Urban food systems for healthy diets in South Africa: Addressing the double burden of malnutrition through a coherent systems approach

在世界上的每一个国家，特别是贫穷国家，人们都因饮食而健康状况不佳。没有吃足够的营养食品，吃太多的不健康食品意味着幼儿不能正常生长，妇女不能获得足够的维生素和矿物质，更多的人受到超重和糖尿病等疾病的影响。这通常被称为“营养不良”，对包括婴儿在内的幼儿尤其严重，他们中的许多人在五岁以下时没有得到适当的母乳喂养或营养不足。南非是一个营养不良问题严重的国家。大多数南非人住在城市，那里的穷人生活很困难。这些人上班要花很长时间，住在很小的房子里。这使得他们很难在家里储存和准备有营养的食物。因此，他们经常依赖那些可以直接吃或不会变质的食物，比如高脂肪的油炸食品和含糖的零食和饮料。因为他们没有多少钱和时间，他们经常给婴儿喂含水的淀粉类食物，没有足够的营养。在他们生活和工作的地方，这种食物很容易买到，而且很便宜。事实上，把食物带到他们的社区的整个系统使得在他们周围创造一个充满错误食物类型的环境变得更容易和更便宜。这个系统被称为“食物系统”。这一切也意味着，南非政府为帮助人们吃得更好所做的许多努力并没有真正发挥其潜力，比如他们为贫困家庭的孩子提供额外的钱，或者旨在帮助他们更好地喂养幼儿的项目。虽然南非有自己的具体情况，但世界上许多其他国家也是如此。在我们的项目中，我们想要改变这一点。我们希望看到一套完整的行动体系，能够真正为城市居民服务。这意味着确保帮助他们的现有行动更好地与粮食系统保持一致并得到该系统的支持，以及在该系统内设计新的行动，认识到人们生活中的挑战。我们将提供证据来了解这个行动系统是什么样子的。我们将以一种不太常用的方式来做这件事：实际上，从倾听城市环境中经历我们所谈论的问题的人们开始。我们将与有5岁以下孩子的家庭交谈，因为有证据表明，这是最需要支持的群体，还有他们的母亲和其他可能很快就要生孩子的女性。我们将和他们一起在他们的社区散步，找出是什么影响了他们的饮食，以及什么可以改变他们的饮食。我们将与他们讨论政府已经试图帮助他们的方式，以及他们是否了解这些方式，或者是否能够对这些方式作出回应。与他们一起，我们将设计一个行动系统，真正为他们和他们的孩子工作。我们还将与政府讨论他们可以做些什么，特别是在整个食品系统以及城市规划方面的进一步改革。我们将把所有影响这些人饮食的人带入一个更广泛的对话。我们将共同努力设计一个系统，支持儿童及其母亲食用有利于其健康和发育的食物。我们将在南非第四大省西开普省的两个社区开展这项工作。我们选择了这个地方，因为当地政府已经致力于改善食品系统，以解决他们社区的营养不良问题，并要求我们帮助他们确定什么可以产生真正的变化。虽然我们将在南非进行这项研究，但它将与该地区和整个世界有关。因此，我们将制作报告和其他材料，帮助其他城市的其他人对他们社区的不良饮食做出更有效的反应。

In every country in the world, especially poor countries, people experience ill-health because of what they eat. Not eating enough nutritious foods, and eating too many unhealthy foods means young children do not grow properly, women do not get enough vitamins and minerals, and many more people are affected by overweight and diseases like diabetes. This is often called "malnutrition" and is especially serious for young children, including babies, many of whom are not properly breastfed or receive inadequate nutrients when they are under the age of five.One country with a major malnutrition problem is South Africa. Most people in South Africa live in cities, where life is difficult for poor people. These people have long travel times to work and live in tiny houses. This makes it really difficult for them to store and prepare nutritious foods at home. As a result, they often rely on food that they can eat straight away or does not spoil, like fatty fried food and sugary snacks and drinks. Because they have so little money and time, they often feed babies watery, starchy foods without enough nutrients. Where they live and work, this food is readily available and cheap. In fact, the whole system of things that bring food into their neighbourhoods makes it easier and cheaper to create an environment around them that's full of the wrong types of food. This system is known as a "food system." This all means, too, that the many efforts the government has made in South Africa to help people eat better have not really reached their potential, efforts such as the extra money they give to poor families for their children, or programmes designed to help them feed their toddlers better. While South Africa has its own specific context, this is also the case in many other countries around the world.In our project, we want to change this. We want to see a whole system of actions that will actually work for people who live in cities. This means ensuring that existing actions to help them are better aligned with and supported by that food system, as well as designing new actions within the system that recognise the challenges in peoples' lives.We are going to provide evidence to know what this system of actions would look like. We will do this in a way that is not done very much: to actually start by listening to the people in urban settings who experience the problems we are talking about. We will talk to families who have children under the age of 5, as this is the group the evidence says needs most support, along with their mothers and other women who might have babies quite soon. We will walk with them around their neighbourhoods and find out what influences the foods they eat, and what could change that. We will talk to them about the ways the government already tries to help them and whether they know about them, or are able to respond to them. And together with them, we will design a system of actions that would actually work for them and their children. We will also talk to the government about what they can do, especially about changes further back into the entire food system, as well as in urban planning. And we will bring into a broader conversation all the people who have influenced what these people eat. Together we will work to design a system that supports children and their mothers eating foods that support their health and development.We will do this in two communities in the fourth largest province in South Africa: the Western Cape. We have chosen that place because the local government is already committed to improving food systems to address poor nutrition in their communities, and have asked us to help them identify what could effect real change. Although we will conduct this study in South Africa, it will be relevant to the region and the whole world. So we will produce reports and other materials that help other people in other cities create a more effective response to poor diets in their communities.