Living in apartheid South Africa, post-apartheid
The lasting legacy of food insecurity in South Africa’s townships
By Leigh Barrett and Marc van Sittert
(This essay is part of a series that looks at various lingering effects of apartheid in South Africa. Please contact the writers should you wish to publish any or all at perspective.editorial@gmail.com.)
Steve, the owner of a fence construction company, speaks with rising frustration, “I want to give my employees the training so they can one day go out and start their own company. Nothing would make me happier. But, there’s one guy, he’s 23 years old, and he went to high school…” he sighs. “I show him how to cut a one meter plank and instruct him to cut 10 the same size. When I come back an hour later, he has two or three the correct length, and the rest vary wildly. He can’t tell me why. So, I have to show him, again, how to use a tape measure. I do that sometimes twice a day.”
There are domestic workers who struggle to remember from one day to the next how to use a vacuum cleaner, office workers who have to be shown how to use common software repeatedly, and many other examples that have been heard across the country for decades. In fact, this kind of problem was an easy way for many apartheid-era white South Africans to keep telling themselves that black people were inherently inferior. But, every human has the capacity to learn. Every human has the ability to retain information. Unless severely brain-damaged, every person can live a productive life. So, what is the problem?
The explanation is often deceptively simple: Food. Or, more accurately, nutrition.
What is ‘food insecurity”?
Put simply, food insecurity, or food insufficiency, means a household does not have enough food to feed itself. In South Africa, this phenomenon impacts around 80% of households across rural and urban communities. Dr. John Parker of Lentegeur Psychiatric Hospital near Cape Town explains; “South Africa does not have a food shortage, but there’s still hunger. The reasons for that are often storage and transport. The food is being brought from miles away to the supermarket, which is a long way for many in the townships, and many people also don’t have a suitable vehicle to go and do bulk shopping.”
Those struggling with food insecurity typically fall into one of two large camps:
- The “working poor” are those economically marginalized, lacking land, capital, livestock, machinery, as well as literacy and formal skills
- The “socially marginalized.” Especially vulnerable are the elderly and disabled, but there is a larger problem concerning women and children. Through generations of migrant labor practices in the country, where men left their rural homes to work in the mines or cities, women were left behind as the head of the household. Almost half the households in the Cape Town region, for example, are headed by women, and women also represent the largest number among the poor. Women are especially vulnerable because of their biasedly limited access to education and employment; additional burdens placed on them through family, whether relatives from rural areas or children; and pay inequality, which sees women paid up to 50% less than men. Women do tend to purchase more nutritional food and spend more time cooking it, but that places an additional burden on them with such an inequitable division of labor when men are present in the household.
While poverty is a major driver of food insecurity, poor education standards also mean that where opportunities are available, access is limited, because people don’t understand how to navigate application processes and/or lack a basic understanding of how the working world turns.
Our legacy
South Africa’s townships were designed to lie on the outskirts of urban areas, and with petty apartheid laws and bursts of unrest keeping the larger supermarket chains out of the townships, spaza (slang for ‘camouflage’) shops sprung up in spurts of entrepreneurial spirit, married with desperation. Owners of spaza shops charged a premium for food (on average around 20% higher than urban retailers) that was typically unrefrigerated and of questionable quality. Offerings also usually focused on a few dry goods staples alongside tempting sweets and tobacco.
In order to access reasonably priced groceries, consumers were forced to buy whatever they could carry home from work, or pay additional taxi fare during their off time for a special shopping trip. With a transit system based on cash, this meant people had to find the money in order to travel to find work, in order to pay for their transport to find food, and a vicious cycle was born. As the politics changed, the spazas shrunk and opened the way for the juggernaut of large chains that started to proliferate in townships.
Even today, a person without work, limited funds, and no transport, can expect to walk an hour or more simply to get to the nearest supermarket and back, located as it usually is on one end of a sprawling township.
Minimal, if any, considerations were provided in the townships to grow food, and if one visits places like Mfuleni outside Cape Town, it’s almost impossible to imagine how any food can be grown in the rocky, infertile sand. Also, the unique Cape climate and soil doesn’t sustain food gardens that could support the labour that has gravitated to an economy based largely on other aspects of human endeavour besides agriculture. The Cape is not an isolated example of this mismatched need for labour and labour’s need for sustenance.
