range of nourishing grains such as sorghum, maize, millet and teff are made into healthy main dishes usually accompanied by some kind of stew, soup or relish. Sub-Saharan Africa also does very well on consumption of beans, pulses and vegetables. The average Zimbabwean eats 493.1 grams of vegetables a day, compared with just 65.1 grams for the average person in Switzerland.13
It was Imamura’s conclusion about the high quality of African diets that ruffled feathers in the world of public health. What about African hunger and scarcity? Zimbabweans may eat more vegetables than the Swiss, but there is more to health than vegetables, given that life expectancy in Zimbabwe in 2015 was just fifty-nine years of age compared with eighty-three for the average Swiss person. Some scientists argue that the low score for unhealthy foods in some African and Asian countries is actually a sign of diets that are ‘poor’ in various ways. If the people of Cameroon consume low amounts of sugar and processed meat, it is partly because they are consuming low amounts of food all round.14
Imamura does not deny, he tells me, that the quantity of food available is very low in some of the African countries, but adds, ‘That’s not the point of our study. We were looking at quality.’ His paper was predicated on the assumption that everyone in the world was consuming 2,000 calories a day. Imamura was well aware that is far from the case in sub-Saharan Africa, where the prevalence of malnourishment is around 24 per cent according to the Food and Agriculture Organisation. But he and his colleagues wanted to isolate the question of food quality from that of quantity. Traditional public health nutrition, he observes, was so fixated on the question of hunger that it paid too much attention to the quantity of food people had access to without considering whether the food itself was beneficial for human health.15
Africa’s hunger can easily blind us to the sheer quality and variety of food that people enjoy in much of the continent. The findings of Imamura’s paper came as no surprise to Graeme Arendse, a South African journalist at the Chimurenga Chronic, a magazine celebrating pan-African culture. In 2017 Arendse helped put together a special food issue of the magazine which challenged the Western idea that African food was all about deprivation and suffering. On a sunny winter’s day, sitting in his offices in Cape Town above the pan-African market in the city centre, Arendse tells me that ‘this story of scarcity is not true’. Arendse sees traditional African food as deeply diverse, with much of it very healthy. A short walk from his office in Cape Town, Arendse can pick up a takeaway of fish and brown rice at a Malian place where he likes to go. Other days, when the mood hits, he goes to a different café to buy a bowl of Nigerian egusi soup made from melon seeds with seafood and bitter greens, for the same price as a fast food meal from McDonald’s.
Arendse worries that unless traditional African cuisine with its soups and stews of many kinds is celebrated more, it will lose out even more to the fast foods and convenience foods that he notices becoming so popular now in South Africa. On the bus into work, in just the past couple of years, he has started to see some commuters breakfasting on crisps and cans of cola. ‘I never saw that in the past.’
Dietary patterns are getting rapidly worse in much of Africa, including South Africa. In recent years, monied South Africans have abandoned the old dinners of mealy maize and have started to drink bottles of sparkling mineral water and to eat salads of roasted vegetables and feta cheese, and, yes, many kinds of avocado toast. But there has also been a colossal rise in the consumption of packaged snack foods and sugary drinks. The balance of what South Africans eat is tipping away from the old vegetables and stews of the rest of sub-Saharan Africa and towards a Westernised diet of fried chicken and burgers and oversized portions of pasta.16
‘These young people have stretched their stomachs,’ observed an old black South African in 2016, startled by the way that children suddenly expected to eat fried foods and meat every day. Middle-income countries such as South Africa have experienced the full fairy tale and the full horror story of food at the same time. Rates of both under-nutrition and over-nutrition in South Africa exceeded 30 per cent of the population as of 2016. In the old days, South Africans ate many wild fruits and breakfasted on a thick maize or sorghum porridge, seasoned to taste with a few drops of vinegar. Now, breakfast is more likely to be nutrient-poor white industrial bread with margarine or jam. With escalating sugar consumption, tooth decay is rising in South Africa at an alarming rate.17
Eating in South Africa, a parched land with relatively poor soil quality, has never been ‘heaven on earth’, as South African dietitian Mpho Tshukudu has written. There is no golden age of food to return to. But nor have South Africans ever had to face food dilemmas quite like the ones they face today on a daily basis. One mother in her forties who came to Tshukudu’s clinic recalled that as a child growing up in a rural village, she walked for miles and ate home-cooked foods every day, always with a vegetable or some kind of legume. She knew no one who was obese and never needed to visit a doctor. But now, this woman lived in the city with her husband and three children and they all ate a lot of takeaway food and were frequently unwell. Her nine-year-old daughter was already so big that, to her distress, she had to buy her clothes in the grown-up section of the store.18
In some ways, South Africa’s new unhealthy pattern of eating is distinctive to the country itself, and to the injustice of the apartheid years. During apartheid, the state controlled who moved to towns and who stayed in the country and no black farmers were allowed to own land outside the ‘homelands’. Adults living in black townships often had long commutes to jobs in the white cities which left less time for cooking than in the past and as a result, some of the old traditional dishes died out.
But the most extreme and sudden changes to South African eating happened after the end of apartheid in the mid-1990s, during and after Nelson Mandela’s presidency, when thousands of black South Africans were lifted out of poverty for the first time. People were free to move to the cities; and they did. By many metrics, life got better and easier, but much of what people were eating now was less healthy than it had been before. As a newly open economy, the country was flooded with fast food and processed food from both home and abroad. From 2005 to 2010, the sales of processed snack bars in South Africa increased by more than 40 per cent.19
New freedom and city living; new snacks and abundance; new obesity and type 2 diabetes: the patterns of both eating and health have shifted fast in South Africa since the 1990s. The speed at which diets are changing here is vertiginous, yet the pattern is a familiar one. It is almost as if South Africa – along with so many other countries in the world – is following a script for eating set by America fifty or so years ago.
Stage four
Growing up in 1950s Wisconsin, Barry Popkin drank only tap water and milk, except for a small glass of orange juice to start the day. His father drank tea and his mother had coffee. At the weekend, as he has explained in his 2009 book The World is Fat, his parents might take a glass of wine for a treat. No one in Popkin’s family drank sweetened lattes or sugary energy drinks and the adults would not have dreamed of drinking alcohol every day. There were no smoothies and no white chocolate mocha frappuccinos. Popkin – Professor of Nutrition at Chapel Hill University, North Carolina – has made it his life’s mission to study the reasons why our patterns of eating and drinking are so different from those of the past; and to figure out ways to save the best of the changes and move beyond the worst of them.20
During the months when I was first researching this book, it felt as if all roads led to Barry Popkin. Whether I was looking for hard facts on snacking or sugar or statistics about how food had changed in China over the past decade, Popkin always seemed to have co-authored the definitive paper on the subject. He was also involved in working with governments to create better food policies in many countries including Mexico, Chile, Colombia and Brazil. His website showed a photo of a cheery-looking man in his seventies with a white beard, but this Popkin was so prolific, I was starting to doubt whether he really existed, or whether he was in fact a team
