The Challenge of Non-Communicable Diseases and Road Traffic ...

An Overview 41
into account [255]. Brazil has used a combination of
fiscal and other legislation to protect and improve
its traditional food system: supporting cooperatives
and small-scale farmers to produce green vegetables
and other fresh foods, and helping to protect
and stabilize prices of healthy staple foods and ingredients
so that they become more affordable and
available [256]. Brazilian children are entitled to one
meal per day at school and legislation also requires
that at least 30 percent of the national budget for
school lunches be spent on fresh foods from local/
family farms [87].
The market for snacks, soft drinks, and processed
foods is growing fastest in LMIC, and its correlation
with higher tobacco and alcohol sales suggests
common industry tactics [257], enabled by rising
incomes and weak regulation. Use of fiscal pricing
(tax or subsidy) policy instruments have also
been proposed to influence food consumption
patterns to favor the intake of healthier, less energy-rich
foods and drinks [258]. For prevention
of overweight and obesity, evidence suggests that
non-trivial pricing interventions could impact on
weight, particularly among children, adolescents,
low socio-economic populations, and those most
at risk, but that small taxes or subsidies have little
effect [259-260]. Restricting the promotion of energy-rich,
high fat, and high sugar foods to young
children through advertising on television or in
schools can be achieved through government-supported
forms of self-regulation and statutory measures
[261-262].
International efforts could be made to prohibit
the hydrogenation process that generates industrial
saturated fats and trans-fats. Governments also need
to mitigate the impact of large transnational food
corporations, some of which have headquarters
within African nations: for example, many of the
South African “Big Food” companies, particularly
the supermarket chains, have invested in other African
nations [263]. For the ultra-processed food and
drink industries, as with tobacco and alcohol, there
is clear evidence that public regulation and market
intervention can help prevent the potential harm
caused by ‘unhealthy commodities’, and that these
industries should not have a role in national policy
formulation [86].
Physical Activity and the Imperative
of Road Safety
Increased communications about healthy eating and
physical activity as part of programs of information
and education at the sub-national and national levels
could be used to reinforce legislation and other interventions.
An important factor is the design of urban
environments and road and transport systems,
which can be influenced to promote or maintain
physical activity.
Keeping people physically active as part of daily
living is important for counteracting obesity [264].
A health-supporting and safe environment that
facilitates walking and cycling can be part of a
pro-growth, pro-health, and pro-poor transport
strategy, helping increase urban productivity, reduce
poverty, and improve health [265]. Only two
SSA countries have national policies that encourage
walking and/or cycling as an alternative to car
travel, and only 10 SSA countries have national
policies to separate road users as a way of protecting
vulnerable road users [61].
As discussed in Box 4, consistent with the goals of
the 2011-2020 UN Decade of Action on Road Safety,
a safe and efficient road and transportation environment
is needed in Africa which gives high priority
to large-scale traffic calming measures, pedestrian
infrastructure, and the provision of safe transport
space for pedestrians and cyclists alongside major
arterial roads [105, 266].
Good and safe roads are increasingly seen as a
critical investment for enhancing competitiveness
and resilience in Africa. International experience
shows that the most effective and sustainable way
to make roads safer is to adopt a “safe system approach”.
The good news is that multilateral development
banks, including the World Bank, have
committed to supporting countries in developing
sustainable “safe systems” to prevent road traffic
casualties, including mobilizing more and new resources
for road safety [267].
The key challenge in most countries in SSA is
to build and strengthen institutions and capacity
to plan, manage, and implement road safety initiatives
at national scale that go well beyond just