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Mail & Guardian
22-07-2025
- Health
- Mail & Guardian
Diabetes is a disease that thrives on inequity
South Africa must treat the conditions that breed diabetes, including by making healthy food affordable. Photo: File It's not every day one finds themselves navigating the buzz of McCormick Place convention centre in downtown Chicago, dwarfed by towering banners, energised scientists and a swirling stream of conversations in a dozen different languages, all united by a single cause: tackling diabetes. For me, attending the 2025 American Diabetes Association (ADA) Scientific Sessions wasn't just about science. It was a reckoning. A moment to understand, reflect and reimagine what this disease means for my country, and for me as a South African woman. I arrived late on Friday, 20 June, after a long-haul flight with cramped legs, airport sandwiches and anticipation. By the time I checked into my hotel, I had missed most of the day's sessions. But there was one I was determined to catch, and I made it just in time. The session was called Social Drivers of Health Needs and Cost. What unfolded in that packed hall was less a session and more a raw, honest confrontation with reality. Dr Jennifer Wallace, the moderator, opened with something that hit me square in the chest: 'If we want to treat diabetes effectively, we cannot ignore the world outside the clinic.' It's a sentiment that resonates deeply in South Africa, where the world outside the clinic, townships, informal settlements and communities living in food deserts, is precisely where the battle against Type 2 diabetes is being lost. Dr Marcus Lee told a story about a patient who managed her insulin levels by eating less. I could immediately picture women back home doing the same, sacrificing meals so their medication lasts longer. Alicia Ramos, a community health navigator, reminded us that for many, the choice is not just between food and medicine, but between survival and wellness. The truth? Type 2 diabetes is no longer a condition we see in sick or older people. It's knocking loudly on the doors of the working class, of families earning just enough to survive but not enough to eat well. Saturday's session, Type 2: From Biology to Behaviour: Is it all in the Family?' took the conversation even deeper. The message was clear: diabetes doesn't just run in our blood. It runs in our habits, our kitchens and our cultures. In South Africa, many of us grow up eating pap, vetkoek, sugary tea, deep-fried carbs and processed meats. These aren't indulgences. They're affordable staples. They have a high-calorie count and they don't break the bank. When healthier options cost twice as much or simply aren't available, how can we realistically expect people to choose better? The session unpacked how family history and intergenerational behaviour create cycles that are hard to break. But what stood out to me was the shift in tone. This wasn't about blaming families for bad choices. It was about compassion, care and giving people the tools and environments they need to choose health. Back home that means school programmes, public health campaigns and food subsidies. But, I thought, are we doing enough to combat the crisis? Or is our inherent socio-economic system jeopardising the problem? Later that day, a quieter ePoster session titled Obesity-Associated Diabetes and Cancer Risk offered a chilling insight: Type 2 diabetes is tied not only to heart disease, but also to several cancers, especially in women. As someone who has watched family members battle both diabetes and cancer, this hit hard. It's another layer of urgency for prevention and early screening, especially in women's health initiatives. In a session, aptly named Are You What You Eat?, the spotlight turned to nutrition. But rather than scolding or moralising, the speakers reframed the conversation. People aren't unhealthy because they don't care. They're unhealthy because they don't have options. One poster presented data showing measurable improvements in insulin sensitivity from small upgrades in food quality, such as switching to whole grains or reducing sodium. But even those small steps can be unattainable luxuries in under-resourced communities. Junk food is cheaper than a tomato and provides more energy per serving, so with a limited income, why would I choose the tomato? We're treating diet like a choice, but it's often dictated by economics. By Sunday, the most emotional session of the conference, Rising Risks, Real Solutions: Tackling Childhood Type 2 Diabetes and Obesity, laid bare a terrifying trend. More children are getting Type 2 diabetes, and earlier. It's aggressive, fast-moving and robs young people of a healthy adulthood. South Africa isn't immune from this; we're on the front lines. The success stories came from schools with integrated nutrition and mental health programmes. This kind of holistic care could transform South African schools. I wondered how much we could change if our health and education systems worked in tandem (on the ground in communities) and how much this synergy could change how we approach diabetes in the future. The final sessions I attended on Monday were visionary. They explored how hunger signals are regulated in the brain, how