Share a Coke, Share Diabetes – Coca-Cola consumption in Africa and the growing diabetes epidemic

With an advanced distribution system, subsidised prices, aggressive marketing to younger people, and a lack of nutrition knowledge regarding health risks; Coca-Cola products can fuel the growing diabetes epidemic in Africa to unprecedented proportions.

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Consumption Levels

Africa is an important market for the major players in the beverage industry such as Coca-Cola, which is the continent’s largest private-sector employer [1]. In 2015, Coca-Cola saw net operating revenues of nearly $2.5 billion across Africa and the Middle East [2]. South Africa is responsible for the majority of Coca-Cola product consumption in Africa. In 2012, the average South African consumed 260 (237ml) servings of Coca-Cola products per year; an 80% increase over a 20-year period. When compared to the global average of 94, this places South Africa in the top ten Coca-Cola product consumers worldwide [3]. Regarding annual consumption, South Africa alone was responsible for 14% of unit case volume consumption, compared to 16% for Central, East and West Africa combined [4]. Hence other parts of the continent have enormous opportunities for growth in the number of consumers. For example, in largely populous Nigeria, annual per-capita consumption was only 27 per person in 2011; making the country a highly attractive market for expansion [5].

Affordability and Accessibility

In Africa as with other developing regions, the price of Coca-Cola products is kept strategically low to ensure affordability. This is possible due to the subsidies Coca-Cola receives from the International Finance Corporation, a unit of the World Bank Group [6]. In addition, Coca-Cola’s incredibly advanced distribution system is the envy of even the Bill and Mellinda Gates Foundation, as it boasts of the ability to reach remote areas of Africa where basic essential medicines are inaccessible [7].

Considerable research has been conducted on the link between sugary drink consumption and obesity, which increases the risk of diabetes and other non-communicable diseases. The average 330ml serving of sugar-sweetened soda or fruit juice contains anywhere between 40-45g of sugar [8]. These drinks contribute to a considerable proportion of total per capita sugar and energy consumption [8]. Thus, ease of access coupled with affordability and insufficient nutritional and health knowledge, Coca-Cola products and other sugary drinks can indeed fuel diabetes and other non-communicable disease epidemics to unprecedented proportions.

 

Diabetes Burden

Africa’s disease burden has grown significantly due to the increased prevalence of non-communicable diseases such as type-2 diabetes [9] In 2012/2013 Africa was said to have approximately 7.4% of the global diabetes burden (27.5 million out of 371 million people). This was predicted to increase to 9% by 2030 (49.7 million people) [10]. It is very likely that the full extent of diabetes burden may be underestimated due to poor disease surveillance [9,10]. By 2030, diabetes is expected to grow by 67% in the world’s poorest countries, and only 27% in the world’s richest [11]. It is also predicted that nine out of 10 countries with the highest rates of diabetes will be in Africa [11]. In fact, by 2030 the total burden of non-communicable diseases in Africa is expected to surpass that of infectious diseases.

Marketing to Younger People

With regards to the marketing of its products to younger people, Coca-Cola has explicitly made the following claims: “We do not advertise to children under 12 years old”; and “We do not place advertising in media where the audience is over 35% children under 12 years old.” [12]. However, data is now available that show the contrary. Moodley et al. [13] used a digital camera and a global positioning system to map the locations of sugary drink advertising in relation to schools within a specified area in Soweto, South Africa; and found that 14 out of 28 primary and secondary school properties were branded with Coca-Cola advertising. Thirteen of these advertisements were on the school sign itself. In addition, researchers utilised spatial analysis to determine that within each square kilometre of the study area contained one school, four Coca-Cola advertisements, and five vendors, three of which sold sugary drinks [13]. Such early brand recognition will carry on into adolescence and adulthood, thus ensuring life-long product consumption.

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Beverage industry giants including Coca-Cola and PepsiCo signed up to reduce the calorie content in products destined for the US market by 20% by 2025 [14]. Similar pledges have not been made for products to be sold on the African market. Companies are instead clamouring to increase consumption of the same high calorie products [15]. Coca-Cola projected an expansion of retail sales by over $600 billion by 2020; fulfilling its commitment made in 2010 to doubling its African investments. Should the beverage industry wish to minimise its contribution to obesity, diabetes and the remaining non-communicable disease burden in Africa, it can and should consider adhering to nutritional guidelines and regulatory measures, including smaller portion sizes, warning labels, and reduced marketing to children; including the use of celebrity endorsements [6, 14].

