Food choice encompasses many different factors that include all aspects of what, how, when, where, and with whom foods are eaten, as well as the ability to acquire and access food products within a local food environment. Urbanisation over the last century in South Africa has shifted the reliance of most consumers from growing much of their own food to a reliance on local supermarkets and street vendors. This shift has changed the local urban food environment in most of South Africa’s major metropolitan areas. In order to better understand the local urban food environment and the way that it influences the food choices made by members of different socio-economic groups, the five food access dimensions must be examined within a South African context.
Today food manufacturers offer consumers thousands of different packaged and prepared processed food products, and supermarkets stock various different types of fresh produce and stable food items. Media and advertising play a large role in influencing the purchasing and consumption decisions made by consumers country-wide, and with such a wide assortment of foods at their fingertips, most consumers find it more difficult than ever to make healthy food choices. The large variety and choice of food products available at large supermarkets, coupled with the inability of consumers to understand food labels has a major influence on their ability to make healthy food choices when shopping.
Urbanisation in South Africa
Urbanisation is defined as the migration of an increasing proportion of rural dwellers of a population into cities . Over the last 60 years, South Africa has become one of the most urbanised countries in sub-Saharan Africa, with the portion of our population living in urban areas rising from 35.2% in 1951 to 60% in 2014 [2,3]. The large population shift in South Africa is largely associated with the period of industrialisation that followed the discovery of natural resources in the 1880s, and the subsequent rapid growth of the mining industry during the 20th century that required a larger labour force, which led to population migration from rural areas to urban Gauteng . Up until the end of the apartheid era, the South African government largely controlled the migration of people into cities and the ability for people to own their own land . Following the fall of the apartheid regime in South Africa, these restrictions were no longer enforced, and many people chose to move from rural areas to urban settings due to the economic opportunities and employment prospects that were available in larger cities where most of the country's income is generated . In addition to this, many higher-order public services, universities, and hospitals are located within urban settings .
The Effects of Urbanisation in South Africa
In many cases, a large proportion of lower-income South Africans that live in urban areas find themselves living below the breadline despite the promise of jobs and economic prosperity in urban areas. Many different challenges and factors are responsible for driving both new and existing urban residents into poverty . Despite this reality, the General Household Survey that was conducted in 2009 showed that food insecurity in South Africa is experienced by a larger portion of rural households (24%) compared with urban households (15%) . A negative consequence of rapid urbanisation is the fact that more people have easy access to cheap, convenient, highly processed foods, and have become distanced from the nutritious fresh produce that many of their grandparents once grew at home themselves . The local urban food environment is largely determined by what rural agriculture is able to supply food manufacturers and retailers, and urbanisation can thus be linked to a shift from relying on rural agricultural production and homegrown produce for food to relying on purchasing food from food retailers [2,4]. The role of food retailers has become increasingly important in South Africa since the 1980s, with a greater portion of both urban and rural populations relying on purchasing food than ever before .
The expansion of supermarkets into lower-income areas has been possible due to their low-cost, high-quality offerings . Unfortunately, supermarkets provide consumers with many food products that contain a large amount of fats, refined sugars, animal products, and highly processed carbohydrates, which are all generally more affordable for low-income consumers to buy than fresh produce . The large expansion of supermarkets and fast-food retailers in urban environments has made a huge impact on food consumption preferences and habits of South Africans . Ultimately this change in food choices and dietary habits has led to a steady increase in overweight and obesity in South Africa, and it can be argued that urbanisation has played a large role in contributing to an increase in non-communicable diseases, overweight, and obesity in older children and adults, as well as an increase in micronutrient deficiencies in young children in South Africa .
Local Urban Food Environment
Food security is described as all people in a population or community, at all times, having access to sufficient, safe and nutritious food that is able to meet their dietary requirements and preferences in order to maintain an active and healthy lifestyle . The local food environment arguably has a large effect on food choices that local communities make, as well as their resulting long-term dietary health . The local urban food environment encompasses the five food access dimensions as found in urban areas, namely: availability; accessibility; affordability; acceptability; and accommodation.
Urbanisation can be linked to a large shift from relying on rural agricultural production and household produce for food to relying on buying food from large food retailers, and the urban food environment is thus largely determined by what rural agriculture is able to supply these food manufacturers and retailers [2,4]. The role of food retailers has become increasingly important in South Africa since the 1980s, with a greater portion of both urban and rural populations relying on purchasing food than ever before . The expansion of supermarkets into lower income areas, and their pushing out of smaller retailers, has been possible due to their low cost, high-quality offerings . In addition to the expansion of supermarkets, there has been a large increase in the number of fast-food chains in urban areas since the 1980s due to their convenient and cheap food offerings .
Urban supermarkets provide consumers with a selection of foods that contain high amounts of fats, refined sugars, and highly processed carbohydrates, which are all generally more affordable for low-income consumers to buy than healthier, but less affordable fresh produce . Urbanisation has thus contributed in an increase in non-communicable diseases and conditions related to unhealthy diet, overweight, and obesity in older children and adults, as well as an increase in micronutrient deficiencies in young children in South Africa .
Food Access and Food Choice
Access to food and the food consumptions that result can be conceptualized in five main dimensions: accessibility; affordability; accessibility; acceptability; and accommodation . Food security in a population relies on a food system in which all five of these dimensions operate efficiently and effectively to cater for different socio-economic groups within the community . Each of these dimensions have a significant effect on the local food environment, and subsequently affect the food choices made by individuals within the urban food environment .
