A socio-historical approach to policy analysis: the case of the Brazilian Workers' Food Policy.

Policy analyses based on traditional or structuralist definitions of the state are important, but they have some limitations for explaining processes related to policymaking, implementation, and results. Bourdieusian sociology links the analysis to objective and subjective dimensions of social practices and can help elucidate these phenomena. This article provides such empirical evidence by analyzing the social genesis of a Brazilian policy that currently serves 18 million workers and was established by the state in 1976 through the Fiscal Incentives Program for Workers' Nutrition (PIFAT/PAT). The study linked the analysis of the trajectory of social agents involved in the policy's formulation to the historical conditions that allowed the policy to exist in the first place. Although the literature treats the policy as a workers' food program (PAT), the current study showed that it actually represented a new model for paying financial subsidies to companies that provided food to their employees, meanwhile upgrading the commercial market for collective meals. The study further showed that the program emerged as an administrative policy, but linked to economic agents. The program became a specific social space in which issues related to workers' nutrition became secondary, but useful for disguising what had been an explicit side of its genesis, namely its essentially fiscal nature.

La comunidad médica y su lucha en contra de la desnutrición en Chile (1860-1940) / The fight against malnutrition of the medical community between 1860 and 1940

The aim of this manuscript is to highlight the contribution of the first two generations of physicians who faced malnutrition in Chile, between the end of nineteenth century and the first decades of the twentieth century. In the history of Chilean medicine, there is a paucity of research about the role of these physicians in the fight against malnutrition. The main interest was centered in the forties of the twentieth century and the first policies and actions for the working class feeding have been overlooked. The existence of two pioneering groups that have common elements and differences to face the problem of under nutrition is established.

Primer congreso sobre la nutrición de los estratos pobres de la población: hacia una historia de la alimentación y nutrición en Chile (1931) / First congress on the nutrition of the poorer strata of the population: towards a history of feeding and nutrition in Chile (1931)

This article studies the First Congress on the nutrition of the poorer strata of the population developed in the City of Valparaiso (Chile) in 1931. It is approached in the context of a conference, the role played by the first generation of doctors concerned about the problem of nutrition and the main conclusions of meeting. We note that the First Congress is the beginning of a nutrition policy to the poorer strata of the population that will be accompanied with the creation of the National Council of Food in 1937.

En este artículo se estudia el Primer Congreso sobre la nutrición de los estratos más pobres de la población, desarrollado en la ciudad de Valparaíso (Chile) en 1931. Se aborda en el contexto de la conferencia, el papel jugado por la primera generación de médicos preocupados por el problema de la nutrición y las principales conclusiones del encuentro. Señalamos que el Primer Congreso es el inicio de una política de nutrición de los estratos más pobres de la población, lo que será acompañado con la creación del Consejo Nacional de Alimentación en 1937.

Trends in Global Nutrition Policy and Implications for Japanese Development Policy.

BACKGROUND: Although the issue of nutrition was long underrepresented in the global health agenda, it regained international attention with the introduction of the Scaling Up Nutrition (SUN) framework. A historical review of global nutrition policies over 4 decades illustrates the evolution of nutrition policy themes and the challenges confronted by SUN. OBJECTIVE: This study reviews major events in global nutrition policy from the 1970s to the SUN movement around 2010 to illustrate the dynamics of global agenda setting for nutrition policy along with implications for the government of Japan. METHODS: The events are categorized according to each decade's nutrition paradigm: nutrition and its socioeconomic features in the 1970s, nutrition and community programs in the 1980s, nutrition as a political issue in the 1990s, and nutrition and evidence in the 2000s. RESULTS: This study identified 2 findings: First, the arguments that led to a global consensus on nutrition policy generated paradigm shifts in core ideas, and second, in response to these paradigm shifts, global nutrition policies have changed significantly over time. With regard to Japan, this analysis concludes that the government of Japan can take a greater initiative in the global health community as supporter of SUN by strategically developing a combination of financial, political, and practical approaches to improve global nutrition policy through the concepts of Universal Health Coverage and Human Security.

Leite e modernidade: ideologia e políticas de alimentação na era Vargas / Milk and modernity: ideology and nutrition policies during the Vargas era

Nos anos 1930 difundiu-se no Brasil a nova ciência da nutrição, que introduziu também a convicção de que o leite de vaca constituía o mais importante dos alimentos básicos. Apesar da campanha levada a cabo pelo Ministério de Educação e Saúde Pública em meados dos anos 1930, o consumo de leite no Rio de Janeiro se manteve muito aquém das recomendações dos experts devido à má qualidade do produto e a seu elevado preço. Este trabalho analisa os esforços do Estado Novo para melhorar o sistema de abastecimento de leite da capital brasileira assim como para atenuar causas e efeitos de seu fracasso final.