Malnutrition is an effect of poor quality food and extreme poverty. The lack of education on maternal and childhood nutrition also meant that, even if people had money, they did not prioritize a balanced diet.
The legacy of apartheid is that there are still millions of people living far from food resources. Despite more shopping malls and supermarkets being built, the nutritional value of the food sold commercially rarely matches that of the more organic crops that could be grown at or near home.
Modern methods that maximize yield and sustainability on less-than-optimum soils and high water tables could probably be applied to great effect. With minimal investment in education, skills, and opportunities from local governments, however, today’s residents are left to deal with the same problems that have existed for decades.
Households receiving government social grants are not encouraged or taught how to diversify and incorporate agricultural practices into their homes. The receipt of a grant often has the result of making the recipient more dependent on grants, instead of more self-sufficient. The smaller the grant, the less able a household is to use it to diversify their nutritional intake as they are spending it on necessities, rather than planning for the future. Since many households are also tenants renting their homes, there is even less inducement to grow their own food.
The vast rural areas that formed the original “homelands” occupied a negligible 13% of the country’s arable land. Thus, even there, residents were and still are largely unable to farm sufficiently diverse crops to supplement food purchased from retailers, to provide a balanced and healthy diet. The retailers are again most often located a long and expensive bus or taxi ride away.
The global phenomenon of the decimation of the rural agrarian lifestyle and accompanying urbanization has also impacted tremendously on households. From a modestly balanced diet in a relatively stable rural existence — assuming that tenuous balance had been obtained — many now experience food insecurity in a peripheral, food-absent, urban squat.
From mother to child
Maternal nutrition plays a critical role in the development of the foetal brain. Synapses — nerve connectors that enable infants to be cognizant of their environment, for example — can be slowed considerably if a pregnant mother lacks proper nutrition. This can result in low birth weight, increased risks to the immune system and an inability to digest food properly. As importantly, the mental health of the mother also plays a role. Depression has been shown to result in the malnourishment of the child, and the longer the exposure to poor nutrition, the greater the chance the child has of forming long-lasting mental health issues. Antenatal depression results in a five-fold increase in the likelihood of the child developing depression by the time they reach their teenage years.
In many townships, teens will try to escape poverty and its seemingly intractable repercussions by joining local gangs. If they are already at risk for mental health issues as a result of the circumstances of their birth and early childhood, it is almost inevitable that a gang lifestyle that typically includes using drugs, will result in them being sent into the penal system or a psychiatric care facility.
The list of cognitive functions impacted by malnutrition include: memory deficiency, reduced language development, reduced problem solving skills in mathematics and language, and impaired performance in school. Understanding this, it starts to become much clearer why someone may not remember how to use a tape measure between morning and afternoon. Even if a person’s economic circumstances improve as an adult, the early impact of nutrition on their brain is irreversible.
Despite the efforts at commercial development, and even two decades after apartheid ended, we still have generations that are struggling to appreciate or access proper nutrition, and the difficulties they face appear set to remain with South Africa long into the future. That said, there are encouraging signs that South African society as a whole is now better educated as to the importance of nutrition. Also, to some extent, the meshing of cultures post-apartheid as well as the impact of the emerging and rapidly swelling black middle class, further impacts the national consciousness needed to put issues of malnutrition to rest.
Dr. John Parker, founder of The Spring Foundation, remarks, “Short term memory is about retention and if anything impacts memory retention, it is anxiety. When anxiety levels are high, that can directly impact how instructions are understood. When we try to ‘hammer home’ a message, it has the opposite effect that we want.”
While trauma and stress are direct causes of anxiety, the problem is compounded by the issues seen across the country. In areas of high poverty like the South African townships, where the inability to access quality food is combined with some of the violence seen in areas like the gang-infested, drug-based industry of the Cape Flats, the country appears to be facing a time bomb.
There are many scientific studies that have traced the correlation of vitamin deficiencies to mental health. In South Africa, the prevalence of common mental disorders showed a lifetime risk of over 30 percent*. One in three South Africans face depression, anxiety, and substance dependence in their lifetimes; all clinically treatable disorders.
