Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008

  1. 1. Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008 Scott Drimie, Girma Kassie & Jo Vearey University of the Witwatersrand Forced Migration Studies Programme Health and Migration Initiative
  2. 2. Urban complexity opportunities for aligned policy responses <ul><li>Health systems </li></ul><ul><li>Urban planning </li></ul><ul><li>Environmental health </li></ul><ul><li>Social protection </li></ul><ul><li>Food systems </li></ul><ul><li>Tiers of government: local – provincial – national – regional - global </li></ul>
  3. 3. Studies Confirm Complex Urban Rural Linkages
  4. 4. Nutrition and Informal Settlements <ul><li>Implications for policy and programming </li></ul><ul><li>Johannesburg as a case study </li></ul>Urban informal settlements have double the HIV prevalence of urban formal areas in South Africa
  5. 5. Dietary Diversity Score <ul><li>A variety of foods in the diet is required to ensure an adequate intake of essential nutrients . Dietary diversity reflects the number of foods or food groups eaten over a reference period. </li></ul><ul><li>Dietary diversity can be used as an indicator of micro-nutrient adequacy (Steyn et al 2006), and as a proxy measure of the nutritional quality of the diet (Swindale and Bilinsky 2005). </li></ul><ul><li>  </li></ul><ul><li>Dietary diversity scores have been positively associated with the nutritional status of young children (Arimond and Ruel 2004) and adults (Savy et al 2007), independent of socio-economic factors. </li></ul>
  6. 6. Addis Ababa
  7. 7. Dietary Diversity Score:
  8. 8. Dietary Diversity Score: respondents residing informally were more likely to have a deficient dietary score Chi-square 89.880; p = <0.0001 Score 0 - 3 Score 4 - 6 Score 7 - 9 24 hour Dietary Diversity Score
  9. 9. [1 GAIn, 2009 ; Steyn et al. 2005 ; Kruger et al. 2007 Comparison of stunting (low height-for-age) for children aged 1-9 years nationally and by area of residence: South Africa 1999 and 2005 Steyn  et al (2006) showed a strong relationship between dietary diversity and child growth for South African children.
  10. 10. An Inadequate Diet: Some Issues <ul><li>Refined foods among lowest cost sources of energy; more nutrient dense foods (lean meat, vegetables and fruit) are more costly. </li></ul><ul><li>In 2006 many healthier food items were 50% more expensive than comparable less healthy ones. </li></ul><ul><li>Low-income people will often select a diet with a high content of refined cereals, sugar and fat (Temple & Steyn, 2009). </li></ul><ul><li>Suggests economic factors may lead to selection of unhealthy diet. However, other factors such as taste and convenience are important. </li></ul>
  11. 11. Implications of an Inadequate Diet <ul><li>High content of sugar and fat in cheap, less healthy foods causes them to have high energy density (ED) </li></ul><ul><li>Many investigators speculate that diets with high ED may be responsible for high prevalence of obesity in people of low socio-economic status. </li></ul><ul><li>South Africa has a high prevalence of both under-nutrition (micronutrient deficiencies in infants and children) and over-nutrition. Poor quality of available food may contribute to both conditions. </li></ul>
  12. 12. HIV/AIDS and nutrition are inextricably interrelated, particularly in Africa <ul><li>Malnutrition and food insecurity are endemic in Africa, where more than 25 million people are living with HIV </li></ul><ul><li>Nearly 40% of African children < 5 are moderately or severely stunted </li></ul><ul><ul><li>> 50% also suffer from micronutrient deficiency disorders </li></ul></ul><ul><li>Malnutrition is not limited to children </li></ul><ul><ul><li>> 50% of all pregnant women are anemic </li></ul></ul>
  13. 13. What can be done? <ul><li>Food access: costs of improving diets a challenge. </li></ul><ul><li>Temple and Steyn, 2009: </li></ul><ul><li>Extra cost of a healthier diet was roughly R198 per month, an amount that represents between 10% and 20% of the entire family budget (Khayelitsha, South Africa) </li></ul><ul><li>Based on food price data collected in 2006. </li></ul><ul><li>Short sighted to advise people to change diets if unaffordable. </li></ul>
  14. 14. What can be done? <ul><li>Food availability: urban agriculture may contribute to urban diets </li></ul><ul><li>Major challenges in Johannesburg and Windhoek: </li></ul><ul><li>Cost of water, availability of land, weak extension/ support, weak markets, spatial planning (“Apartheid City”), poor sectoral integration </li></ul><ul><li>However, there seems to be growing interest (food prices) and there are important lessons from Addis Ababa </li></ul><ul><li>Short sighted to advise people to change diets if unaffordable </li></ul>
  15. 15. What can be done? <ul><li>Food utilisation: Health promotion messages formulated to advise selection of foods that are healthy and affordable – including maize meal, oats, lentils, rice, dry beans, vegetables and fruit. </li></ul><ul><li>But what about broader structural issues? – challenge of addressing the reality of food prices. Address through: </li></ul><ul><li>Taxation? Subsidies? Disincentives for price collusion? </li></ul><ul><li>These elements of food insecurity cannot be taken in isolation </li></ul>
  16. 16. An Aligned Approach?
  17. 17. Implications and challenges <ul><li>Considering the interlinked livelihood systems, what interventions are required……. </li></ul><ul><ul><li>To improve conditions for poor urban households to create sustainable livelihoods with positive health and food security outcomes? </li></ul></ul><ul><ul><li>To support poor urban households to mitigate the negative impact of chronic illness? </li></ul></ul>