In the 1930s the new science of nutrition was disseminated in Brazil, which also introduced the conviction that cow’s milk was the most important of staple foods. Despite the campaign promoted by the Ministério de Educação e Saúde Pública (Ministry of Education and Public Health) in the mid-1930s, the consumption of milk in Rio de Janeiro remained far short of the recommendations of experts due to the poor quality of the product and its high price. This paper analyzes the efforts of the Estado Novo to improve the milk supply system of the Brazilian capital as well as to mitigate the causes and effects of its ultimate failure.

The effects of the National School Lunch Program on education and health.

This paper estimates the effects of participating in the National School Lunch Program in the middle of the 20th century on adult health outcomes and educational attainment. I utilize an instrumental variables strategy that exploits a change in the formula used by the federal government to allocate funding to the states. Identification is achieved by the fact that different birth cohorts were exposed to different degrees to the original formula and the new formula, along with the fact that the change of the formula affected states differentially by per capita income. Participation in the program as a child appears to have few long-run effects on health, but the effects on educational attainment are sizable. These results may suggest that subsidized lunches induced children to attend school but displaced food consumption from other sources. Alternatively, the program may have had short-run health effects that dissipated over time but that facilitated higher educational attainment.

INCAP studies of hematologic and gastrointestinal function in healthy individuals and those with protein-energy malnutrition and infection.

Anemia is highly prevalent, especially in poorly nourished populations living in unsanitary conditions. Studies of the Central American population showed that iron was the predominant deficient hematopoietic micronutrient and that correction of nutrient deficiencies led to hematological normality as defined by WHO. The bioavailability of diverse iron compounds added to the mostly vegetable diets of such populations showed the superior absorption of chelated iron (NaFeEDTA) and its strong effectiveness in correcting iron deficiency when added to sugar. The consequences on development and mental behavioral functions as well as on work capacity of iron deficiency and anemia in infants, children and adults, and the positive effects of their correction was demonstrated. In protein-energy malnourished (PEM) children, the deficit in active tissue mass (basal oxygen consumption) and in total hemoglobin content were closely related. This relationship persisted as the rates of active tissue mass repletion was modified by levels of protein intake. This demonstrated the strong adaptive nature of hemoglobin content in response to oxygen needs in PEM and during recovery. Gastrointestinal functions in PEM and in populations demonstrated the bacterial invasion of the upper GI tract and how this resulted in secondary bile acids that are toxic to the intestinal mucosal cells impairing their absorptive functions. Environmental hygiene in populations reversed gut bacterial migration and improved GI function.

Historical and contemporary perspectives on children's diets: is choice always in the patients' best interest?

On 29 March 1744, Thomasin Grace, a 13-year-old girl, was the first inpatient admitted to the Northampton General Infirmary (later the Northampton General Hospital). Inpatient hospital diets, then and now, are mainstays of effective patient treatment. In the mid-18th century there were four prescribed diets at Northampton: 'full', 'milk', 'dry' and 'low'. Previous opinions concerning these four diets were unfavourable, but had not been based upon an individual dietetic assessment. Thomasin would most likely have been given the milk diet, but use of the full diet cannot be excluded. 'Grace Everyman' is Thomasin's modern equivalent. Under current NHS guidelines Thomasin would be considered a paediatric patient, but in 1744 she would have been considered as an adult. This study undertakes a full dietetic analysis of all the prescribed diets available for Thomasin in 1744 and compares this against random choices for Grace from the 2009 inpatient menu from the paediatric (Paddington) ward, and the adult ward inpatient menu at the Northampton General Hospital. The results show that, for Thomasin, the 1744 milk and full diets met the current advised nutritional requirements for adequate dietary intake. However, for Grace, the present 2009 Paddington and adult ward menu, although generally meeting nutritional requirements, could, if Grace or her carer consistently chose poorly during a prolonged inpatient stay, lead to inadequate nutrition. This challenges assumptions that hospital diets were historically inadequate, and that choice in present day equates with satisfactory nutritional intake.

Measuring food environments: a historical perspective.

Food and nutrition environments are believed to contribute to obesity and chronic diseases. There is a need for valid, reliable measures of nutrition environments. Familiarity with previous efforts to measure food and nutrition environments can help researchers and practitioners build on past accomplishments. This article describes sources of food-environment data, discusses how they have been used, and places the definition and measurement of food and nutrition environments in historical context. Review articles, agency websites, and peer-reviewed articles were the main sources of information. The review is organized around three main types of data sources identified as historic traditions: government, industry, and research. Types of data include archives, business monitoring records, surveys, observational assessments, and self-report surveys. Future development of clear, adaptable measures of food and nutrition environments will build on lessons of the past and will update and improve on past tools.

