knew I had to write my book,” Mqwebu says about the award-winning recipe book that chronicles African cuisine.

Isidudu (soft porridge made from ground corn) with pumpkin. Picture: Nompumelelo Mqwebu and Nicole Louw Photography

Financial and health benefits

According to the World Travel & Tourism Council, in 2018, the tourism sector “contributed 319 million jobs, representing one in 10 of all jobs globally and is responsible for one in five of all new jobs created in the world over the last five years. It has increased its share of leisure spending to 78.5%, meaning 21.5% of spending was on business.”

To narrow in on how lucrative food can be, the World Food Travel Association estimates that visitors spend approximately 25% of their travel budget on food and beverages. The figure can get as high as 35% in expensive destinations, and as low as 15% in more affordable destinations. “Confirmed food lovers also spend a bit more than the average of 25% spent by travelers in general.”

However, there is a widely-held view that the African continent is not doing enough to maximize its potential to also position itself as a gastronomic tourism destination, using its unique edge of indigenous knowledge systems (IKS).

“We are not a culinary destination and we will never be while we are still offering pasta as the attraction for our tourists,” Mqwebu says.

Dr George Sedupane, who is the Coordinator of the Bachelor of the Indigenous Knowledge Systems program in South Africa’s North-West University, echoes Mqwebu’s sentiments.

“I often cringe when I go to conferences and there are guests from all over the world and we serve them pasta. Why would they come from Brazil to eat pasta here? They can have pasta in Italy. Why don’t we serve them umngqusho (samp and beans)?

Umngqusho (samp and beans). Picture: Nompumelelo Mqwebu and Nicole Louw Photography

“We need to be creating those experiences around our culture. We are failing to capitalize on our strengths. There is a lack of drive to celebrate what we have,” says Sedupane, who also teaches modules and supervises research in indigenous health and nutrition.

Writer and historian Sibusiso Mnyanda says current innovations in African food technology are born out of necessity, rather tourism and cultural ambitions.

“Food security is becoming an issue that is leading to IKS around farming being prioritized. In Nigeria, they are innovating dry season farming, because of deforestation and soil being de-cultivated. 

“So those indigenous knowledge strategies are being used in countries where it is a necessity and where there are enough advances related to the fourth industrial revolution. The traditional ways of producing food are not only much more organic, they are also crop-efficient,” Mnyanda says.

Nigeria may have inadvertently innovated a health solution related to colon cancer through its diet. Sedupane tells FORBES AFRICA an anecdote.

“There was a study where the colons of an African country that did not consume a lot of meat was compared to Europeans. The Africans had a much better profile as a result and there are people who want to buy African stool to get that kind of rich bacteria, that you get on an African plant-based diet.”

Dr George Sedupane, who is the Coordinator of the Bachelor of the Indigenous Knowledge Systems. Picture: Supplied

The study Sedupane is referring to was conducted in Nigeria and it states that: “Nigeria showed the average annual incidence of colorectal cancer was 27 patients per year. This shows that even if it seems that incidence rates are increasing in Nigeria, such rates are still about one-tenth of what is seen in the truly developed countries.”

In a bid to find reasons for this rarity of colon and rectal cancer, the study concluded that, among other reasons, the protective effects of Nigeria’s starch-based, vegetable-based, fruit-based, and spicy, peppery diet, and geographical location which ensures sunshine all year round, played a role in the country’s colon health.

Interestingly, it seems the potential value of African food could not only be based on what goes in but what also comes out as healthy faecal matter is big business globally. In 2015, The Washington Post published that one could potentially earn $13,000 a year selling their poop. 

The American-based company OpenBiome has been processing and shipping frozen stool to patients who are very sick with infections of a bacteria called C.difficile. It causes diarrhea and inflammation of the colon, leaving some sufferers house-bound. “Antibiotics often help, but sometimes, the bacteria rears back as soon as treatment stops. By introducing healthy faecal matter into the gut of a patient (by way of endoscopy, nasal tubes, or swallowed capsules), doctors can abolish C. difficile for good… And yes, they pay for healthy poop: $40 a sample, with a $50 bonus if you come in five days a week. That’s $250 for a week of donations, or $13,000 a year,” the publication stated.

Sedupane is of the view that a diet which includes indigenous foods could vastly improve one’s quality of life.

He says small changes could be made, such as including more of indigenous greens, namely sorghum and millet, to breakfast. The grains are gluten-free and produce alkaline which boosts the pH level of fluids in the body and reduces acidity.

