Traditional bobotie, slow-cooked Karoo lamb shanks, boerewors rolls, braai broodjies.

Not sure what I’m talking about? These are all traditional foods of South Africa, which are mouth-watering and can also be hip-size-increasing if made part of a regular diet.

Over the last ten years, South Africa has seen the number of people with non-communicable diseases (NCDs) increase to the point where the numbers are higher then those suffering from communicable diseases.

Today, South Africans have a 51.9 per cent chance of dying from an NCD – diabetes, heart diseases and stroke being the most likely culprits – according to the NCD Countdown 2030. South Africa is also the country with the highest obesity rate in Sub-Saharan Africa, with two-thirds of women and one-third of men overweight or obese. This goes hand-in-hand with the fact that 25 per cent of children in the country are undernourished.

Diet has at least something to do with this increase in NCD rates in South Africa. The average South African is eating the caloric equivalent of an extra candy bar a day, according to the World Health Organization (WHO). South Africans spent more money on fast food and coffee in 2018 than in in 2017, according to Stats SA, and already in 2017 there were about 50 fast food chain brands with 5,800 brand outlets across the country. Ninety per cent of South Africans lived within five kilometres of at least one fast food outlet, and families visited these outlets an average of twice a week in the higher income bracket and once a month in the lower income bracket.

“Fast food joints are popping up everywhere because they are perceived to be cheaper and more convenient than their healthy alternatives,” said Sibongile Nkosi, Executive Director of Healthy Living Alliance to Down to Earth Magazine.

Healthy food costs more and takes more time to prepare – a study in PLOS Medicine found that in 2012 healthy food cost South Africans between 10 and 60 per cent more than junk food.

So, what can the government do to help?

Most governments do not spend enough on healthcare. At the Abuja Declaration in 2001, African Union countries pledged to increase healthcare spending to 15 per cent of their budgets and urged donor countries to scale up support – only one country met this target, but spending on NCDs is low across the board.

In South Africa, there has been progress and political commitment when it comes to dealing with HIV/AIDS and tuberculosis. The government has legislated to see to the reduction of tobacco consumption, fatty acids, salt and sugar. However, because of small healthcare budgets and inadequate infrastructure in the sector, NCDs do not get the diagnosis, treatment or follow-up they require.

To prevent premature deaths, South Africa has only started to look at unhealthy diets, tobacco smoking, physical inactivity and alcohol abuse and their link to cancer, diabetes, cardiovascular diseases and chronic respiratory diseases in a way that is local to each community.

In his budget vote for health in 2016, Dr Aaron Motsoaledi, the Minister of Health, talked about “the four highways [through which] South Africans are marching to their graves” (which were HIV and AIDS, maternal and child mortality, injuries and violence and NCDs). This led to a national conversation on NCDs and a path to tackle the epidemic in line with equity that was taking root in the country.

The government began to lead campaigns against alcohol and substance abuse in the 1990s with rehabilitation and assistance programmes. These became focused on making help available for drug addicts and strongly regulating alcohol consumption, production and distribution and tended to have less of a focus on public health.

In the early 2000s the South African government began to support healthy lifestyles by promoting physical activity and healthy diets with salt (2013) and trans-fats (2011) reduction in processed foods. In 2018, South Africa was the first African country to tax sugary drinks.

The more successful policy initiatives in South Africa related to NCDs are smoking related. The popularity of smoking decreased when the government levied higher taxes on cigarettes and made it more difficult for people to smoke in public spaces. The smoking education programmes were less successful in pushing people to quit the habit.

South Africa has been struggling to tackle NCDs since the 1990s, and it wasn’t until recently that it had a comprehensive set of policies and programmes to start dealing with the increase in prevalence of NCDs throughout the population – from children to the elderly. But with that regime now in place, there is an opportunity to make rapid progress. A multi-sectoral approach is necessary, as is an infusion of funding into the healthcare system to ensure that no one is left behind.