(Published - 14 December 2018)

“Public health really is exciting. As a researcher in the field, you have the potential to save millions of lives as you explore ways to improve health at the population level.”

It’s that sense of excitement that took Capetonian Mark Spires all around the world, from Edgemead High School to the United States, where he obtained a degree in Cultural Studies and a master’s degree in Public Health - both of which served him well while he worked at Johns Hopkins University, in Baltimore, as a Research Programme Manager in Global Health.

And it’s that excitement that brought him back home to further his studies at the University of the Western Cape (UWC) - where he received his PhD from the School of Public Health (SOPH) in UWC’s 2018 Summer Graduation Ceremony.

His thesis work was on: Community insights into, and an international perspective on the role food environments and diet play in the self-management of type 2 diabetes mellitus in urban and rural South Africa

Type 2 diabetes mellitus (T2DM) is the most common form of diabetes, occurring primarily as a result of obesity and lack of exercise, as well as genetic and environmental factors - and individuals with T2DM may require support to manage their disease effectively.

“Research has shown that food environment-related factors influence our food choice and subsequent diet more than things like personal knowledge and attitudes,” Mark says. “What is immediately available to us, how much it costs, and how it is promoted usually determines what food items we end up acquiring.”

Here’s what Mark has to say about diabetes, diet and the delights of public health research...

How did it feel to graduate?

I am - naturally - very excited to have completed my PhD. I feel that I have learned a lot from my experience at UWC, especially from my supervisors, and I appreciate the time and effort that my PhD supervisors have put into mentoring me through this process, while imparting their wisdom and experience.

What were your research findings? How *do* local food environments affect diet?

I found that levels of knowledge regarding what healthy food is, and how to navigate food environments, is high among those living with type 2 diabetes in my research settings; however, food environments, specifically issues related to ‘affordability’, ‘availability’, and ‘accessibility’, do not facilitate the regular, easy access to desired healthy food items.

What policy and intervention-related recommendations were developed and explored in your work?

Current policies related to food environments and increased nutrition in South Africa are reasonably progressive. However, issues exist with regards to coherence across these policies, as well as effective implementation at sub-national levels.

Some specific recommendations that resulted from my inquiry included:

• Improving the effective household production of food (especially in rural settings);
• The greater aligning of food pricing policies with desired national health outcomes by helping to make healthy eating choices the easier, cheaper options;
• Advancing policies that give greater consideration to the role informal vendors play in both urban and rural food environments, and their ability to provide healthy food options; and,
• Heavier restrictions on the advertisement of unhealthy foods and beverages (in the community, in-store, and on product packaging) in general, including on advertisements that target purchasers (who are not usually children) are needed in urban and rural settings to curb the promotion of these items.

Additionally, initiatives from government agencies (both provincial and national) to introduce health-promoting advertisements that encourage healthier diets (among other healthy behaviours), are lacking - and sorely needed.

So what’s next for you?

I’m looking forward to putting the skills and knowledge that I have attained into practice. I hope to be able to continue to conduct groundbreaking research to forward the field of public health and improve understanding on how to improve lives at the population level.