 

 

Reference list available on request

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‘All Poor Everything’ – The Food System, Poverty and the Double Burden of Disease

Based on the fact that the term ‘malnutrition’ has been redefined to include undernutrition AND overnutrition, it’s safe to say that malnutrition is now a global problem. However, even though it’s no longer just about starving children in Asia and Africa, it is about obese children in Europe and America…AND Asia and Africa. Yes indeed, thanks to globalisation and the nutrition transition, poor people in poor countries with poor diets and poor healthcare are now dealing with potential obesity epidemics and all the trimmings that come with it; including the chronic diseases once associated with the more affluent parts of the world such as cancers and heart disease and hypertension. So, all of this new burden is being piled on top of an existing burden of infectious diseases associated with undernutrition, which has actually gotten worse (See A Broken Food System…). So yes, poor people in poor countries with poor diets and poor healthcare (which I will now refer to as P to the 4th power or P4, or ‘All Poor Everything’) now have to battle against a double the burden of disease with the same malfunctioning, mediocre healthcare system they’ve always had – which is apparently seventy-six doctors for every one hundred thousand people; not to mention poor infrastructure, poor sanitation, poor road systems and poor electricity supplies (Pearson and Jordan, 2010) – talk about reverse progress.

So in addition to the 800 million people suffering from what is called ‘chronic hunger’ – “not consuming enough energy to lead a normal life”; another 600 million people are consuming too much energy to lead a normal life, suffering from what is called ‘obesity’. On top of this, another two billion people are deficient in essential micronutrients. In fact, here’s a not-so-fun trivia question: What do children’s diets in India, Kenya, Senegal and Guatemala all have in common? Answer: They are all deficient in micronutrients (vitamin A, Iodine and Iron) that are oh-so important for their optimum growth.

I think that everyone can now agree (at least I hope so) that this state of nutrition chaos is all down to an incredibly messed up food system – from the policies to the production to the processing to the marketing to the purchasing to the preparing to the consumption to the wasting. Yet the link between the human food system and human health is a relatively recent one and a difficult one to make at that, as audacious as that might sound – (like which other species relies on their food system to keep them healthy?) Worse yet are the links between agriculture, nutrition and health: the food you grow becomes the food you eat, which provides the nutrients you need to keep you in good health – sounds like a no-brainer right? Well apparently it’s more complicated than that; so complicated that some of the highest incidences of chronic hunger and childhood stunting are found in agricultural regions and in the households of small-scale farmers – people that grow food for a living. Let that one sink in…

To explain this complication, I find it fitting to use a quote made by Uncle Ryan from ‘Everybody Hates Chris’ – “you can get it good and cheap but not fast; fast and cheap but not good; or good and fast but not cheap.” Indeed he was referring to passport photos for a fake ID, but it can apply to the global food system as well. For many P4 people, food is either not available or not accessible, of really bad quality, or simply way too expensive. Not only that, but in those cases where food IS available AND affordable AND of good quality; some people apparently either don’t have the knowledge of how important this food is for their health, or have neither the time nor resources to prepare it, for whatever reason; be it too busy working in a fast-paced urban environment, or limited water to wash and cook with in a rural setting.

So change is needed – and not just any change, but quick and drastic change; something radical… like a food revolution; a total reshaping of the food system. So how do we go about achieving this? Some experts recommend that this should begin with governments improving national food policies to make them more sensitive to the nutrition needs of their population. Given that undernutrition during infancy and childhood can lead to poor cognitive development, permanent IQ loss and a decreased potential for lifelong learning; perhaps the emphasis should be placed on the economic impact of poor nutrition instead – after all, everyone talks, but money usually has the first say. So it may be momentarily heart-breaking to hear that three million children die every year because of undernutrition; but the fact that that undernourished children go on to earn 20% less when they become adults compared to those that were well nourished; and that Africa and Asia stand to lose eleven percent of their Gross National Product every year due to poor nutrition; and (one more) that chronic diseases can cost the global economy $35 trillion US dollars by 2030 might motivate more of a response.

Part 2: More expert recommendations – coming soon

Source: Healthy Food for a Healthy World: Leveraging Agriculture and Food to improve Global Nutrition. Sponsored by the Chicago Council on Global Affairs

 

References available on request