Good nutrition for children is the foundation of learning and therefore fundamental to productivity and growth. This should be reflected in our economic priorities and budget allocations, say the authors
It doesn’t seem intuitive that South Africa’s richest province, Gauteng, has the highest stunt rate among children under five. Finally, stunting (short for age) is a measure of chronic malnutrition that one might expect to be more related to the poverty of the former home countries.
No province has reason to be proud. Nationwide, more than a quarter of children are stunted, a proportion that has not changed in over two decades. However, a full third of Gauteng’s young children are chronically malnourished.
What does that matter? Ironically, children in South Africa stunted not because we are poor as a nation, but because we are relatively rich and deeply inequalities. In search of a better life, people move to cities to look for work. They live in overcrowded conditions with poor amenities, especially water and sanitation. Cut off from local agriculture, they rely on cash but cannot afford nutritious groceries as prices are driven by consumer demand from the richer half of the population.
This structural dynamic is what drives our stunt rates, as the recently released 2020 South African kids ad shows
In the context of South Africa, food and nutrition insecurity is not a passing anomaly in a country shifting towards greater productivity and economic growth. However, this is one of the main reasons we are on a slow growth path and have little prospect of significant gains in the medium term.
We have gone as far as we can without including the economic potential of the other half of our population. Economist Thomas Picketty argues that, aside from wealth taxes, the only way to reduce income inequality is to be more productive. The only way to significantly increase productivity is to expand our skills base. This is limited by the fact that 50% of our children do not complete 12th grade. The main reason for dropping out and failure at school is primarily because children go to school without the basics of learning – of which good nutrition is the foundation. If we are to get out of the inequality trap, we need to address the root causes of low productivity.
This recognition needs to be made clearer by the government: good nutrition is fundamental to productivity and growth. It should be reflected in our economic priorities and budget allocations. If the government has to choose between another margin for higher education or for child nutritional support, it has to be for nutrition. If we have to choose between new investments in a smart city or nutritional support, so must nutrition.
As Nobel laureate in economics Angus Deaton has shown, better health outcomes are achieved primarily through higher income equality and not through higher spending on health care. and better health leads to higher productivity.
Given the constraints of the public treasury, we cannot expect massive new funding for nutrition, as Brazil, Mexico or Chile did with great success in the 1990s. Still, there are strategies that could break the cycle of malnutrition and low productivity.
The first is for the government and the food industry to agree on a basket of highly nutritious staple foods that need to be made much more affordable. This could be done by having food manufacturers and retailers withhold their markups on ten healthy foods – such as eggs, pilchards, dried beans, peanut butter, and ground soy – and the state provide a corresponding subsidy. Volumes can be limited per transaction. These modest concessions are unlikely to have a material impact on overall profit margins. Finally, it is seldom recognized that the food industry derives significant benefits from social grants – an amount of R200 billion, most of which is spent in their shops. Now is the time for the food industry to become more involved in solving the country’s food problem.
At the same time, we need to make far better use of the informal economy by expanding food value chains for children in townships (defining value in terms of both profit and nutrition). The current offer in Spaza shops is high in carbohydrates and low in food. As the redemption of electronic grocery vouchers during the COVID-19 disaster demonstrated, Spaza stores will adjust their inventory to accommodate more groceries if consumers request it.
We have focused on urban areas and community economies, but children in rural areas are also malnourished. Joint ventures promoting food production need more support. One example is a local co-op in southern KwaZulu-Natal supported by the NGO Thanda, which produces enough food to feed the farmers’ families and generate income from sales. The community action networks established in 2020 show the contribution that such civil structures are capable of.
One of the most effective protective measures in connection with extreme income inequality is the child benefit subsidy. Its current value of R450 per child per month is well below the food poverty line (R585), so that 30% of children in households live below the minimum necessary to meet the highest nutritional needs. Child benefit must be adjusted upwards and linked to the food poverty line. Babies with a low birth weight account for around 20% of the stunt. Hence, the grant needs to be expanded to include pregnant women, which could prove to be a breakthrough in reducing stunts.
These are practical strategies with significant economic returns. The World Bank recognizes investment in food as one of the best ways to get value for money, realizing an average return of $ 16 for every dollar invested. It is time for the country’s economic and government leaders to step back and embark on a new twenty year path to economic growth by developing the source of the human capital pipeline.
David Harrison is the CEO of the DG Murray Trust and Professor Julian May is the Director of the DSI-NRF Center of Excellence on Food Security at the University of the Western Cape. For more information on child nutrition and food security, see the South African children’s teaching 2020, an annual review of the situation of children in South Africa, published by the Children’s Institute at the University of Cape Town.