Non-communicable diseases (NCDs) cause 71% of all deaths globally, says the World Health Organization (WHO), and 77% of these are in developing countries. Yet in South Africa, no one outside a relatively small group of very worried scientists, researchers and activists seems to be treating this fatal and far-reaching problem with the same urgency as the coronavirus pandemic. In part one of #Food Justice’s miniseries on food advertising and marketing targeting children, we unpack the problem.
A silent killer
There is a slow, silent killer stalking the South African population — and it’s not (just) Covid-19, though Covid-19 has certainly made it more visible. It is our shockingly high rates of overweight and obesity — on average 27% of adults, at South Africa’s last official count in 2016 — which cause astronomical rates of diabetes, hypertension and cardiovascular disease, among other non-communicable diseases (NCDs).
Diabetes is the second-largest cause of death among South Africans after tuberculosis, with Type 2 diabetes responsible for 90% of South Africa’s 4.5 million cases among adults.
This is not new information and it is not unique to South Africa.
According to Professor Karen Hofman of the University of the Witwatersrand’s School of Public Health, there is a “tsunami of diabetes and hypertension underlying most of the nearly 250,000 excess deaths from Covid-19” (documented and updated weekly by the SA Medical Research Council here) which, Hofman says, the government is ignoring.
“The ICU beds are filled with people who have overweight conditions and are dying of Covid but they ignore the overweight and obesity conditions as the driving factor.” (On December 9, The New York Times reported on new research, not yet peer reviewed, suggesting that the coronavirus can attack fat cells directly, infecting “both fat cells and certain immune cells within body fat”, which may explain more severe Covid-19 disease among people with obesity.)
Marketing madness
Experts, local and international, identify ultra-processed foods, or UPFs, as the culprit: sugary drinks, salty snacks, processed meats, prepackaged biscuits, sweets, chocolates and fast foods — usually high in added hydrogenated fats, sugar and salt, as well as additives, flavourants, colourants, all of which are there to create an addictive “bliss point” for the unwitting consumer. (The term “bliss point” was originally coined in the late 1990s by US food engineer Howard Moskowitz, to define the perfect amount of sweetness, saltiness or richness in a product to stimulate craving and maximise consumption.)
Our collective addiction to UPFs begins in childhood, fuelled, some experts say, by manipulative advertising and marketing by multinational, industrial food manufacturers that dominate the global food supply, especially targeting children.
“What schoolchildren don’t understand is that they’ve been manipulated and duped,” says Hofman. “Targeting children very young, often as young as two but certainly from five upwards, is a very productive thing for companies, because children are particularly vulnerable to ads, both on TV during children’s hours and family time, as well as on social media — and there’s more and more work being done on social media by companies.”
“It’s a global issue,” says Lori Lake, a children’s rights advocate based at UCT’s Children’s Institute, and an issue that is playing out particularly severely in South Africa.
“We’re seeing a dramatic rise in overweight and obesity driven by the consumption of unhealthy foods: 13% of South African children under five are already overweight or obese — that’s one in eight children, and double the global average. Rates then increase dramatically across the life course, especially for adolescent girls and women, with two in three adult women overweight or obese.”
Like many low- and middle-income countries, South Africa is undergoing a rapid “nutrition transition”, the term used to describe low-income countries’ progressive shift to Westernised diets, with greater consumption of processed foods and animal fats, and more sedentary lifestyles — both the result of globalisation (of brands) and urbanisation (of populations). The result? Skyrocketing rates of obesity-related chronic diseases.
Between 1975 and 2016, writes University of the Western Cape (UWC) obesity researcher Tamryn Frank, “southern Africa saw the world’s highest proportional increase in child and adolescent obesity – an alarming 400% per decade”.
Almost 9% of older teenage boys and 27% of older teenage girls are overweight, says the UCT Children’s Institute South African Child Gauge 2020 report, and the number gets much worse as teens turn into adults.
South Africans’ increasing consumption of fast food as well as ultra-processed foods and drinks, such as crisps and sugary drinks, is a major contributing factor, Frank told Maverick Citizen.
“Global sales of highly processed foods increased overall by 44% from 2000 to 2013,” reports Marion Nestle, professor emerita of nutrition, food studies and public health at New York University, “but only by 2% in North America as opposed to 48% in Latin America and 71% in Africa and the Middle East.”
A 2020 report summarising multiple adolescent-focused nutrition studies in the South African Journal of Clinical Nutrition found that adolescents’ food intakes showed a marked shift to “energy-dense, processed foods high in sugar and fat, but low in essential [micro]nutrients”. (This, in a nutshell, is how people can become overweight but undernourished at the same time). The same study found that South African adolescents “demonstrated poor knowledge of unhealthy foods overall, being unable to classify high fat and sugar products such as pies, samosas and sugar-sweetened beverages as unhealthy items”.
A Soweto study tracking a cohort of children since 1990 shows that high-fat, high-carbohydrate and low-micronutrient diets in childhood lay the foundations for adolescent and then adult obesity. This has become worse over time, the South African Child Gauge says, with the prevalence of overweight and obesity among women climbing from 56% in 1998 to 68% in 2016 (Lake’s “two in three” women).
Lake, the editor of The South African Child Gauge, echoes Hofman’s disquiet about marketing to children. “My biggest concern is that the harm associated with this kind of advertising is invisible,” Lake told Maverick Citizen.
“If you were to look at a Cadbury’s or a McDonald’s or a Coke ad, they tap into our deepest desires for love and belonging as well as our hopes and dreams. From family birthdays to celebrating a victory on the sports field, to our matric dances and our first kiss — all these important milestones and celebrations in our lives are used by industry [in their advertising] because that’s what we long for, never mind the food.”
