The development of a strategy to promote fruit and vegetable consumption in South Africa

Abstract

The theory is that increased intake of fruit and vegetables will address both under nutrition and over nutrition, which are both apparent in South Africa. Because of the nutrition transition evident in South Africa, which goes hand in hand with the increased prevalence of non-communicable diseases (NCDs), the focus in this dissertation is on over nutrition, hence addressing the problem of NCDs in South Africa. In the Global Strategy on Diet, Physical Activity and Health developed by the World Health Organization (WHO) and endorsed by the May 2004 World Health Assembly, the increase of fruit and vegetable consumption is one of the recommendations to reduce the risk factors for NCDs. In September 2004, a joint Food and Agricultural Organization (FA0)MIHO workshop addressed the need for a global increased fruit and vegetable consumption. The workshop resulted in a framework that will guide the development of interventions for the promotion of adequate consumption of fruit and vegetables at national level. Non-communicable diseases were the number one cause of death in South Africa in the year 2000 and accounted for 37% of the deaths. Fruit and vegetable intake has been shown to reduce the risk for cardiovascular diseases, diabetes and cancer. However, overall intakes of fruit and vegetables for South Africans cannot be regarded as meeting the recommendation of five portions daily. The low fruit and vegetable consumption patterns of South Africans resulted in the need to adopt a national framework sensitive to the present situation by using the above-mentioned framework as reference. As starting point, a review of available literature regarding South African eating patterns was used to characterise the fruit and vegetable consumer domains and their corresponding supply networks and to identify barriers to eating fruit and vegetables. The consumer domains in South Africa are characterised as follows: (i) rural small-holders producing fruit and vegetables for own consumption; (ii) market dependent consumers; (iii) mixed consumers; and (iv) institutional consumers. The most commonly perceived barriers to eating fruit and vegetables are affordability, availability and household taste preference. The recommended national goal for fruit and vegetable consumption is five portions a day. Possible stakeholders involved in reaching this goal primarily fall under four sectors namely, the public sector, private sector, non-governmental organisations and international stakeholders. There is an opportunity to revise existing national policies and programmes that do not consider fruit and vegetables for example specifying the amount of fruit and vegetables to be mandatory in the Primary School Nutrition Programme (PSNP). The way forward would be to involve a broader stakeholder participation especially at regulatory and government level to create a national coordinating team. It is suggested that the 5-A-Day for Better Health Trust be the driving force of the whole process. It, however, needs to be capacitated further with regard to the generation of funds and expansion of the Board of Trustees and objectives. Discussions should be held with the WHO to hold an implementation workshop with regard to the suggested framework for increasing fruit and vegetable consumption in South Africa with the national coordinating team and the most important stakeholders. Specific short-term, medium-term and long-term objectives should be set for the team. The national coordinating team would provide leadership at national level by inter alia developing sustainable and cost-effective interventions through applying the proposed framework, whilst focusing on the most vulnerable target groups. From the planning to the implementation of projects, programmes and interventions, the evaluation of processes and outcomes should be of high importance. The evaluation and monitoring of interventions are a continuous process and invaluable to ascertain the progress made, whether the target group has been reached and/or whether the intervention has been successful.