Nutrition and food system policy priorities

In both countries, the policy analysis indicated that addressing malnutrition and food insecurity was a stated national policy priority and with leadership from the national development agency (National Development Planning Commission in Ghana and The National Planning Commission in South Africa). This enabled a whole-of-government approach to (under)nutrition and food security, with national coordination for multi-sectoral action. It was evident that food security in particular had been integrated into sectoral mandates related to agriculture and welfare (Social Development) and nutrition into health sector mandates.

With reference to the nutrition transition, however, it was evident that the policy priority for (mal)nutrition at the central government level in both countries did not extend to diet-related NCD. It was within the health sector (i.e. the Ministry/Department of Health) that there were specific policies to address both undernutrition and NCD. Overall, resource allocation and technical expertise related to nutrition were still focused on undernutrition and nutrition-specific interventions. While the Ministry/Department of Health in both countries formally recognised the importance of healthy food supply to support nutrition objectives, they had no formal remit for policy instruments relevant to food governance.

Food policy decisions were within the purview of Agriculture, Industry and Trade sectors. Interviews with food system actors and food policy actors in both countries indicated little active consideration of nutrition by food system actors or policy. In both countries, cross-sectoral coordination to integrate nutrition into sectoral mandates and to manage conflicts of interest remained challenging. Policy respondents across sectors recognised that unhealthy diets were associated with poor health outcomes but emphasised individual/consumer-oriented reasons for citizens eating unhealthy diets, such as a lack of knowledge. As a result, they located responsibility for addressing nutrition with the Ministry/Department of Health and with individuals. Interviewees within both Ministry/Departments of Health in turn reported that engaging across sectors to promote healthier food environments was challenging. This was in part due to the ‘responsibility’ of the health sector for nutrition, which created challenges for action in food system sectors, which had clear economic and livelihood mandates related to trade, industry, finance and production. One element of the broader context of this effective separation of food policy mandates from nutrition policy was very different framing of engagement with food industry actors by policy actors. In the economic food policy sectors, (formal) industry was one of the primary stakeholders in policy, and there was significant attention to their concerns and interests. In contrast, in the health sector with respect to nutrition, there was limited engagement with industry actors (other than with respect to food safety, specifically). Interviewees from the health sector raised concerns about potential conflicts of interest regarding nutrition and economic objectives related to the food system, particularly with respect to regulation of the food environment (e.g. labelling and marketing restrictions).

In interviews for this study, policy-makers within economic sectors often expressed interest in identifying new approaches to achieving objectives – both economic and broader social goals. For example, in South Africa, there was growing recognition that food system outcomes were contributing to ongoing inequalities and not fully achieving social, health or economic goals. In Ghana, there was a sense that current approaches to economic development were achieving limited benefits for the food sector and that human development was being hampered by persistent undernutrition. These factors suggested opportunities and goodwill in both study countries for considering new approaches to food system governance that would better support integration of nutrition as a priority within policy sectors that govern the food system.

The political economy analysis presented here, which brings together the policy analyses and value chain analyses conducted, was thus focused on understanding the disconnect between the evident priority for improving nutrition at the national level and within the health sector, and the limited translation of this into food system policy and action. By examining the interests, incentives and institutions that lie beneath formal structures and enable or constrain change, we sought to shed light on the persistence of the policy status quo that is resulting in poor nutrition (and other) outcomes.

Interests of food system actors

In both study sites, we examined the interests of food system actors and food policy actors. The primary considerations of food industry actors were, unsurprisingly, economic in nature, but they varied by type of industry actor. In Ghana, the agricultural sector was dominated by resource-poor smallholder farmers, who are the main suppliers of local food stuffs to traditional open markets, and also have a significant subsistence concern. In contrast, South Africa is not an agricultural-based economy, and small producers made a fairly small contribution to the food supply (agriculture represents less than 3 per cent of the country’s GDP compared with Ghana’s 17 per cent). In both countries, the evident interests of small farmers were reported as livelihoods and subsistence, while larger farmers sought to attain and increase access to domestic value chains through enhancing efficiencies and production volumes (agricultural ‘modernisation’, and particularly integration into formal value chains). In Ghana, in particular, improving market access and wastage were identified as significant interests by food system actors, although small producers had limited interest in accessing international value chains through trade. In contrast, agricultural production in South Africa is dominated by large commercial agriculture entities, often concerned with liberalising international trade. It was notable that the dominance of large-scale commercial farming in South Africa has deepened with post-apartheid liberalisation and agricultural market deregulation, as well the preference of large manufacturers and retailers for ‘stable’ supply (see below on trends evident in Ghana).