Moringa fruit which is an African superfood. Picture: Getty Images

“Moving to our legumes, we have indlubu (Bambara groundnut) which is very rich and helps in the secretion of serotonin in the brain. This so important nowadays with the increase of depression. It’s easy to digest, and is great for cholesterol and moderating blood sugar,” Sedupane says.

 Mnyanda is also of the view that food is imperative to health and medicinal properties. He says traditional healers primarily use natural herbs in their practice. “These are used in pain relief and healing. Things like cannabis, camphor, African potatao and red carrots. So, food is not just used for nutritional purposes.”

Other African superfoods include, Baobab fruit, Hibiscus, Tamarind, Kenkiliba, Amaranth, Moringa and pumpkin leaves. 

Cultural and historical benefits

Gastronomic tourism also includes the promotion of heritage sites that are known to revolve around dishes that are of historic importance. They enhance the travel experience, they encourage the acquisition of knowledge and a cultural exchange.

There is a unanimous view that vast amounts of knowledge have been lost to history and there is a huge knowledge gap in African societies as a result of colonization and urbanization.

“Part of the colonial agenda was to make sure food security did not belong to indigenous groups. Therefore, archiving of these knowledge systems was not a priority. Especially during industrialization, where people moved from their villages to the city you found that the knowledge got left behind,” Mnyanda says.

Abathwa (the San people) hunting. Picture: Getty Images

He offers a contemporary example of how modernization continues to push African practices to the fringes: “To this day, abathwa (the San people) hunt their meat, but you find that because of changing agricultural practices and land reform on the Kruger National Park, they are being forced to move into the cities and industrial areas, therefore they are no longer able to practice their culture of hunting. As a result, their diet is changing.” Sedupane shares the view that the fundamentals of farming and astrology have also been exiled from public knowledge.

“The fundamentals of IKS were based on the understanding of the laws of nature – how and when things were done. Harvest cycles were linked with understanding astrology. They would not harvest until certain stars were visible in the sky. There was a dependence on nature.

“With industrialization, rather than working with nature, humans are seen as being above, as controlling, as directing it. The natural cycle is often tempered with rather than trying to work with it.”

Not all is lost however. There are historical practices that have stood the test of time and continue to be a part the few foods that are internationally associated with South Africa. Mqwebu says that, “historically, we ate more plants than meat because our ancestors had to hunt and the game back then was not tame. So, there were no guarantees that you would return with meat. And that’s where things like umqwayiba (biltong) come from. They had to preserve the meat, because wasting was not part of the culture”.

Umqwayiba (biltong). Picture: Getty Images

According to a 2015 exploratory research project conducted under the guidance of research institute Tourism Research in Economic Environs and Society director Professor Melville Saayman, biltong contributes more than R2.5 billion ($163 million) to the South African economy.

Perhaps, like the faecal transporting company, Africa will soon realize the ‘wasted’ opportunity and that there is loads of money to be made in gastronomic tourism for all its inhabitants, whether they are rural or urban, technological or indigenous.

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Potential Cases Of Vaping-Related Illnesses Are Climbing

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The number of potential vaping-related illness incidents under investigation by health federal authorities keeps climbing, as officials narrow their search on counterfeit vaping products, according to a report from the Washington Post.

READ MORE | Is Vaping Really Helping You Quit Traditional Tobacco Cigarettes?

  • The Federal Drug Administration and the Centers for Disease Control said Friday they are investigating 215 potential cases of respiratory illness reported after use of e-cigarettes across 25 states. That’s up from 153 last week.
  • Health officials say patients reported a gradual start to symptoms, such as breathing difficulty, shortness of breath and chest pain before hospitalization. Some cases reported vomiting, diarrhea, fevers or fatigue.
  • According to the Washington Post, the investigation is focusing on counterfeit or black-market products that use potentially mislabeled solvents that consumers buy themselves.
  • The announcement comes a week after the first vaping-related illness death was reported in Illinois. 

Key Background: Although scientists are still unsure of vaping’s long-term health impact, most believe that e-cigarettes are a less dangerous nicotine source than tobacco cigarettes. The CDC recommends that all nonsmokers stay away from vaping.

The CDC warned users Friday of buying e-cigarette products off the street or adding any substances to products that are not intended by the manufacturer.

-Rachel Sandler; Forbes

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