Malnutrition and unhealthy diets are common problems in EU and SSA: lessons from the InnoFoodAfrica project

by Kanerva, Noora |  June 04 2021

The mission of InnoFoodAfrica is to create solutions to establish diets and eating habits based on sustainably produced plant-based nutritious foods. Since the project covers all levels of food systems, there is, of course, an entire team dedicated to nutrition: Work Package 2 contributes to improving African diets in the prevention of all forms of malnutrition (undernutrition, micronutrient deficiencies, and overweight/obesity). The aim is to identify drivers causing undernutrition and overnutrition and develop food-based solutions and contribute towards dietary guidelines and nutritional recommendations that aim to reduce malnutrition in South Africa, Ethiopia, Kenya, and Uganda.

As the first step towards this aim, we conducted a comprehensive review that gives a picture of the food and nutrition situation in the four Sub-Saharan African (SSA) countries. We have described the trends in all forms of malnutrition (undernutrition and overweight/obesity) and how this related to the evolution in the burden of diseases and cause of death. This analysis can have programmatic and policy implications by showing where attention is needed. It also provides guidance for improving diets through food-based solutions. These solutions will provide an entry point for a much-needed food systems’ transformation through nutrition-sensitive value chains and responsible business models that ensure sustainability.

The InnoFoodAfrica project is not limited to the SSA countries but is also seeking opportunities in EU countries. Therefore, in order to get a more holistic view of what might lay ahead on the future trajectory we included two countries from Europe – Finland and France – and conducted a similar review to them and compared it with the SSA review. This comparison surfaced several interesting points that are summarized as follows:

1) Countries and continents share many unhealthy dietary patterns

Even though the prevalence of undernutrition has been declining, undernutrition is still a huge challenge in SSA countries. On the other end of the “malnutrition scale”, obesity is the greatest threat to health in the EU countries. This should not be news to anyone. During the last decade, overweight and obesity have started to burden also the SSA countries, changing the shape of the disease burden away from infectious diseases towards chronic non-communicable diseases. This is partly driven by the economic development of SSA countries together with very rapid changes in lifestyle behavior towards unhealthy diets and physical inactivity.

Obviously, within and between the continents, Ethiopia, Finland, France, Kenya, South Africa, and Uganda are in very different stages of their economic development, which affects the food consumption patterns and nutritional status in these countries. Ethiopia and Uganda belong to the low-income economies by World Bank classification, Kenya being in the lower-middle-income and South Africa in the upper-middle-income economies, whereas Finland and France are in the high-income economies. There are also many obvious differences in food production and diets stemming from geographical location, history, and food culture.

After getting these facts straight, we were quite surprised to realise that these countries share many unhealthy dietary patterns, such as too low intake of fruit, legumes, nuts, and wholegrain as well as too high intake of salt. The similarities in unhealthy dietary patterns are partly reflected in the leading causes of death as all the countries that we studied had cardiovascular diseases ranking among the top three causes of death.

2) Socioeconomic disadvantage affects malnutrition despite of country’s developmental status

Between SSA and Europe, the absolute level of socioeconomic disadvantage is – again – obviously completely different. However, socioeconomically disadvantaged people are at a higher risk of malnutrition, for instance, due to inadequate material, physical, and psychosocial resources regardless of the country of residence compared to people in higher socioeconomic groups. Additionally, women with adverse social and economic circumstances through the life course are more vulnerable to malnutrition compared to men in all countries. Bringing equity at the forefront of policies and programs is therefore critical to prevent malnutrition, but also halt further widening of inequalities.

3) Food environment requires monitoring and regulation to ensure food and nutrition security within and between countries

Urban areas are locations where the food environments are getting very similar around the world. As the urbanisation level of the country rises in parallel to an improving economy, the prevalence of unhealthy dietary patterns and adult obesity is increasing. Fast-food chains, supermarkets, and malls are concurring spaces in the cities of SSAs. This influences food choices, food acceptability, economic access to food, and food and nutrition security.

On one hand, access to a market where one can buy food may alleviate malnutrition caused by seasonal variation among local farming families. On the other hand, access to the market by itself (e.g., in urban areas) is pointless unless there aren’t nutrient-dense foods are made available at an affordable price, requiring a wider food systems’ transformation. Having access to nutritious food will have a positive impact on people’s nutritional status only when these nutritious products are actually bought, transformed into meals, and eaten.

Looking at our two EU countries the question of availability and affordability sets into a bit different light: even though both healthy foods are available in almost every grocery shop at an affordable price, consumer’s preferences which are modified by food culture, health literacy, advertising, and layout of foods in the store, and food prices are drawing people towards unhealthier options. This gets us to the conclusion that – even though a key factor – affordability is not the final answer to malnutrition but also rigorous regulations and increasing consumers’ knowledge on healthy diets remain a priority across continents to direct consumer behaviour towards better food choices.

4) We are all dealing with the same global challenges

Both SSA and EU countries are facing the same global challenges of demographic and climatic changes, even though from different aspects. Regarding population growth, Finland and France are battling with lowering birth rates as the population gets older and older. At the same time, populations in Ethiopia, Kenya, Uganda, and South Africa are growing and are expected to grow faster in the following decades. Climate change will affect the food security of all countries. Many of the SSA countries will be affected by weather variability and the frequency of droughts which are expected to increase in intensity and frequency. All countries need to bring food systems transformation agendas to the forefront. The transformations will need to be guided to ensure that they prevent all forms of malnutrition. Given the shared challenges, cross-learning and partnership among EU and SSA countries should be fostered.