muscle mass affects metabolism and how next-gen drugs are not just managing, but potentially reversing diabetes. The promise? Therapies that promote weight loss, cardiovascular protection and even remission. The problem? Access. I learnt a lot about the various medicines on the market, but just because they exist, doesn't mean they're readily available. In South Africa, even metformin can be out of reach for some. GLP-1 therapies such as semaglutide are available (technically), but are they accessible to the majority? That's where Danish pharmaceutical multinational Novo Nordisk and others like it have a crucial role to play. Novo Nordisk has been pioneering research and partnerships for more than 25 years to improve the lives of people with diabetes and obesity. This symposium made me think about equity in a different light. Equity isn't just about distribution, it's about systems, partnerships and policies that bring the future to those who need it most. And equity is about having choice and the option to choose. Being denied options is being denied agency. What I took from ADA 2025 wasn't just knowledge, it was clarity. Type 2 diabetes is no longer a niche concern or an affluent disease. It's a social epidemic, shaped as much by economics as by biology. South Africa must act: boldly and collaboratively. From health policies to supermarket aisles, from school lunchboxes to transport infrastructure. If we want to treat diabetes, we must treat the conditions that breed it. That means making healthy food accessible. That means reimbursing community health workers. That means equipping clinics with tools to screen not only glucose levels, but social risk. The shift isn't just from control to cure. It's from treatment to transformation. I arrived in Johannesburg jetlagged and overloaded with information, but I returned with purpose. Diabetes is not a disease that exists in isolation, it is something proliferated by our socio-economic systems. And if we don't change our systems, diabetes will continue to become more and more of a concern. In the end, health isn't just about science. It's about justice. Katie Mohamed is the chief executive of BrandFusion, W-Suite and ChangeHub.
New York Times
21-07-2025
- Business
- New York Times
The Solution to $10 Eggs Lies Within New York City Limits
A big feature of Zohran Mamdani's upset win in the New York City Democratic mayoral primary was his focus on the unfairness of current food prices. He proposed piloting five city-run grocery stores. Voters loved it. Pundits mocked it. The idea was labeled communist, irrelevant, dangerous and silly. But the mockery missed the larger point: Cities have the power to bring down food prices and bring life to food deserts. They just haven't been using it. The food system in the United States is rigged in favor of big retailers and suppliers in several ways. Big retailers often flex their muscles to demand special deals; to make up the difference, suppliers then charge the smaller stores more. Those discounts are one reason independent grocers struggle to survive. They're a major reason we have food deserts. They're also a major reason that prices are so insane. Consider eggs. At the independent supermarket near my apartment, the price for a dozen white eggs last week was $5.99. At a major national retailer a few blocks away, it was $3.99. (For an identical box of cereal, the price difference was $3.) Any number of factors may contribute to a given price, but market power is a particularly consequential one. The thing is, preferential discounts can violate federal law. A 1936 statute called the Robinson-Patman Act forbids suppliers from offering sweetheart deals that aren't based on actual efficiencies of scale. The idea behind the law was to make sure smaller retailers could get a fair shake and consumers could get the benefit of real competition. But in the 1980s, amid a general climate of deregulation, the government largely backed off. For the two decades after 2000, no cases were brought at all. When Lina Khan became chair of the Federal Trade Commission in 2021, she brought two Robinson-Patman cases. But one of the first acts of President Trump's new commissioners was to pull the plug on one of them. Cities like New York don't have to wait for the federal government to act. They can pass their own laws against price discrimination and include real penalties. That could improve profit margins for existing independent stores. It would help them to survive in the areas where people most lack access to good, affordable groceries and fresh food. And it would incentivize more small groceries to set up shop — all developments that could bring the kind of neighborhood-level competition that drives down prices. The standard objection to this logic is that big national chain retailers earn those discounts simply by being more efficient. That may be true in individual cases, but more broadly, the evidence is not so straightforward. Independent grocers that band together in associations — as many of those in New York City do — can be just as efficient as their larger competitors. Even if the little stores' costs are higher in a few areas, any economist will tell you that more retail competition leads to lower prices overall. Want all of The Times? Subscribe.