Not surprisingly, studies have also shown there is a direct correlation between hunger and mental disorders. In one study, The South African National Health And Nutrition Examination Survey (SANHANES-1) by W Parker, 2013, the only demographic in the country that rises above 50% of food secure households is found in the “urban formal” sector.
The study showed that there is an alarming association between not having sufficient food, and having long-term anxiety and a mood disorder like depression, with a lack of education increasing that risk. These factors increase the likelihood of substance abuse and dependency, which in turn creates further mental health issues. With the prevalence of HIV in South Africa, another vicious cycle is also being created. Food insecurity lowers the body’s ability to fight infection, putting people at higher risk of contracting HIV. Once a person is HIV positive, their ability to find work and improve their socio-economic situation through employment (as well as being able to deal emotionally with the stigma that comes with the diagnosis), diminishes. The lower the income, the more food insufficient the household becomes.
Some 30 percent of school children between 10 -14 years old have no food at home to carry them through the school day. The lethargy and dizziness that comes from extreme hunger becomes all-consuming and soon, the only thing any child — or adult, for that matter — can focus on is the need for sustenance.
It’s not surprising then, that in the SANHANES-1 study, around 20 percent of teens over 15 years old develop psychological disorders, and 40 percent show signs of post-traumatic stress disorder (PTSD). These are South Africans who, due largely to the stigma attached to admitting to a mental health disorder, are generally not going to seek psychiatric assistance, yet will one day be looking to lead the country as their generation eventually takes the reins of power.
This can be changed — and is changing — with a focus on developing community and market gardens.
Managing the issue
The Spring Foundation, launched in 2013 under Dr Parker’s leadership, is building a food model that can be replicated in a wider community setting.
Lentegeur Psychiatric Hospital outside Cape Town treats the more severe manifestations of mental disorders, including schizophrenia, bipolar disorder, and dementia. Almost one third of their admissions, however, come from methamphetamine users. The Cape Flats has been the epicenter of the meth trade, with one in 10 users developing psychotic disorders, including hearing voices. Between 2003 and 2010, the numbers doubled every year, finally leveling off, although remaining at a high level. The strain on the hospital means that patients with other treatable disorders, like depression, are often unable to be helped.
While science hasn’t been able to definitively state that nutrition is exclusively responsible for the many forms of severe psychiatric disorders, there is undoubtedly a link. Genetics play a role too and, without treatment, disorders are often passed onto children.
Socio-economic factors also play a role. “The lower down the socio-economic scale one goes, the more severe disorders one sees. The more poverty, the more stress, the more vulnerability there is to mental disorders,” says Parker.
There is also good news, he explains, “Conditional grants for people who take their medication and receive support, can uplift people economically, and that improves their mental health, and improving mental health can help them socio-economically. There’s a clear relationship there.”
The Spring Foundation’s market garden was started specifically for the forensic patients — those who have been found not guilty of crimes by reason of mental illness. With little chance of being released, they are usually sent to live out their days at Valkenberg Hospital, the tertiary psychiatric hospital established in 1881 as a “lunatic asylum”. These are people who have often lost everything — family, home, job, and position.
“It’s amazing how they’ve developed,” Parker says. “We started this through the Occupational Therapy Department. We approached the Forensic Unit for suitable patients to work in the garden. They originally sent us their older, more chronic patients, some of whom were very frail. We later found out they gave us the patients nobody could do anything with, and who had little hope of ever being released back into society. Those guys are now the superstars of the project. They went from being people who wouldn’t pull a weed out without the promise of a cigarette to now, within a few months, coming in and working on the weekends under their own initiative. They are physically much healthier, their mental stability has improved, they’ve learned to work as a team, and their social skills have improved. Now they get a stipend, have to open a bank account and they’re learning to work with money.”
Lentegeur sees about 40% of the patients returning for treatment. First admissions often involve young people who dropped out of school in their mid-teens, began taking drugs and by age 20, were hearing voices. Gangs and drugs become the only economic opportunities for them in many of the townships and, on release, they return to the very situation that got them into trouble in the first place.
