The prevalence of type-2 diabetes in the Sub-Saharan Africa region has increased tremendously. According to the International Diabetes Foundation’s (IDF) 2021 data, approximately 24 million adults between the ages of 20-79 are living with diabetes in the IDF African region. They estimate it will only increase, reaching 33 million by 2030 (Diabetes in Africa, 2022). The top five countries with the most cases in Sub-Saharan Africa are Nigeria, with 1.2 million; South Africa, with 840,000; the Democratic Republic of Congo; with 552,000; Ethiopia, with 550,000; and Tanzania, 380,000. (Jean, 2020)
The management of type-2 diabetes is challenging for African countries' health care and services systems (Bekele et al., 2019). The high cost of treatment for type-2 diabetes increases the economic burden and reduces the overall health status of African countries. That leads public health institutions to focus on the primary prevention for reducing the incidence of type-2 diabetes in the population. For example, South Africa ranks the highest costs of diabetes care, with a $663 (international dollar) overall per capita health expenditure. Followed by Kenya, which ranked second with $115 in overall per capita health expenditure. (Jean, 2020)
Lifestyle and diet habits are significant for improving their health status. Regulating a healthy diet and maintaining weight is vital for type-2 diabetes first prevention. This brief will overview the effects of accessibility of healthy food on type-2 diabetes and critically discuss influencing factors on accessibility and potential solutions or interventions to move toward a more nutritious diet in Africa.
The Accessibility of Healthy Food in Sub-Saharan Africa
The study of food accessibility and type-2 diabetes found that malnutrition from food insecurity can increase the risks of type-2 diabetes (Carruth & Mendenhall, 2019). An unbalanced diet is a critical cause of malnutrition, leading to an increased risk of type-2 diabetes. Chronic lack of vegetables, fruits, the consumption of low-fat foods, and prolonged intake of high-sugar food, sodium foods, and animal fats can lead to micronutrient deficiencies, thus increasing the prevalence of type-2 diabetes (Carruth & Mendenhall, 2019). Countries such as South Africa, Ethiopia, and Ghana, are experiencing a lack of healthy food accessibility (Agbadi et al., 2017) (Carruth & Mendenhall, 2019) (Clarke et al., 2021), leading to an increased risk for type-2 diabetes.
One of the most common factors of lacking food accessibility in the African region is poverty. In a research study, statistics have shown that deprivation can directly lead the family to be unable to purchase the food (Clarke et al., 2021). Some families choose lower-cost food resources for their diet, and some decide to skip dinner to save money on food. Due to poverty, 29.3% of households in South Africa are at risk of hunger, and 37.5% of households experience hunger. This research claims that the high unemployment rate in South Africa and the large family sizes lead to approximately 50 percent of households earning less than needed to purchase healthy food. The lack of food accessibility can result in family members not consuming the minimum required nutritional requirements, leading to nutritional deficiencies and an increased risk of type-2 diabetes. A similar correlation between poverty and food accessibility can also be found in Angola and Côte d'Ivoire. Both Angola and Côte have been evaluated as middle-income countries; however, nearly 32. 3% of Angola’s population and around 39.5% of the people in Côte d'Ivoire are facing poverty-related food inaccessibility (Angola: World Food Programme, n.d.) (African Development Bank Group, 2022) (Côte d'Ivoire: World Food Programme, n.d.) (The World Bank, n.d.).
In Ethiopia, changes in the climatic environment have decreased the intake of fresh food by the local population compared to the food systems used in the past (Carruth &Mendenhall, 2019). As a result of urbanization and economic growth, Ethiopia's food system is changing, from only accessing the local and short-distance agricultural products for their own consumption, to a capitalized market economy supplemented with long-distance products (Minten et al., 2018). Additionally, the globalization rebuilding their local markets, which are dominated by supermarkets, has led to an increase in the intake of high sugary food, high-sodium food, and refined carbohydrates by the local population. This change in the food system has decreased the availability of healthy foods and an increased risk of type-2 diabetes.
The availability of local healthy food resources is limited due to changes in the climatic environment. In Ethiopia, due to the negative correlation between corn production and temperature and the importance of rainfall in crops and livestock farming, the increased temperature and decreased rainfall are associated with reduced production of corn and other crops as well as livestock production (Mekonnen et al., 2021). Moreover, with globalization and urbanization, the local population preference leads to a higher daily intake of spaghetti, rice, wheat foods, soda drinks, and sugars (Carruth &Mendenhall, 2019). The high price of meats, fresh vegetables, and fruits reduces the Ethiopian population's intake of suggested healthy food to prevent type-2 diabetes.
Recommendations to Strengthen Access to Healthy Foods
Changes needed to be made to increase healthy food accessibility, and several factors need to be considered. A study suggests that generating interventions that target market conditions, land size, farm type, and education at the same time can help improve the outcomes. Teaching students about nutrition, an ideal healthy lifestyle, and food habits will not necessarily have efficient results if there is a lack of access to diverse foods, which is also influenced by access to land. And various foods and nutrition education are associated with one’s knowledge and cause a change in behaviours. (Access to Food and Nutrition in Africa., 2019) Those outcomes were based on a study that used a survey to examine the association between the diversity of household diets and access to purchased food and food from household farms. The data was derived from eight African countries, which weren’t listed in the paper, and questions were generated around accessibility concerns and possible challenges. (Access to Food and Nutrition in Africa., 2019) Nutrition interventions that encourage healthy eating while tackling health challenges in low-income countries are complex. However, that does not mean we should continue to neglect and not try to find a possible solution or strategy to decrease the cases. While thinking of potential interventions, we can consider behavioural economics strategies, as these strategies target healthy eating behaviours. United States, Canada, and Australia used these behavioural economics strategies and demonstrated positive customer purchases and store sales outcomes. One of the strategies was product management, where healthy foods are located near the cashiers and entrance for easy accessibility, and unhealthy foods are placed at the back of the store. (Fergus et al., 2021)
We have examined the effects of accessibility of healthy food on type-2 diabetes, influential factors on accessibility, and potential solutions or interventions to move toward a more nutritious diet in the Sub-Saharan African region.
Ionnie is a 4th-year student majoring in Health Sciences at Simon Fraser University. She is passionate about topics regarding mental health and substance use among adolescents.
Yicheng Cao (Cynthia):
Cynthia is the 4th year Health Science student in Bachelor of Arts from Simon Fraser University. Her interests focus on socioeconomic inequity and gender inequity from her learning at the university. She expects her future career to be focused on implementing interventions or programs that can promote health equity and gender equality.