Yahoo
20-07-2025
- Business
- Yahoo
Republicans' food aid cuts will hit grocers in many towns that backed Trump
The deep cuts Republicans made to federal nutrition programs this summer are poised to devastate independent grocery stores that are central to many low-income communities, including those that voted for President Donald Trump. Food aid recipients often make up the majority of small grocers' customer base in remote areas and food deserts — places that have limited options for fresh, healthy food. But a central part of paying for the GOP policy megabill Trump signed on July 4 relied on slashing the Supplemental Nutrition Assistance Program, the nation's largest anti-hunger initiative. Even though some provisions in the new law won't go into effect for another three years, others, like expanded work requirements for SNAP participants, could kick some families out of the program and hit the bottom lines of small grocery stores within months. It's a chain reaction set off in Washington that's likely to reshape how people access food in more isolated communities even if they don't use federal assistance. 'I lean pretty heavily right most of the time, but one of the things that I do lean to the left on is we're a pretty wealthy country, we can help people out,' said St. Johns, Arizona, Mayor Spence Udall, whose town overwhelmingly supported Trump in 2024. 'The businesses that will be affected most by this are the businesses that are most disadvantaged, that are struggling, and you're going to find that in the rural markets,' he added. Udall's community, which sits halfway between — but still far from — Phoenix and Albuquerque, has one grocery store and one local food bank serving over 3,500 people. If the store shutters due to the food aid cuts, the next closest option for groceries is roughly 30 miles away. Republicans' overhaul of the anti-hunger program will lead to thousands of job losses and a drop in revenue across the agriculture, retail grocery and food processing industries, according to a study from the Commonwealth Fund. Independent grocers said in interviews that they are considering cutting staff or pivoting to e-commerce and delivery services to stave off some of the anticipated profit loss. 'I'd just as soon cut a leg off than have my customers out in the poorest county of the United States go without food. That just isn't an option in my mind,' said RF Buche, the owner of the only grocery store for the Pine Ridge Indian Reservation in South Dakota. 'It is as essential as anything that is in that area.' Between 60 percent and 80 percent of Buche's customers rely on SNAP, accounting for nearly half of his revenue. Buche said he's weighing layoffs in order to keep his doors open. Republican lawmakers, many of whom represent districts with substantial numbers of food aid recipients, defended their megabill, saying the cuts will ultimately help low-income families and their local communities. 'Grocers are good people, hard-working families, and they only make a 1 to 2 percent margin,' said House Agriculture Chair G.T. Thompson (R-Pa.), a top negotiator in the plan to slash SNAP. 'A significant number of people who currently are on SNAP through unemployment will now be climbing a ladder of opportunity, which [means] they'll be able to have more resources to buy more food. So our grocers are going to do well with this.' Thompson said grocers have been 'the victim of fear mongering by the Democrats' and the benefits restrictions will be a boon to their industry. Democrats like Rep. Shontel Brown (D-Ohio) disagree and are exploring ways to mitigate the SNAP cuts through upcoming legislation and negotiations. 'We'll use every tool at our disposal,' said Brown, deputy ranking member of the House Agriculture Committee. 'I know there's been some conversation around a skinny farm bill, and I don't know, candidly, what that will look like. But if there's any opportunity to reverse course or to supplement funds, I will certainly do that.' Several Republican and Democratic state officials have already warned that it will be difficult to backfill the loss of federal dollars. They will need to consider redirecting funds from existing programs, cutting benefits, raising taxes or finding some alternative method to protect their budgets. 'I don't think any state is going to cut [SNAP benefits],' Thompson said. 'If they do, the governors and state legislators that do the cuts are not going to be governors and state legislators for very long.' Rep. Gabe Vasquez (D-N.M.) said that his state is bracing for 'tens of thousands of people' losing access to SNAP. 'The key here is that if we keep enough folks buying at local rural grocery stores, those local rural grocery stores have a higher chance to survive,' Vasquez said. 'We have to make sure folks either have money in their pocket and that states can make up the shortfall in SNAP cuts to preserve that access, or for other folks, provide alternate means to be able to feed them.' Tom Charley owns Charley Family Shop 'N Save in Greensburg, Pennsylvania, a town about an hour outside of Thompson's district. Like Buche, Charley is considering reducing his workforce as he braces for the megabill cuts to slice into his store's already razor-thin profit margin. 