In the meantime, on a metabolic level the damage happens really slowly, over time, in ways that we’re not fully aware of, Lake says. “It’s not that you drink a Coke or eat a Big Mac and feel sick — actually it feels good, there is the ‘rush’.
“Many of these products are carefully engineered to be incredibly addictive. So how do you make people see that something that tastes so good and that is tapping into all their longings and aspirations is actually harmful to our health? It’s part of what we call the ‘slow violence of malnutrition’.”
O regulation, where are thou?
The answer lies partly in changes that need to happen in global food systems (which also drive national food systems) — and in South Africa, in regulations that restrict advertising and marketing to children, which do not yet exist.
In light of the outsize threat posed by ultra-processed foods, one could argue that the national Department of Health’s definition of “food safety” is ripe for reinterpretation. (The Constitution guarantees children the right to safe and adequate nutrition.) The assurance that food “will not cause harm to the consumer when it is prepared or eaten according to its intended use”, by rights should extend to processed and ultra-processed foods high in added fats, sugar and salt that certainly do cause harm to the consumer.
“Children are especially vulnerable,” says Professor Desiree Lewis, of UWC’s Centre for Food Excellence. “There are so many issues that are raised when it comes to children and their rights. It’s very easy to see it as a problem of children’s right to health being violated and compromised — but it’s also their rights to decision-making, to guided development, their rights to be properly cared for — rights that are enshrined in our Constitution.”
Globally, food marketing to children — especially via digital media, including social media platforms such as YouTube, TikTok and Facebook — is increasingly seen as an infringement of children’s rights. (WHO’s Europe office has published guidance on how to restrict marketing to children on digital media.)
Lynn Mafofo, who co-authored with Lewis a chapter in the Child Gauge on corporate fast-food advertising targeting children, says that some of the more egregious recent examples of fast-food ads on TV targeting children are no longer around.
“I know for sure KFC stopped the chicken meal [for kids] but the McDonald’s ‘happy meal’ has resurfaced. But I can equally argue that as much as we don’t see them on TV, we still see them on YouTube, and this is where most of the children spend their time,” Mafofo says.
“We say they are no longer in the public eye but in the absence of regulation, they are still there in the virtual scape.”
This issue of inadequate regulation looms large in the public-health sector these days.
“It’s unconscionable that the government is allowing our children to be in these obesogenic environments and that the advertising is allowed to take place,” Hofman says. “There are many countries in the world where governments have acted [to prohibit this].”
Hofman is referring particularly to other low- and middle-income countries such as Mexico, Chile, Peru, Malaysia and Thailand, which, like South Africa, are undergoing a nutrition transition.
“They’re consciously trying to expand their markets in the Global South,” Lori Lake says of multinationals such as Kraft, Coca-Cola, Nestlé, Kellogg’s and Unilever, “because northern markets are saturated and because we’re poorly regulated and because we don’t have an ‘awake’ citizenry.
“The thing to understand is that there’s this massive multibillion-dollar industry that is profiting off our ill health. Industry makes profits and then families and local governments are the ones that have to pick up the pieces 10 or 20 years later.” Lake is referring to the massive illness, death and financial tolls on countries from their obesity and NCD epidemics.
“These are for-profit companies that want to make money,” UWC’s Frank says. “That is their business objective. And so they make use of tactics that are going to increase their profits, which means making their foods more desirable to people. This takes the form partly of advertising and marketing to children — but also to adults — and trying to build brand loyalty with children as young as possible.”
Food industry pushback
There is industry pushback to this view.
Gail Schimmel, CEO of the Advertising Regulatory Board, the industry “self-regulating” mechanism that acts as an advertising watchdog, described advertising as something of a scapegoat for critics of fast-food and other industrial food producers.
“There is a lot of focus on advertising junk food to children,” Schimmel says. “And in [developed countries], advertising may have a profound link to childhood obesity. But I don’t believe in South Africa that advertising is a core driver of childhood obesity and bad eating habits — I think poverty is the core driver.”
Professor Rina Swart, a dietician, nutritionist and researcher at UWC’s Centre of Excellence in Food Security, is on the other side of the aisle but also believes that poverty plays a central role in determining what people eat.
“Implementing your knowledge or your understanding and exercising your choices is often very limited if you are resource-restricted — so people would make choices that are most cost effective for them. If you have to fill four bellies [with food] that is also desirable and palatable, you have to do your sums. If you have to choose between R10 for fruit or R10 for a loaf of bread, it will be the [processed] loaf.”
Frank, who works with Swart and specialises in obesity prevention, told Maverick Citizen that “the proliferation of ultra-processed foods” is one of the biggest problems South Africa is facing.
“The marketing and advertising is one of the things that the food and beverage industry do to sell their products,” Frank says, “but the marketing alone is not the problem — it’s the ultra-processed foods giant companies, multinationals operating across the world producing cheap food that is not nutritious, and that study after study is linking to NCDs, diabetes, hypertension, and obesity.
“There is an oversupply of unhealthy, cheap ultra-processed foods high in saturated fat, salt and sugar, that are readily available at an affordable price. This makes it near impossible for people to make healthy food choices, even if they want to.” DM/MC
Note: The national Department of Health has not yet responded to questions about a possible update to the stalled 2014 food-related regulations R429, but has indicated that it will. Maverick Citizen has it on reliable authority that new regulations are in the pipeline, awaiting legal and ministerial approvals.
McDonald’s, KFC and Chicken Licken have not yet responded to questions about their respective stances on the marketing and advertising of foods to children and their positions on in-store menu displays and/or nutritional information labelling on packaging.
Maverick Citizen will publish separate articles on South Africa’s current food-related regulations, what local and international experts say new regulations should contain and why government regulations alone will not solve our bigger food-system problems. Follow our ongoing reporting in #FoodJustice.
Article by Adèle Sulcas originally published here.
