A new interministerial strategy for the promotion of healthy eating in Portugal: implementation and initial results

Abstract

ObjectiveTo describe the implementation, main intervention areas and initial results of the Integrated Strategy for the Promotion of Healthy Eating (EIPAS) in Portugal.MethodsEIPAS was published as a Law, in December of 2017, as a result of a collaboration between several ministries, including the Finance, Internal Affairs, Education, Health, Economy, Agriculture, and Sea Ministries, aiming at improving the dietary habits of the Portuguese population. The working group, led by the Ministry of Health, developed this strategy for over a year. The framework produced was based on WHO and European Commission recommendations as well as on relevant data from the last Portuguese dietary intake survey (2015/2016). EIPAS also reflects the results of a public hearing, including the food industry, among others, and the experience gathered, since 2012, through the National Programme for the Promotion of Healthy Eating. It considers the ‘health in all policies’ challenge set by WHO and has four different strategic areas, namely (1) creation of healthier food environments, (2) improvement of the quality and accessibility of healthy food choices for consumers, (3) promotion and development of literacy, in order to encourage healthy food choices, and (4) promotion of innovation and entrepreneurship. In order to achieve these goals, a set of 51 actions was established and assigned to the seven ministries involved.ResultsUnder the scope of this strategy, Portugal has already implemented several actions, including (1) definition of standards for food availability at all public healthcare institutions; (2) implementation of a sugar tax on sweetened beverages; (3) implementation of a voluntary agreement with the food industry sector for food reformulation (work in progress); (4) design of a proposal for an interpretative model of front-of-pack food labelling; (5) improvement of the nutritional quality of food aid programmes for low-income groups; and (6) regulation of marketing of unhealthy foods to children.ConclusionsFor the first time, Portugal has a nutrition policy based on the WHO concept of ‘health in all policies’ and on the national data on food intake. The implementing process of all 51 actions and the inherent complexities and difficulties found so far have made this process be an authentic political and social laboratory that deserves to be followed.

Sustainable food transition in Portugal: Assessing the Footprint of dietary choices and gaps in national and local food policies

“…The work of the UN Food and Agriculture Organization (FAO), the World Health Organization (WHO) and the European Union (EU) triggered early Portuguese efforts to create a national food and nutrition policy starting from the late 1970s, with the creation of the Centre for Studies in Nutrition , the first studies on food intake and nutrition, as well as the launch of the first campaign “ Knowing how to eat is knowing how to live ” ( Graça and Gregório, 2013 ). Since then, Portugal has experienced a continuous evolution of its food policy and governance landscape (see Table 3 ), with the creation of a National Food Council in the 1980s ( Graça et al, 2018a ), a focus on food literacy in schools in the 1990s ( Loureiro, 2004 ), a focus on obesity in the 2000s ( Graça et al, 2018a ), and the launch of the first National Program for the Promotion of Healthy Eating (PNPAS) by the Portuguese Directorate General for Health (DGS) in 2012 ( Graça and Gregório, 2013 ). This led to the publication of various guidelines on healthy eating ( Silva et al, 2015 ; Pinho et al, 2016a ; Pinho et al, 2016b ) – including the Integrated Strategy for the Promotion of Healthy Eating (EIPAS) in 2017 ( Diário da República §, 2017 ) – and the implementation of a National Food, Nutrition and Physical Activity Survey (IAN-AF) ( Lopes et al, 2017b ).…”

Knowledge and acceptance of interventions aimed at reducing sugar intake in Portugal

“…We focused on interventions aimed at reducing sugar intake, which is still an understudied topic. Portugal offers an interesting context to study this issue because, due to the high sugar intake, several policies have been implemented in recent years (13) .…”

“…In 2016, the Portuguese government developed a public health programme aiming, among other goals, to prevent diabetes and obesity through the promotion of health literacy (12) . Besides this focus on promoting citizens' capability to make informed choices about their health, multiple actions have also been implemented to promote healthier dietary habits (for a review, see (13) ). For example, to reduce the excessive intake of sugar, salt and fat, there is a regulation defining which products may be sold in vending machines placed in national healthcare facilities (14) .…”

One size does not fit all: implementation of interventions for non-communicable diseases

“…It is not unusual for different sectors of the same government to hold opposing priorities, which may lead to disagreements on acceptable interventions and policies. For example, in 2014, the Portuguese Ministry of Health tried to implement a single front-of-pack traffic light nutrition labelling system 25. However, in Portugal food labelling falls under the control of the Ministry of Agriculture, which viewed such legislation as against agricultural interests and the labelling system was never approved.…”

“…The strategy was approved in December 2017, after one year of negotiations led by the prime minister with the coordination of the health sector 26. One of the four strands of the strategy was to improve the quality and accessibility of the information available to consumers, and Portugal has already produced proposals for front-of-pack nutritional labelling based on the French Nutri-Score model 2527…”