Developing and applying a constitutional rights-based approach to the regulation of the modifiable risk factors for noncommunicable diseases in South Africa.

Doctoral Degree. University of KwaZulu-Natal, Durban.Non-communicable diseases (NCDs) caused by unhealthy diet, contribute significantly to South Africa’s burden of disease and are preventable. Policies and laws offer an evidence-based mechanism improve diet and prevent NCDs. However, the adoption of these measures is complex, often facing opposition from many actors. To address these challenges to the adoption of these interventions, scholars have looked to develop human rights-based (HRbased) approaches to the prevention of obesity and diet-related NCDs. These approaches have the advantages of supporting and guiding government action on NCDs, holding various actors accountable and providing a means to manage the competing rights implicated in NCD prevention efforts. However, to fully realise the benefits of an HR-based approach to NCDs, there is a need to anchor the approach in context-specific rights married with concrete and enforceable obligations. This thesis seeks to develop an HR-based approach to NCDs under the rubric of the South African Constitution. Often the right to health or the right to food can form the basis of an HR-based approach to NCDs. However, the peculiarities of section 27 of the Constitution require that the content of these rights be further developed to encompass NCD prevention, particularly where the interventions sit outside the healthcare system and are not biomedical in nature. This thesis explores and develops the content of the right to healthcare and the right to sufficient food to identify obligations that could support action on NCD prevention. Recognising that NCD prevention interventions may limit individual rights, this thesis then explores the relationship between public health and HR through the lens of colliding rights and section 36. Since many NCD prevention interventions may be novel, there arise implications for the section 36 limitations analysis. This thesis therefore addresses the application of section 36 analysis to novel NCD prevention interventions, outlining the kinds of considerations influencing whether the limitation of rights by a public health intervention can be found to be justifiable. This thesis with recommendations on how this HR-based approach may be used in South Africa to prevent NCDs

Human rights and healthy diet research support initiative

The HRHD Initiative aimed to support researchers, civil society organizations and policymakers to strengthen their understanding and application of human rights-based approaches to promote healthy diets through regulatory and fiscal interventions in Kenya, Tanzania and Uganda. The Initiative aimed to highlight knowledge gaps and implementation barriers, as well as opportunities and entry points to apply human rights-based approaches to promote healthy diets, identifying priority areas in research and policy where additional support is needed. The HRHD Initiative created a unique opportunity to bring government, civil society organizations and academia together, build networks and improve the understanding of the added value of a human rights-based approach to the development and implementation of food policies and thereby increase the chances that such an approach is adopted

Rhodes University v Student Representative Council of Rhodes University: The constitutionality of interdicting non-violent disruptive protest

Section 17 of the Constitution of the Republic of South Africa, 1996 enshrines the right to assemble, peacefully and unarmed, and the Regulation of Gatherings Act 205 of 1993 enables the exercise of this right peacefully and with due regard to the rights of others. The recent student protests across South Africa have occasioned litigation seeking to interdict protest action, which the universities claim is unlawful. Overly broad interdicts, which interdict lawful protest action, violate the constitutional right to assembly and have a chilling effect on protests. In a decision of the High Court of South Africa, Eastern Cape Division, Grahamstown, a final interdict was granted interdicting two individuals from, among other things, disrupting lectures and tutorials at Rhodes University and from inciting such disruption. In this note, the constitutionality of interdicting non-violent disruptive protest is discussed and analysed, using Rhodes University v Student Representative Council of Rhodes University and Others (1937/2016) [2016] ZAECGHC 141

Human rights and healthy diet research support initiative : scoping review

The African region is facing the double burden of malnutrition driven by changing food environments and the increasing availability, affordability, and acceptability of unhealthy food, which in turn raises major health and sustainability concerns. This report argues that human rights can play a powerful role in supporting State-led policies intended to promote healthier food environments and prevent diet-related diseases. It reviews the growing academic literature and policy documents at the intersection of human rights and food environments and identifies the relevant international legal treaties and conventions that can be used to support the integration of a human rights-based approach to promote healthy food environments and therefore prevent diet-related diseases, particularly in Africa

Determining food industry compliance to mandatory sodium limits: Successes and challenges from the South African experience

