RESUMO
We investigated the trajectory of depressive symptoms ("depression") from the start of the COVID-19 pandemic in South Africa (March 2020) until 2021, between individuals with and without pre-pandemic depression, specifically regarding the role of food security. Our investigation used publicly available panel data (N = 6,930) from the South African National Income Dynamics Study Coronavirus Rapid Mobile Survey (SA-NIDS-CRAM from 2020-2021) on those who had also participated in the pre-pandemic South African National Income Dynamics Study (SA-NIDS, 2017) depression interview. We investigated trends in depressive symptomatology (based on a 2-item Patient Health Questionnaire) at SA-NIDS-CRAM Wave 2 (July 2020), Wave 3 (February 2021) and Wave 5 (May 2021). Generalized estimating equations (GEE) with post-estimation linear combinations of estimators were fitted to investigate the roles of pre-pandemic depression (based on 2017 SA-NIDS data) and food insecurity during the pandemic on depressive symptomatology. During the pandemic, the highest levels of depression were observed consistently among those with pre-pandemic depression and food insecurity; and were lowest among those without pre-pandemic depression and food security. Depressive symptomatology rose in nearly equal magnitude during the early phases of the pandemic in two groups: those without pre-pandemic depression but food insecure during the pandemic; as well as those with pre-pandemic depression but food secure during the pandemic. However, this dynamic changed later in the pandemic, when higher depressive symptomatology was observed in the group with both pre-pandemic depression and food insecurity, widening the gap between them from Wave 3 (adj ß = 0.63, p < 0.01) to Wave 5 (adj ß = 0.79, p < 0.01). Our results highlight the importance of addressing both population mental health and food insecurity, particularly at the early stages of a crisis/disaster. As we showed that mental health impact is linked to food insecurity during a pandemic, strengthening social protection measures, especially around food and nutrition, would help build resilience to crises in the long term.
RESUMO
South Africa faces the triple burden of malnutrition, high poverty levels, unemployment, and inequality. "Wicked problems" such as these require innovative and transdisciplinary responses, multi-stakeholder coordination and collaboration, managing complex synergies and trade-offs, and achieving sustainable outcomes. Through qualitative content analysis of national and provincial sector-based policies, we explored the interlinkages between the agriculture, environment, and health sectors in South Africa in the context of sustainable food and nutrition security and the extent to which these interlinkages are integrated into policy and planning. A systemic analysis of the review outcomes was performed to identify its main learning outcome, the status quo in the policy process. The nature of feedback loops was identified, and a leverage point was suggested. The review highlighted that policymakers in the agriculture, environment and health sectors are aware of, and have understood, the relationships among the three sectors. They have also made attempts to address these interlinkages through collaboration and coordination. Unfortunately, this has been met with several challenges due to fragmented sector-specific mandates and targets and a lack of resources for integrated solutions. This creates implementation gaps and unintended duplication of activities, leading to poor service delivery. Transitioning to sustainable and healthy food systems will only be possible after these gaps have been closed and implementation optimization has been achieved. Focusing on meta-level problem-framing, functional collaboration through transdisciplinary approaches, and integrated targets are critical to successful policy implementation and progressive realization of national goals related to sustainable food and nutrition security, unemployment, poverty, and inequality.
