One of the biggest revelations of the COVID-19 pandemic has been that people with pre-existing, diet-related conditions such as obesity, heart disease, and diabetes, are more at risk of suffering severe forms of the disease leading to a need for intensive hospitalization.
In Kenya, for instance, the Ministry of Health in July reported that 16 percent of seriously ill COVID-19 patients had diabetes, while diabetes and hypertension alone accounted for 47 percent of the COVID-19 deaths linked to pre-existing conditions.
According to WHO data, these chronic diet-related conditions were among the main risk factors for illness and mortality in Africa prior to COVID-19. The current crisis is simply throwing fuel on the fire. It has highlighted the criticality of diet as the key determinant of health of individuals and populations, particularly in urban areas, where an increased uptake of highly-processed and unhealthy foods is increasingly undermining regional nutrition goals.
In fact, data from countries in East and Southern Africa published in the Journal of International Development show that highly-processed foods now account for more than one third of the purchased food market. Not all of these foods are unhealthy, but many are, and combined with the availability of cheap, convenient and tasty street foods, the result is cheap food that is high in saturated and trans fats, salt and sugar.
To change these devastating trends fresh foods such as vegetables, fruits, high-protein legumes, nuts, eggs and fish must become more widely available and much more affordable in Africa’s food markets. Healthy diets are often inaccessible to most of Africa’s population.
The UN estimates that 74% of Africans cannot afford healthy diets. That is nearly 1 billion Africans. This is shocking and unacceptable. These numbers are only likely to rise during this time of a pandemic, where job cuts have greatly reduced people’s spending power and lockdowns have broken food supply chains, further increasing food prices, especially the prices of perishable fresh foods.
Temporary and very partial workarounds include the expansion of social protection programmes such as in Nigeria providing targeted transfers to poor and vulnerable households. These financial packages help the vulnerable to meet their minimum dietary and nutritional needs, but they are not a complete or sustainable solution.
As was greatly emphasized at this year’s African Green Revolution Forum (AGRF), long-term solutions must be sought; a process that demands the involvement of all the world’s leaders from communities, governments, civil society and the private sector. The challenge is clear: to incentivize food producers, processors, distributors and marketers to make nutritious food more available and affordable.
First public policy needs to be aligned with this goal. Too many policies are working against this aim. For example too few food production and consumption subsidies are going to nutritious foods; too little public agricultural research development and farmer extension focuses on these foods; too often public food procurement disfavours these items and infrastructure development ignores cold chain development.
Agriculture in Africa is a key economic driver and supporter of livelihoods. Productivity needs to be increased, biodiversity promoted and climate resilience attained. Is this possible? Yes. Already, farmers in countries like Zambia are recording up to a 60 percent increase in yields through the application of ecosystem-based adaptation techniques.
Elsewhere, in Burkina Faso, farmers have reclaimed 200,000 to 300,000 hectares of degraded lands by digging shallow pots in barren land and filling them with organic matter. The reclaimed land now produces an estimated 80,000 to 120,000 additional tonnes of cereal for the Burkinabe. The challenge is to replicate these successes throughout the continent.
Second, private investment into these more nutritious foods needs to be incentivised. Of the $200 billion impact investment fund industry, GAIN estimates less than 0.3% goes to nutritious foods in Africa. Fund facilities that stimulate private investment in small and medium sized companies that produce nutritious foods for low income populations need to be established that offer loan rates that are lower than market while targeting nutrition outcomes.
Institutional investors such as pension funds need to signal to the bigger companies with extensive value chains in Africa that they will favour companies producing more nutritiously beneficial foods.
Third, consumer demand needs to be shifted towards healthy foods. Too often healthy food campaigns pale in comparison to private sector campaigns for highly processed foods: they lack imagination, humour and flair.
Healthy eating campaigns must be engaging, aspirational and memorable. Food environments—where consumers come face to face with food—are stacked against the consumption of healthy foods which are often consigned to unattractive spaces in markets and stores. This needs to change too.
Fourth, civil society campaigns can hold businesses and governments accountable for promoting healthy foods. Civil society activism is particularly essential to focus attention on silent crises such as unhealthy diets.
Together these four levers can incentivize businesses and other stakeholders to innovate and develop business models, products and services that make nutritious and safe foods more available, affordable, desirable, and sustainable. Africa cannot move ahead smoothly if 1 billion of its people cannot afford a healthy diet.
The approaches defined above are not exhaustive, but if well implemented will bring the continent closer to better nourishment, further improving the prospects of properly fighting emerging health challenges such as COVID-19, both from a health and economic perspective.