**6. Conclusions and recommendations**

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

Some empirical studies [45] have reported about caregivers of child support grants citing forgery of more birth certificates including having multiple children so that they could secure more grants as safety nets. Similarly, there are also reports of increased teenage pregnancy in households particularly in rural areas as strategy to secure more child grant support. In turn, this increases poverty and unemployment among such households because the young mothers are likely to drop out of school and stay unemployed; in cases where they fail to secure their child support grants, such families find it difficult to cope with the cost of maintaining large households. Alcohol abuse is another identified risk factor for poverty and compromised healthy lifestyle in South Africa. Some studies revealed that some grant caregivers do not utilize the money for the intended purposes but divert a portion of it on alcohol

Furthermore, it is reasoned that poverty levels in South Africa are also escalated by undocumented immigrants in the country. For instance, given that the grants are exclusive to documented persons or citizens (vulnerable groups) of South Africa, this leaves the resource-poor undocumented or illegal immigrants in the country to fend for themselves. Of note is that, South Africa has the highest number (>4 million) of immigrants legal and undocumented (mostly from low income countries),

In 2010–2011, South Africa drafted a National Development Plan-2030 (NDP-2030) as a broad strategic framework for a more prosperous and equitable South Africa, where poverty and its related conditions such as individual food insecurity and non-communicable diseases will be adequately addressed by enhancing socialeconomic opportunities such as health care, education, social security and safety nets [48]. The implementation and success of the plan would depend on every South African taking responsibility for the NDP, led by the head of state and the Cabinet. However, several years after the implementation of the program whereby, less than a decade is remaining to reach the year 2030, the problem of social-economic inequalities persistent common in South Africa. Likewise, a report on South African household poverty as proxy for household food insecurity revealed that in 2015, some 13,8 million individuals were vulnerable to hunger because they lived below the national food poverty line of R441.00 per person per month [49]. This was an increase from 11 million people in 2011. The most affected were the histori-

in Africa [47] most of whom are highly vulnerable to poverty and hunger.

cally disadvantaged, single-parent households, and the rural households.

much poorer, despite that the urban–rural economic gap has narrowed.

Consequently, most recent research shows that poverty, vulnerability to hunger, and compromised health lifestyle are still common in South Africa. Accordingly, the 2019 Statistics South Africa report showed that, 11.3% or 6.5 million people by head count experienced hunger while vulnerability to hunger by households was 9.7%. In terms of food access inadequacy, 15.7% of the households that lived in metropolitan areas had experienced inadequate or severely inadequate access to food during the preceding year [50]. At the same time, severe inadequate food access affected 5.2% of the households. Moderate food access inadequate stood at 15.0%. In the same study, it was reported that inadequate food access was influenced by rising economic challenges or poverty in the country. More so, rural poverty areas remained

Another research [51] revealed that in South Africa, chronic malnutrition coexisted in increasing cases of obesity and overweight whereby compromised diet often caused high levels of malnutrition. As such, high food prices, high poverty levels and socio-economic inequalities meant that many households were unable to consume a diverse diet. In the same study, socio-economic status was measured using income and relative asset index. The study concluded that a consistence of pro-rich Socio Economic Status (SES) influenced dietary intake among high income households. Of note is that, although, consumption of starch and energy dense food (high

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consumption [46].

This chapter concludes that in a developing country like South Africa, poverty is one of the influencers of compromised-dietary intake and vulnerability not only to cardiovascular diseases such as stroke, heart attack and heart failure, but also to other non-communicable diseases, malnutrition and undernutrition, and type 2 diabetes. This is evident in the majority of the historically disadvantaged group in South Africa.

A comprehensive public health approach is needed to curb the inequality and ignorance which are the main source of compromised dietary intake among vulnerable groups. The problem associated with malnutrition related diseases cannot be left in the hands of government alone. It requires multi sectorial approach from civil society actors, researchers and the public itself; the approach that requires public awareness.

As the world continues to nurse its latest public health disaster—COVID-19 pandemic which infected >62 million people and claimed >1.5 million lives in 2020 [52, 53], individuals with pre-existing unhealthy conditions such as malnutrition, cardiovascular disease, and diabetes are highly vulnerable to succumbing to the virus. Deliberate policies that promote household food security are critical in fostering dietary diversity, and health lifestyle such as physical exercises.

Furthermore, global extreme poverty is expected to rise in 2020/2021 for the first time in over two decades. This is due to the disruption of the COVID-19 pandemic that has worsened the pressures of conflict and climate change, which were already slowing poverty reduction progress in Sub-Saharan Africa. As a result of the COVID 19 pandemic, Sub-Sahara Africa's fragile economy, will negatively affect the vulnerable groups who are dependent on government handouts for their livelihood as is the case in South Africa.

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*
