Addressing the double burden of malnutrition in South Africa: Expert assessment of public policy using the expanded Healthy Food Environment Policy Index (Food-EPI)
1
Chronic Diseases Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
2
Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
3
Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität, Munich, Germany
4
Pettenkofer School of Public Health, Ludwig-Maximilians-Universität, Munich, Germany
5
Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa
6
School of Public Health, University of the Western Cape, Bellville, South Africa
7
School of Public Health, University of Cape Town, Cape Town, South Africa
8
Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
Popul. Med. 2026;8(Supplement Supplement 1):A2982
ABSTRACT
INTRODUCTION:
South Africa faces an increasing double burden of malnutrition (DBM), which consists of undernutrition, micronutrient deficiencies, and overweight / obesity within individuals, households and communities across the life-course. The food environment plays an important role in shaping the DBM. The aim of this study was to assess the extent of implementation of healthy food environment policy in South Africa, benchmark implementation against international best practice, compare progress since a prior assessment, and develop a list of priority policy actions.
METHODS:
Public food environment policies in South Africa were compared with international best practice using the Healthy Food Environment Policy Index (Food-EPI) developed by INFORMAS. The process included adaptation to the local context through expert and policy reviews, identification of international best practice and validation of the evidence, and workshops with 13-17 national experts from government, academia and civil society to benchmark policy across 60 indicators and rank policy actions based on perceived implementation gaps.
RESULTS:
Perceived implementation levels of the 48 original indicators improved from 2016 to 2024, driven by introduction of the sugar-sweetened beverage (SSB) tax in 2018, evidence uptake in policy development, health impact assessments and draft food labelling regulation. Of the 12 new indicators, eight were rated as low to very low, including maternal protection, child directed marketing, public access to WASH, and support of the informal sector. Priority policy considered relevant and achievable included regulation of child directed marketing, increasing the SSB tax, supplement income support programs, and ensure affordability of healthy foods for vulnerable populations. Policies also need to regulate relationships with industry, ensure adequate resource allocation, and implement monitoring and evaluation mechanisms.
CONCLUSIONS:
Assessment of public food environment policy in South Africa showed improvements since 2016 but highlights the need for more efforts to improve public food environment policy and address the DBM.
South Africa faces an increasing double burden of malnutrition (DBM), which consists of undernutrition, micronutrient deficiencies, and overweight / obesity within individuals, households and communities across the life-course. The food environment plays an important role in shaping the DBM. The aim of this study was to assess the extent of implementation of healthy food environment policy in South Africa, benchmark implementation against international best practice, compare progress since a prior assessment, and develop a list of priority policy actions.
METHODS:
Public food environment policies in South Africa were compared with international best practice using the Healthy Food Environment Policy Index (Food-EPI) developed by INFORMAS. The process included adaptation to the local context through expert and policy reviews, identification of international best practice and validation of the evidence, and workshops with 13-17 national experts from government, academia and civil society to benchmark policy across 60 indicators and rank policy actions based on perceived implementation gaps.
RESULTS:
Perceived implementation levels of the 48 original indicators improved from 2016 to 2024, driven by introduction of the sugar-sweetened beverage (SSB) tax in 2018, evidence uptake in policy development, health impact assessments and draft food labelling regulation. Of the 12 new indicators, eight were rated as low to very low, including maternal protection, child directed marketing, public access to WASH, and support of the informal sector. Priority policy considered relevant and achievable included regulation of child directed marketing, increasing the SSB tax, supplement income support programs, and ensure affordability of healthy foods for vulnerable populations. Policies also need to regulate relationships with industry, ensure adequate resource allocation, and implement monitoring and evaluation mechanisms.
CONCLUSIONS:
Assessment of public food environment policy in South Africa showed improvements since 2016 but highlights the need for more efforts to improve public food environment policy and address the DBM.
| eISSN: | 2654-1459 |
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