OP ED: Help protect your fellow South Africans against predatory food practices

The National Department of Health has released front-of-pack warning label regulations for public comment. South Africans need to participate in the process to ensure that we are all protected from profit-driven corporate activities promoting harmful goods and unhealthy food.

Growing up in the Eastern Cape, I remember eating foods prepared from start to finish in our home kitchen. Boarding school introduced me to packaged foods. And university introduced me to fast food. 

But I would never have imagined that this change was seeping into the food environment, with ultra-processed foods becoming the norm.

It is no wonder that the explosion in obesity rates and the rise in noncommunicable diseases in the Global South coincided with the proliferation of fast, convenient food.

Research shows that two in five women and one in nine men in South Africa are obese. Children don’t fare any better. The South African National Health and Nutrition Examination Survey found that South African children between the ages of 6-14 years have a combined overweight and obesity prevalence of 13.5%.

The idea is that we are being sold convenience and affordability. Little is said about the negatives: the rising rates of diabetes, heart disease and cancers.

To make them cheaper and more profitable, many of the ultra-processed foods we eat are loaded with additives such as sugars, salts and trans fats which wreak havoc on our bodies and put us at risk of preventable premature death, while we are armed with little more than impossible to understand back-of-pack nutrition labels.

To curb the ballooning burden of noncommunicable diseases, the World Health Organization recommends the implementation of evidence-based government-ledstrategies and policies to improve the food system and diet in the population.

One of these strategies is the use of stronger food regulations such as front-of-pack warning labels that are visible and consumers can understand at a glance. A deluge of research has found that large warning labels with a contrasted background for better noticeability, and the use of “excess” instead of “high in”, improve understanding of the nutritional content found in certain foods, leading to a change in people’s food-making choices for the better.

Fresh regulations

The National Department of Health has released front-of-pack warning label (FOPWL) regulations for public comment. South Africans need to participate in the process to ensure that we are all protected from profit-driven corporate activities promoting harmful goods and unhealthy food.

The newly published FOPWL and marketing draft regulation, R3337, will make it easier for all South African consumers to have clear information about the food we consume, empowering us to make better food choices. The regulations will also make it harder for major food organisations to market to children, who are vulnerable to the food industry’s predatory marketing practices.

Of course, the food industry could take a page out of big sugar’s playbook to block or water down the regulations, citing the cost to the economy caused by the implementation of front-of-pack warning labels and other effective public health policies. At the end of last year, the sugar industry used this tactic to bolster its calls for the scrapping of the Health Promotion Levy, a government policy aimed at reducing the consumption of sugar-sweetened beverages, which have been shown to have a negative effect on consumers’ health.

The tactic, used against a population suffering from hunger and poverty, is a low blow. The reality is that people should not have to choose between filling their stomachs in the short term and irreparably damaging their health in the long term.

We know that unless the food and beverage industry is forced to change, it is unlikely to. Experts from Priceless SA at the University of Witwatersrand School of Public Health found there is no evidence that voluntary actions by the food and beverage industry can safeguard public health. In fact, voluntary actions can delay the implementation of lifesaving interventions. Mandatory regulatory interventions are easier to monitor than self-regulation.

Contrary to the food and beverage industry’s claims about the cost to the economy, the costs of diseases such as diabetes, heart disease and some cancers are impossible to ignore. Disease itself has a cost, and for many South Africans, the cost of paying for healthcare and the inability to work due to illness takes food out of their mouths.

Researchers at Wits University crunched the numbers and found that “overweight and obesity are costing South Africa’s health system R33-billion a year”.

It is condescending to assume that poor people do not care about the quality of the food they eat. Researchers found that parents were more than keen to choose better food for their families, particularly if there was a sick person at home. What they needed was easy-to-understand information on which to base those choices, as outlined earlier.

It is true that warning labels alone won’t fix the entire problem of a profit-driven food environment, but it is a step in the right direction. Failure to act will result in more deaths and increased suffering.

We need your voice to ensure that the new front-of-pack warning label regulations are passed. Use this link to ask the National Department of Health to listen to YOU and pass the regulations. DM

Zukiswa Zimela is the communications manager at the Healthy Living Alliance (HEALA).This opinion piece was published in the Daily Maverick on the 16th of May 2023

No evidence that voluntary actions by the food and beverage industry can safeguard public health

Recent research by PRICELESS SA at the University of Witwatersrand School of Public Health found that there is no evidence that voluntary actions by the food and beverage industry can safeguard public health.  

