the nutritional status of - Health Systems Trust

Not many studies examined the direct relationship between food availability and undernutrition. Booth (1982)
found that protein-energy malnutrition in children under 5 years in Lebowa was inter alia caused by inadequate
local food production. Westcott and Stott (1977) reported that, in addition to low incomes, lack of agricultural
resources was a strong contributor to undernutrition in the Transkei. The extent to which food insecurity contributes
to undernutrition is, therefore, not known.
Many factors influence both national and household food security. They are dependent on a stable and effective
enabling economic and political environment with good governance at all levels. At present, food subsidies,
international trade, price controls and stabilisation, protection of staple food production, rural development, land
reform, agricultural marketing, education and training, drought relief, protection of the environment and natural
resources, as well as other strategies and policies to ensure national and household food security are under
discussion in several briefing, working and policy papers (see for example those from the Land and Agriculture
Policy Centre, 1993; 1994; 1995). In this regard, Heydorn (1996) recently pointed out that South Africa should move
to an approach which will promote optimal and long-term regional development, which will fulfil economic,
environmental and all-embracing human requirements in order to prevent economic collapse and exhaustion of
our natural resources. In addition, population growth and stabilisation should form an integral part of policies to
establish household food security.
4.3.2 POVERTY
As shown in Figure 5, poverty is universally accepted as a fundamental cause of undernutrition. In South Africa, it
is associated with high unemployment, inability to pay for food, health care and basic services, disintegration of
families, vulnerability, risk of homelessness, and despair (RDP, 1995). It is also accepted that South Africa has a very
serious poverty problem with a strong race, rural, and regional dimensions (RDP, 1995; May et al., 1994, 1995). For
example, 95 % of the poor in South Africa are African, 5 % are coloured and less than 1 % are Indian and white.
Although there is not an uniformly agreed poverty line for South Africa, using a minimum per capita caloric intake
at 2000 Kcal/day and a minimum per capita adult equivalent caloric intake at 2500 Kcal/day, it is estimated that
39-42 % of the people of South Africa are poor (RDP, 1995). Most of the poor (75 %) live in rural areas, and about
two-thirds of the poor live in only three provinces: Eastern Cape (24 %), KwaZulu-Natal (21 %) and Northern Province
(18 %). The Eastern Cape and Northern Province also have the highest poverty rates of 78 and 77 % (percentage of
population who are poor). The rates for the other provinces are: Western Cape (23 %), Northern Cape (57 %),
KwaZulu-Natal (53 %), Free State (66 %), Mpumalanga (52 %), North West (57 %) and Gauteng (19 %).
Although there is no doubt that poverty is a root cause of undernutrition, it should be realised that not all poor
people are undernourished. Figure 6 compares poverty rates (percentage people of a given group that are poor) in
the different provinces with the prevalence of stunting (low height-for-age) among preschool and primary school
children (Table 7). The provinces with the highest poverty rates (Eastern Cape and Northern Province) have lower
prevalences of stunted children than the Northern Cape which had the highest figure of stunted children. Table 7
also indicates that the prevalences of stunting among school entrants measured in the National Survey of 1994
were equal in coloured and black children. This is despite the much higher poverty rate of Africans (65 %) than that
of coloureds (33 %). Also, relatively high obesity prevalences have been reported for African and coloured women
(Walker, 1995). Clearly, other factors such as climate, household ability to produce food, expenditure patterns and
social support networks will influence the impact of poverty on the extent of malnutrition within communities.
4.3.3 URBANISATION
The process of urbanisation is often associated with improved economic circumstances, better access to medical
care and an increased availability of a wider variety of foods. However, in developing countries, urbanisation is also
accompanied by changes in family structures, decreased activity, abrupt changes in cultural norms and social
safety nets, exposure to chemical contamination and noise pollution, stress, increased demands on available
money and possibly extreme poverty, homelessness and destitution (Gross & Monteiro, 1989; Solomon & Gross,
1995). All these factors could lead to undernutrition.
Little is known about the effect of urbanisation on nutritional status of South Africans. In KwaZulu-Natal, Margo et
al. (1978) found a higher prevalence of nutritional anaemia in urban children from a “city slum” area than in rural
control children. Byarugaba (1991) examined the effect of urbanisation on the health of black preschool children in
the Umtata district in the Eastern Cape. Urbanisation was associated with several risk factors for undernutrition,
such as increased poverty, overcrowding, decreased availability of clean water, diarrhoeal disease, less breastfeeding
and the replacement of “mother-care” with “maid-care”. In this study, urbanisation was associated with
less underweight and stunting, but with more wasting (acute malnutrition).
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