The profit and long-term economic concerns of large agribusiness and food industry were expressed primarily in an emphasis on sector growth and access to global value chains, and, in the case of South Africa, regional expansion. In South Africa, large national and multinational food processors and retailers had strong policy interests in liberalising trade and investment policy, and domestic deregulation. In contrast, these large industry actors in Ghana were primarily wholesalers and retailers (large supermarket chains are fewer in number, and they deal mostly in imported commodities), and their policy interests reflected the less organised production sector, in particular, strengthening domestic supply chains and access to imports to offset fluctuations and limitations in domestic supply.

Priorities articulated by food policy actors across sectors governing food systems (namely, Agriculture, Trade and Industry sectors) in both countries primarily focused on economic considerations, including trade, employment and economic growth. Policy-makers in food system sectors referenced both industry interests, as described above, and national economic priorities (namely, employment). Policy priorities were oriented to the interests of larger and formal industry actors, in particular, priorities related to active investment in and incentives for increasing and facilitating food trade, which focused on value-adding and connecting domestic industry actors with international value chains. Formalisation of the food system was also a priority, particularly integration of small-scale farmers into the formal (industrial) food system. The latter was notable in the nature and focus of South Africa’s support for black (indigenous) entrepreneurs, which included public–private partnerships with major food industry actors. In contrast, although modernisation of agriculture was a policy priority in Ghana, the small-scale nature of agriculture in Ghana created challenges, especially the lack the infrastructure, knowledge and capacity among farmers. Consumer interests were also clearly evident in food system policy. In both countries, we found that governments were concerned with food safety as well as stability in food prices.

Power in food system governance

In both countries, we identified alignment between the interests of large agri-food system actors in the value chains and the industrial (and agriculture) policy focus on value addition, processing and trade, although this was tempered in Ghana by the significance of small-scale farmers and limited number of large agri-food industry actors. The interview data indicated two key avenues through which industry actors exercised power in the policy space. First, interviewees in both countries indicated that the alignment of industry interests with dominant government policy priorities for economic growth and employment meant that their specific policy-relevant interests were very influential. In Ghana, for example, wholesalers and importers are well resourced and powerful in the food system and able to provide support to politicians. These actors have effectively lobbied to liberalise trade and limit restrictions on imports, even though high volumes of imports have tended to stifle domestic production capacity (i.e. in the domestic broiler and rice industries). Large industry has also tapped into concerns about employment to curtail regulation in both countries. For example, in South Africa, poultry producers lobbied against the relaxation of import tariffs on imported frozen chicken. However, it was also evident that their influence reflected the disproportionate visibility and policy salience of formal employment and formal sector revenue generation, compared with the smaller-scale informal sectors.

Second, the interviews with value chain and policy actors indicated that knowledge was a source of power: industry positioned themselves effectively as knowledge holders or technical experts. In South Africa, large industry was effectively positioned as a ‘knowledge holder’ to inform policy decisions and also as experts in food system development, for example, through public–private partnerships in which large industry mentored smallholder farmers and small manufacturers. In Ghana, a lack of knowledge among farmers and other value chain actors was articulated as a reason for food system ‘failure’, for example, the decline of the domestic chicken industry. This narrative functioned to reinforce arguments for modernisation and more ‘developed’ industry actors as essential to achieving food system goals in Ghana.

Formal responsibility for food policy was quite separate from nutrition policy, and within food policy forums, industry tended to be influential. In South Africa, there were evident disconnections between jurisdictions of government (viz. national, provincial and local), with food largely viewed through lens of ‘food safety’, which is vested in local government as ‘environment health’. Nutrition was not within their purview. Similarly, in Ghana, food safety was strongly regulated by the Food and Drugs Authority. In both countries, there were complex dynamics across jurisdictions within food system sectors, in terms of National Agriculture (with subnational programmes), National Trade & Industry (with subnational programmes to foster export-oriented Small and Medium Enterprises), and Provincial and Municipal Urban Planning. Within all of these sectors, there were multiple forums for consultation and input by the private sector. In both countries, planners and developers were hugely influential on urban planning policy and policy related to food retail, with a strong focus on modernisation and the formal sector. The urban–rural interface within the food systems was largely ignored, and municipal planning processes were rarely linked to agriculture policy or to nutrition policy.