1. Accessibility & Availability
Food availability and accessibility refer to factors that relate to the geographical component of food access . Availability refers to the level of food production, supply, and net trade within a specific area, and includes the density and geographical distance of food retailers [6,8]. Food accessibility on the other hand specifically looks at the geographical ease with which food can be procured . This dimension also takes into consideration the income, expenditure, and buying capacity of households, and whether or not a household or individual has the resources to access and acquire enough good quality foods . Food accessibility and availability at a national level does not necessarily ensure food security at a household level . In urban food settings it has been shown that the availability of foods found in supermarkets does not have as great an effect on consumer choice as accessibility does . It can be argued that this is due to the fact that most urban supermarkets stock a large variety of different food items, and are located in close proximity to one another, compared with rural supermarkets, which are located a great distance apart and generally have a limited selection of products to choose from. Large supermarkets that provide lower prices as well as a wider selection of fresh, healthy food choices, tend to locate themselves in profitable areas that are often beyond walking distance of poorer communities .
In addition to urbanisation in South Africa, researchers Feeley et al.  argue that a major contributing factor to increased consumption of fast-foods in South Africa is that healthier food options are just not as accessible to consumers living in urban areas. Individuals who do not have their own form of transport, for example, will not have easy access to food retailers that are available in an urban suburb that is a distance from their home. Quite often, the local corner store in this type of urban setting, which may be the only accessible food retailer for this consumer, will only stock limited fresh produce that will be sold at higher process, and a large variety of processed foods with a long shelf-life, which will be the most affordable choice for the consumer . Research has shown that many lower-income South Africans prefer to purchase food from local spaza shops despite their consistently higher prices, due to their convenient location and ease of access for consumers who do not have their own means of transport .
Affordability involves the cost of food and the ability for households and individuals to purchase food from a financial perspective . Case studies of poor urban households in South Africa suggest that most spend between 60 and 80 percent of their income on food. Affordability is thus a very important factor that affects the food choices made by these consumers, who are particularly vulnerable to market fluctuations, inflation, and the overall affordability of food . The effective procurement policies and strategic management of large food supermarkets, as well as their relationship with large food manufacturers, has allowed these retailers to offer food products at much lower prices than smaller . It is argued that lower prices that are offered by such retailers are beneficial to low-income households, as they are able to afford larger quantities of food for a smaller amount of money. The cheaper foods offered by large retailers is however usually less nutritious and more highly processed than pricier but healthier fresh . The most affordable sources of energy for South Africans include refined cereals and grains, foods high in sugar and fat, margarine, oil-rich snacks, and sugar-filled beverages . On the other end of the scale, higher-income South African consumers are often willing to pay a large premium for ready-to-eat food products that require little preparation purely for convenience sake .
Acceptability is a food access dimension that describes the attitudes and perspectives of communities and populations about the local food environment . Urbanisation in South African has led to differences in food acceptability of different ethnic groups, with urban residents shifting from traditional foods to more Westernised food choices. As mentioned by Osseo-Asare , South Africa is composed of a variety of different cultural and demographic groups, each with their own acceptance of food norms. Foods traditionally consumed among black South Africans include maize, amasi (sour milk), millet, sorghum, beans, meat, pumpkin, spinach, cabbage, and certain types of fruits . Within black South African groups, a number of cultural structures and requirements influence food acceptability and subsequently food choice. Food products such as amasi, as well as others described above, remain acceptable food choices of black South Africans in addition to more processed Western food products. Another example includes the use of curry powder, onions, Indian spices, and chutneys in Cape Malay cooking, with dishes such as bobotie, bredie, atjar, boerewors, and kerrie served with yellow rice being the accepted foods in such communities, also in addition to processed food products .
Accommodation describes how well equipped local food sources are to meet the food needs of local households and individuals . Urban households rely heavily on purchasing groceries from large food retailers, and the urban food environment is thus largely determined by what rural agriculture is able to supply them [2,4]. Factors such as the drought that is currently being experienced in many parts of South Africa, poses a threat to the ability of local farmers to meet the needs of the population. South Africa, normally a maize importer, may need to import as much as 5 million tonnes of maize during 2016 in order to compensate for the lack of fruitful crops throughout the country . How equipped local food sources are to meet the needs of the South African population may lead to food choices due to the availability of staple food items, possibly less of a variety, as well as their affordability.
There are many different factors that determine what types of food people within a population choose to purchase and eat on a daily basis. Consequently, these factors and the choices that are made with regards to food choice play a major role in the nutrition-related health problems that are being experienced in South Africa. Urbanisation in South Africa has resulted in a large shift from relying on subsistence farming and local produce to a reliance on large supermarkets and street vendors for food products. Food manufacturers and retailers in urban settings offer consumers thousands of packaged, processed foods, as well as fresh produce and other food items. With such a wide assortment of foods available, most consumers find it more difficult to make healthy food choices. Factors such as affordability, accessibility, acceptability, and accommodation play a large role in the choices are made. Cultural influences, socioeconomic circumstances, and even the inability of consumers to understand food labels has a major influence on their ability to make healthy food choices when shopping.
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