Parker says, “We have short-term patients for six to eight weeks and, if we can give people something to do, something that will give them pride and that can help with nutritional support. That can be the beginning of hope for them. We want to focus their attention on doing something more useful, so the idea is that as they leave, we can set them up with small container or box gardens of their own. We’re trying to take them from zero to hope.”
The market garden may have been created as therapy for forensic patients with no future, but through the efforts of the Spring Foundation, many are now considered stable enough to be discharged and integrated back into society. Even those who may remain in the hospital permanently are able to provide their families with much-needed food when they come to visit. The pride that patients and their families feel in doing productive work, can also dramatically reduce the negative stigma of having a mental illness.
The market garden is designed to eventually be independent of government funding, as sales increase through their presence at food markets around Cape Town.
There are areas across the country where it is extremely difficult to grow one’s own food, but with greater awareness, education, and support, box or planter gardens can be developed in most households. The resultant pride, hope, and sense of purpose would not only start to limit the damage on South Africans’ mental and physical health, but would also make a significant difference to employees like Steve’s, who want to do a good job, and often can’t understand why they’re unable to retain the information required to do it.
Government support trickles down slower than the sterling existing legislation would imply, yet the framework of state assistance in matters of malnutrition does exist and, combined with initiatives like the Spring Foundation, could slowly start to bear the fruits of a well fed nation.
* The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders. Author: Allen A Herman, MD, PhD. Et al.
Profile # 1: Gladys
Gladys* is one of millions of Zimbabweans who joined the trek towards a still-functional economy in South Africa, leaving Zimbabwe in 2008 amid the collapse of that country’s economy. Finding herself unregistered and ‘illegally’ living in South Africa, with few options available to generate income, she started a small spaza stall which she attends daily, six days a week. The only reason she skips Sundays is because the streets are quiet. She used to work Sundays, but it wasn’t viable.
Epitomizing the very smallest of traders, Gladys sells chips, sweets and tobacco products from a single plastic crate, stacked on bricks, on a city pavement. Unlike many others, Gladys was raised by a family that knew the value of good food. They could seldom afford it, however, but her mother always had a veggie patch behind their house and tried to stretch extremely limited funds to feed her family a balanced diet. That said, Gladys is open about the fact that she hasn’t eaten properly for over a decade. Earning an average net income of around R60 ($4.40) a day, her meal options are extremely limited. All of her earnings go to food and rent. While she is not a peri-urban township dweller and rather shares an apartment in the inner city with her unemployed sister and her sister’s baby, nonetheless the same cycle of food insecurity manifests in her life too.
Profile # 2: Thobani
Quiet, diminutive and unassuming, Thobani* works as a general cleaner at an inner-city apartment block. He stopped attending school two years ago as he felt it was “a waste of time” and speaks enthusiastically about sending money home to his mother sometimes. Typical of a vast swathe of formerly outlying citizens who constitute the local manifestation of the global wave of urbanization of the last two decades or so, his mother and siblings stay far away in a rural village. Amicable and full of life, he nonetheless has zero ambition and a rather philosophical approach to his station in life.
“It’s hard to push all the bins in the morning,” he says, looking pained. One of his responsibilities is to empty the trash bins every day. “I see what people are eating, and I know I can’t ever afford those things. But I guess I should be grateful.”
Thobani also sorts through all of the trash in the name of recycling. He has to ensure that plastics and papers and food waste all go in different directions. He knows what the few hundred people in the building consume. And knows he cannot, even in a low-end establishment like this, emulate their diets.
“I get paid less than R1000 ($66) a week,” he says. “I know these people in the building staying here are not rich. Many of them struggle just like me, but even their food is too expensive for me.”
*Names have been changed
Photos courtesy Marc van Sittert.
This year, a Cape Town-based NPO, Angels Training and Resource Centres, expanded their success in the Northern Cape to Fish Hoek in the far south Cape Peninsula.
Angels, under the leadership of sociologist Lizelle Coombs, created programmes like Big Waste Wake-Up, teaching survivalist entrepreneurs that the trash seen on the streets, can be turned into a sustainable business.
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