In both South Africa and Ghana, there was an indication of growing civil society advocacy regarding food systems and the right to food. However, the influence of the civil society voices in both countries appeared limited (effectively fragmented) because of both the multiple spaces for decision-making described above and because of the multi-dimensionality of the ‘food policy’ issues being advocated for. In effect, advocacy regarding environmental sustainability, livelihoods, inequality, food security, nutrition and (in South Africa) the right to food were separate advocacy issues. This meant that even where consultation structures exist for policy-making, civil society voices were often marginalised. In addition, there was not a strong constituency related to prevention of either chronic undernutrition or diet-related NCD, because the deleterious effects are invariably long term, have systemic causes and tend to be individualised.

Conceptions of the food sector

We identified three dominant ideas or narratives about the food system and food system governance in both countries that helped us understand the sway of large industry over policy and the limited consideration of nutrition. First, evident in both countries was a shared perception among food industry and food system policy actors that the role of the food sector in relation to nutrition was simply to produce sufficient food and that issues of nutritional quality – apart from technical action on reformulation and fortification – were a marginal or side concern for the food industry. This was reflected in an overriding policy paradigm of sufficiency in food policy evident in both countries. Although industry actors in South Africa recognised diet-related health concerns, it was clear that ‘nutrition’ was seen as a concern for a niche market, with potential for sector growth arising from growing middle-class concerns about diets and health. In Ghana, there was more attention to undernutrition and sufficiency from the industry side, with little concern regarding diet-related NCD. However, value chain actors often did not perceive that they had any role in judging the nutritional quality or influencing the supply of ‘healthy’ foods, with food framed and managed as a commodity. An underlying narrative was evident in both countries that the food industry is simply responding to consumer demands in a competitive environment and that it is up to consumers to choose healthier options.

Second, in both study sites, we found that nutritional quality and by extension diet-related NCD were simply ‘externalities’ and that there was structurally no incentive for food system actors to consider these factors. There were no evident incentives – policy or otherwise – to ‘internalise’ the costs of nutritionally suboptimal foods (e.g. ultra-processed foods, high-energy–low-nutrient foods, etc). In fact, in value chain terms, minimally processed food had significant disadvantages for food manufacturers and retailers due to limited scope for value-add, challenges with product differentiation and branding, their perishability and presentation often in non-standard units. In contrast, food safety issues were strongly internalised. For example, in South Africa, major corporate efforts on food safety were evident because food-borne illness events exacted reputational costs, which translate into potentially large financial losses.

Third, there was a shared belief between food industry and food system policy actors that (formal, large) industry is the appropriate – indeed predominant – pathway to economic growth. Industry effectively positioned itself – and was viewed by economic policy-makers – as important to the economy and society. In both countries, large industry was seen as imperative for economic efficiencies and scale of production required to meet growing domestic demand. It was also linked to urbanisation and need for effective domestic distribution, which large retailers were seen by economic sector interviewees as being able to achieve. Informality was seen as undesirable for a ‘modern’ economy – but at the same time somehow necessary in a ‘transitional’ context. There was thus an absence of policy priorities for, and policy engagement with, the informal sector in both countries other than a general push for formalisation (in other words, an apparent implicit assumption that informality will eventually be eclipsed by development). The ‘informal’ food industry in both countries was characterised by the lack of a coordinated approach, limited recording keeping, organisation and lobbying. However, in both countries, the informal sector constituted a significant element of the food system and retailed both minimally processed fresh foods and ultra-processed products. There was also significant interplay and flows of products from the ‘formal’ to the ‘informal’ food sector, particularly in South Africa.

A significant difference between the two study countries was the prevalent discourse regarding indigenous traditional (largely healthy) foods in Ghana, such as cocoyam leaves (kontomire), other indigenous leafy greens and cowpeas. This discourse was not evident at the policy level in South Africa, where the historical disruption of indigenous foods and food culture sees many contemporary ‘traditional’ dishes constituted from ingredients (chicken, maize, sugar, etc) produced by the industrial food system. In Ghana, the persistence of minimally processed traditional foods and cuisine also meant that there was a clear identity regarding the primary producers of these foods, despite the shift towards imported food items and highly processed foods.

Another notable difference was the health promotion levy in place in South Africa, which is a tax on sugar-sweetened beverages. Interviewees noted the successful adoption of the tax as an indication of public health nutrition interests being recognised as important in the economic policy space. However, the reduction of the proposed tax rate by half in the final regulation was the result of intense lobbying activity by the sugar industry, which also mobilised support from the Congress of South African Trade Unions (COSATU) and appealed to economic interests through potential job losses.