To provide an update on the compliance to the Na reduction regulation (R.214) and to highlight some challenges and successes experienced by South Africa in the implementation of a mandatory Na regulation. The study design was observational. Nutritional information of packaged food (specified in the R.214 regulation) was collected between February 2019 and September 2020, before and after the implementation date of the final Na targets in the regulation. Six supermarket chains that accounted for more than 50 % of the grocery retailer market share in South Africa were included. The Na content (per 100 g) of products was extracted from photographs. Products were classified according to the thirteen food categories included in R.214. The percentage of targeted food categories that met the pre and post-regulation targets as well as the percentage by which Na limits were exceeded was calculated

Determining food industry compliance to mandatory sodium limits: Successes and challenges from the South African experience

Abstract Objective: To provide an update on the compliance to the sodium reduction regulation (R.214) and to highlight some challenges and successes experienced by South Africa in the implementation of a mandatory sodium regulation. Design: The study design was observational. Nutritional information of packaged food (specified in the R.214 regulation) was collected between February 2019 and September 2020, before and after the implementation date of the final sodium targets in the regulation. Six supermarket chains that accounted for more than 50% of the grocery retailer market share in South Africa were included. The sodium content (per 100g) of products was extracted from photographs. Products were classified according to the 13 food categories included in R.214. The percentage of targeted food categories that met the pre and post regulation targets as well as the percentage by which sodium limits were exceeded were calculated. Setting: Low-and-middle-income suburbs in Cape Town, South Africa. Participants: N/A Results: A total number of 3278 product were analysed. After the final implementation date, none of the categories targeted by the R.214 regulation fully complied. However, nine out of the 13 food categories targeted by R.214 were above the 70% compliance mark. Conclusions: The compliance to R.214 in South Africa is good, although not 100% compliant. This research also highlights the complexities regarding the monitoring and evaluation of a national regulation. Findings from the current study could aid by providing valuable information to countries in the process of implementing a sodium reduction strategy

A systematic scoping review evaluating sugar-sweetened beverage taxation from a systems perspective

Systems thinking can reveal surprising, counterintuitive or unintended reactions to population health interventions (PHIs), yet this lens has rarely been applied to sugar-sweetened beverage (SSB) taxation. Using a systematic scoping review approach, we identified 329 papers concerning SSB taxation, of which 45 considered influences and impacts of SSB taxation jointly, involving methodological approaches that may prove promising for operationalizing a systems informed approach to PHI evaluation. Influences and impacts concerning SSB taxation may be cyclically linked, and studies that consider both enable us to identify implications beyond a predicted linear effect. Only three studies explicitly used systems thinking informed methods. Finally, we developed an illustrative, feedback-oriented conceptual framework, emphasizing the processes that could result in an SSB tax being increased, maintained, eroded or repealed over time. Such a framework could be used to synthesize evidence from non-systems informed evaluations, leading to novel research questions and further policy development

The World Health Organization was born as a normative agency: Seventy-five years of global health law under WHO governance

The World Health Organization (WHO) was born as a normative agency and has looked to global health law to structure collective action to realize global health with justice. Framed by its constitutional authority to act as the directing and coordinating authority on international health, WHO has long been seen as the central actor in the development and implementation of global health law. However, WHO has faced challenges in advancing law to prevent disease and promote health over the past 75 years, with global health law constrained by new health actors, shifting normative frameworks, and soft law diplomacy. These challenges were exacerbated amid the COVID-19 pandemic, as states neglected international legal commitments in national health responses. Yet, global health law reforms are now underway to strengthen WHO governance, signaling a return to lawmaking for global health. Looking back on WHO’s 75th anniversary, this article examines the central importance of global health law under WHO governance, reviewing the past successes, missed opportunities, and future hopes for WHO. For WHO to meet its constitutional authority to become the normative agency it was born to be, we offer five proposals to reestablish a WHO fit for purpose: normative instruments, equity and human rights mainstreaming, sustainable financing, One Health, and good governance. Drawing from past struggles, these reforms will require further efforts to revitalize hard law authorities in global health, strengthen WHO leadership across the global governance landscape, uphold equity and rights at the center of global health law, and expand negotiations in global health diplomacy