The increasing availability of unhealthy, ultra-processed foods is linked to rising rates of obesity and non-communicable diseases (NCDs), such as diabetes and hypertension, in low- and middle-income countries (LMICs)1. Well-designed, evidence-based fiscal and regulatory policies can improve food environments (the contexts in which people engage with food) by limiting the availability, afford- ability and accessibility of unhealthy foods to reduce consumption and improve public health2. However, the introduction of these policies has been heavily opposed by the food and beverage industry, which favours the use of voluntary actions (VAs) instead of binding government regulations . The use of VAs by the food industry has been endorsed by international bodies, despite similar action taken by the alcohol and tobacco industries being ineffective. Given that VAs often replace evidence-based policies, it is crucial that their effectiveness is evaluated and understood.

READ MORE: Click here to read the rest of the study

WHO report unmasks the deceitful marketing of the $55 billion formula milk industry

On Wednesday 23rd February 2022, Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) and partners launched a new report, ‘How the marketing of formula milk influences our decisions on infant feeding’. This report – the largest of its kind to date – draws on the experiences of over 8,500 women and 300 health professionals across eight countries, including South Africa. It exposes the aggressive and manipulative marketing practices used by the formula milk industry and highlights the negative impacts on families’ decisions about how to feed their babies and young children.

The largest formula milk producing company has had a century and a half of experience perfecting the marketing of an inferior child feeding product. How? By positioning its formula milk as the closest formulation to human breastmilk, and by using trusted and credible health professionals to endorse and recommend formula milk as a suitable replacement to breastmilk. The infant formula industry has mastered the art of manipulation by using product marketing strategies to convince mothers that infant formula ‘is just like breastmilk’. But the established scientific body of evidence has illustrated that breastmilk is far superior to formula milk and that child health costs due to inappropriate formula feeding are multiple, robbing children of optimal health and cognitive development while fuelling the obesity epidemic in childhood and adulthood, and increasing the risk of children dying of pneumonia and diarrhoea. And while industry profits, these costs are carried predominantly by the public health system.

As a society, we must recognize how efforts to increase infant formula sales undermine breastfeeding. As Phil Baker pointed out in the United Nations University IIGH webinar: Infant and Young Child Feeding: Policy, Power and Politics – as the formula industry has globalized so has its “power of marketing”. Exposure to such marketing reduces breastfeeding initiation, duration, and exclusivity irrespective of context. Without significant and purposeful interventions to protect, promote and support breastfeeding, many countries, particularly here in Africa, will see a steady decline in breastfeeding rates and a concurrent rise in malnutrition, with more pronounced childhood obesity and its associated health conditions of non-communicable diseases like hypertension, diabetes, and cardiovascular diseases. While we may think of these as adult diseases, their origins lie in early inappropriate infant feeding.

This is why South Africa committed to protecting, promoting, and supporting breastfeeding at Tshwane in 2011 and introduced Regulations relating to Infant and Young Child Feeding, R991 to protect mothers and caregivers from the inappropriate and misleading marketing of formula milk. Yet despite these efforts, the 2016 Demographic Health Survey found that one in four infants under the age of six months has never received breastmilk (25%), while only one in three is exclusively receiving breastmilk (32%), the larger portion of 43% is mixed fed, receiving breastmilk and other feeds, predominantly infant formula. This means that 68% of infants under six months of age are receiving sub-optimal feeding and are not being exclusively breastfed as recommended by the national Department of Health and WHO.

At the same time, the infant formula industry has earmarked low and middle-income countries for market expansion, and Euromonitor reported that the sale of formula milk in South Africa more than doubled from 2000 to 2015. The R991 prohibits the advertising and promotion of infant formula, in any form, on all media platforms. But since then infant formula companies have continued to breach the existing regulations and developed new strategies to promote and market their product. These include below-the-line advertising on social media, the sponsorship of continuous professional development courses for health professionals, sponsorship of conferences and symposiums linked to infant and young child nutrition, funding for students and researchers through industry-affiliated entities like the Nestlé Nutrition Institute, Africa (NNIA) and sponsorship of lecturer positions that specifically teach infant and child nutrition. Without diligent monitoring and reporting, infant formula companies continue to cross the line and test the strength of R991.