'When you're talking about cutting out that substantial size of funding that goes directly to these customers, it means that there's going to be less people working in our stores because of it, just from the pure fact that we have to make sure that our budgets are extremely tight because all of the competition,' Charley said. If a community loses a grocery store, especially a rural community, the economic impact is often broader than the individual store's revenue loss, said Stephanie Johnson, vice president of government relations for the National Grocers Association. In many areas, small grocery stores double as community hubs, hardware stores and stock products from local producers. Each SNAP dollar spent in a rural area generates $1.50 in local economic activity during recessions, per USDA data. NGA is helping grocers seek clarity on how the SNAP cuts will be implemented in their states, according to Johnson. 'The grocery store employs 15 people, maybe more, and if we lose the grocery store, what do those people do?' said Udall, the St. Johns, Arizona, mayor. 'It's not just about people shopping at the grocery store. It has a ripple effect.' Samuel Benson contributed to this report. Solve the daily Crossword
The Guardian
08-07-2025
- Health
- The Guardian
Liverpool mobile greengrocer to reach ‘food deserts' with aid of mapping tool
A mobile greengrocer will deliver fresh fruit and vegetables in areas of Liverpool where it is 'easier to buy a vape than an apple' as part of a new government scheme to tackle food inequality. Families in social housing will receive visits from the Queen of Greens, a mobile greengrocer in the city, which will be directed to the areas of highest need. Researchers at the University of Liverpool have created a mapping tool to identify areas with the poorest access to fresh fruit and vegetables, known as food deserts. More than 7 million adults across the UK, the equivalent of one in seven households, experienced food insecurity in January this year, according to the charity Food Foundation – almost double the figure in 2020. Food insecurity is defined as skipping meals or cutting back due to difficulties in affording or accessing nutrition. Peter Kyle, the science secretary, described the number of families struggling to eat nutritious food as 'shocking'. He said he hoped the Liverpool project, which began on Monday, would be expanded across the UK if it was successful. 'Places like Liverpool for too often have been the last to benefit from new waves of investment [and] new technologies,' he said. 'As the country goes through economic change sometimes it's been at the detriment to places like Liverpool – but not with this government … I want the rest of the country to learn from Liverpool.' The Queen of Greens delivers affordable fresh food to about 470 households a week after launching in the city three years ago, when the cost of living crisis left many cutting back on essentials. Lucy Antal, the director of the community interest company that runs the service, said: 'There's always a lot of talk about people needing to eat better … but when you're living in a space where it's easier to buy a vape than an apple that makes it very difficult for people to follow public health advice, to feel good about themselves. 'It probably has an adverse effect on people's mental health to realise that they can't give their children the best start in life because of where they live or what their environment is like.' Antal said she estimated that another 100 families a week would be served by the government-funded expansion, which will be targeted in areas of social housing ill-served by supermarkets. The University of Liverpool will analyse the effect of this new approach on people's diet and their broader health. Prof Charlotte Hardman, who is leading the project, said the mapping tool would draw on social housing data and direct the Queen of Greens to those in greatest walking distance to healthy food. Sign up to Headlines UK Get the day's headlines and highlights emailed direct to you every morning after newsletter promotion She said the three-year pilot, expected to get under way next spring, would estimate the potential public health impacts of mobile greengrocer schemes if they were rolled out more widely. Liverpool's mobile service is one of six projects given a combined £8.5m by the government to tackle food inequality. In Dundee and Nottingham, two state-subsidised 'public restaurants' will open to provide healthy meals costing £3 to £5 in areas of high need. Other schemes in Southampton, the New Forest and the Isle of Wight will aim to improve the quality of ingredients handed out at food pantries, which are similar to food banks but do not require a customer referral. A survey by the Food Foundation in January found that 2.4 million adults – 4.6% of UK households – had gone without food for a whole day because they could not afford or access it. Single parents were more than twice as likely to experience food insecurity than other families with children, the research found, with nearly one in three reporting skipping full meals.
Washington Post
01-07-2025
- Business
- Washington Post
Mamdani's seriously bad idea for government-run grocery stores
It seems bizarre, in the year of our Lord 2025, to be debating whether the government should run the grocery stores. History has thoughtfully answered this question with multiple experiments, from the old Soviet Union to modern-day Venezuela. The answer is: 'No! Absolutely not! Are you crazy?' But here is Zohran Mamdani, the winner of New York's Democratic mayoral primary, suggesting that the city needs a 'public option' for groceries: five pilot stores, one in each borough, to help bring prices down and provide oases in the city's 'food deserts.' Forget the old-school communist talk about socializing the means of production — Mamdani wants to socialize the means of consumption.