In recent years, these formula milk marketing strategies have exploited social media to reach consumers with enticing and misleading health claims and false promises of better growth and development of their children often coaxing mothers with words that conjure up superiority like ‘Opti-pro’, ‘Gold’ and ‘Supreme’. This is in modern terms ‘false advertising’. The survey of pregnant women and mothers that was part of this study found that strikingly almost half of women (49%) believed that formula is very much like breastmilk. These perceptions are clearly aligned with formula companies’ marketing messages said Prof Tanya Doherty from the South African Medical Research Council, one of the researchers assisting with analysis of the South African data.

What is particularly concerning in the context of South Africa’s high levels of poverty, unemployment and food insecurity, is the inability of households to adequately and safely provide infants with sufficient formula milk to ensure good growth and development. One in three children in South Africa live in households below the food poverty line which leaves insufficient money to buy sufficient formula milk to meet the needs of growing children. Ms Pumla Dlamini from Vitamin Angels and Nutrition Lead for the health rights coalition, South African Civil Society for Women’s, Adolescents’ and Children’s Health (SACSoWACH) points out, “What is most frustrating is that Nestlé uses home-grown social protection measures like stokvels to idealize and liken infant formula to breastmilk. This erodes indigenous healthy feeding practices such as breastmilk, rendering them less desirable.”

In 2021, civil society efforts led by HEALA galvanized action through the #NotTodayNestle campaign to stop a Nestle-funded series of mom & child events. The formula milk industry has a track record of violations and underhand tactics, and in this case, Nestlé, a Swiss-based company, chose to exploit the long-held tradition of stokvels – using these community-based savings schemes to market their products to women who can ill-afford formula milk, highlighting the lengths that the profit-focused formula industry employs to ensnare unsuspecting and trusting consumers.

As researchers and food justice activists, we, therefore, call on the government of South Africa, to place children’s health before profits and support WHO’s efforts to protect women from exploitative marketing practices. This can be done by strengthening the enforcement of R991 and to accelerate efforts to gazette the regulations governing the advertising of unhealthy food to children. We call on the whole of society to protect, promote and support breastfeeding. This includes progressive maternity protection and paid maternity leave for six months for all mothers, regardless of employment status; state-funded childcare services; and community-based support for breastfeeding mothers. If South Africa is to turn the tide on childhood obesity, it will have to counteract the aggressive and insidious marketing of infant formula. The health of the nation depends on strategic and decisive leadership to curtail the inappropriate marketing of the $55 billion formula milk industry.

HEALA is a civil society coalition working to advance food justice in South Africa to ensure that communities are able to exercise their right to affordable, nutritious food.

SACSoWACH is a civil society coalition that advocates for the health of newborns, children, adolescents, women and mothers.

For interviews:

Dr Chantell Witten
Lecturer, Faculty of Health Sciences, Division Health Education, University of Free State
SACSoWACH Nutrition Working Group Member
chantell.witten@gmail.com
+27(0)71 485 5893

Angelika Grimbeek
Nutrition Programme Manager for HEALA
angelika@heala.org
+27(0)72 078 3160

Professor Tanya Doherty
Health Systems Research Unit, SAMRC
tanya.doherty@mrc.ac.za

Who is HEALA?

HEALA is a coalition of civil society organisations that advocate for equitable access to affordable, nutritious food in South Africa by building a more just food system.

Access to nutritious, affordable food is a fundamental human right. Section 27(1)(b) of the South African Constitution guarantees all the right to sufficient food and commits the state to the progressive realisation of this right. Additionally, Section 28(1)(c) states that every child has the right to basic nutrition, shelter, basic health care services and social services.

Still, South Africa suffers from high levels of hunger, food insecurity, and obesity – all of which are consequences of the country’s broken food system.

A healthy and sufficient diet is essential for all people to achieve their full potential.
HEALA believes that only by fixing South Africa’s broken food system will the country be able to guarantee everyone equitable access to affordable, nutritious food.

Click here to view our Fact Sheet.