Roberto Rueda Williamson: su gesta en la enseñanza de la nutrición y la creación del Instituto Colombiano de Bienestar Familiar / Roberto Rueda Williamson: their geste in the teaching of the Nutrition and the creation of Instituto Colombiano de Bienestar Familiar

Se presenta una visión socio-histórica de la instauración del programa de nutrición y dietética de la Universidad Nacional de Colombia, desde la perspectiva de la salud pública, y de las circunstancias nacionales que dieron origen al Instituto Nacional de Nutrición y su articulación con el Instituto Colombiano de Bienestar Familiar, con especial referencia a la vida y obra de Roberto Rueda Williamson

Mal de fome e näo de raça: gênese, constituiçäo e açäo política da educaçäo alimentar: Brasil 1934-1946 / A matter of famine, not race: origin, constitution and political action of nutrition education: Brazil 1934-1946

Recupera dois períodos importantes no conjunto da literatura especializada em alimentaçäo e nutriçäo, ressaltando as aproximaçöes e diferenças entre os autores, bem como os deslocamentos operados na demonstraçäo da tese Mal de Fome e Näo de Raça: o de 1934 a 1939, marcado pelo lançamento das bases científicas da alimentaçäo racional, configurando a dietética como matriz instrumental, sob orientaçäo social; e de 1940 a 1946, caracterizado pela síntese e definiçäo dos marcos conceituais e disciplinares da ciência da nutriçäo.

Programa de Alimentação Escolar no Brasil: limitações e evolução nas décadas de 80 e 90 / The brazilian program of school meals: limitations and evaluation in 80s and 90s

This work describes the trajectory of the National Program of School Meals ­ PNAE ­ implemented in Brazil for about 50 years. The main and decisive changes made by the Federal Government in the last two decades are examined. Among them, the decentralization of the program deserves a highlight, which affects the consumption of the meals distributed and the nutritional status of the beneficiaries. The analysis shows that during this period, the decentralization of the program was definitively implemented, with the Federal Government transferring the money to buy food directly to the school administrators. It was also verified that at the end of the eighties, the PNAE, benefited students with a greater per capita income and enrolled in the schools of the southern and southeastern region (more economicall y developed). In the nineties, there was a modification in this tendency and the PNAE reveals itself better focused in relation to the students in elementary education. Nourishment consumption analysis shows that the meal contribution to the group recommendation is low, mainly in energy, vitamins, and minerals, particularly calcium and iron. It shows also, low presence of fruits and vegetables in the school meals. With regard to the nutritional status, the coexistence of two problems ­ growth deficits and overweight ­reveals a complex nutritional situation of superposition that demands differentiated intervention to these very different realities

El objetivo de este trabajo fue describir la trayectoria del Programa Nacional de Merienda Escolar (PNAE) vigente en Brasil aproximada-mente 50 años. Se examinaron las principales modificaciones implementadas por el Gobierno Federal en las últimas décadas. Entre estas, hayque destacar la descentralización del programa y su repercusión en el consumo de las merendas distribuidas y en el estado nutricional de los beneficiarios del programa. El estudio revela que durante este período se consolidó definitivamente el proceso de descentralización, principalmente a mediados de la década del 90, cuando los recursos destinados a la compra de alimento comenzaran a ser repasados directamente a los administradores de las escuelas. Fue comprobado también que al final de la década del 80,el PNAE, beneficiaba indebidamente a alunos con mayor renta per cápita matriculados en las regiones Sur y Sudeste (que son economicamente más desarrolladas). En los años 90, esa tendencia fue modificada y el PNAE se mostró mejoren focado en relación a la población que frecuenta la enseñanza básica. El análisis del consumo alimenticio muestra que la contribución de la merienda no atiende las recomendaciones para ese grupo y es deficiente principalmente enenergía, vitaminas y minerales, principalmente calcio y hierro, siendo bastante escasa la presencia de frutas y hortalizas en la minuta de los escolares. Con relación al estado nutricional, la coexistencia de 2 problemas, el retardo del crecimiento y el sobrepeso, revela un panorama complejo que requiere intervención diferenciada para cada realidad

Este trabalho visa descrever a trajetória do Programa Nacional de Merenda Escolar (PNAE), que vigora no Brasil há cerca de 50 anos. São examinadas as principais e decisivas mudanças implementadas pelo governo federal, durante as últimas décadas. Entre essas, merece destaque a descentralização do Programa, as repercussões desta no consumo das refeições distribuídas e no estado nutricional dos beneficiários da merenda escolar. As análises revelam que durante o período concretizou-se, de forma definitiva, o processo de descentralização, coma inovação (especialmente em meados da década dos 90) do repasse das verbas federais, destinadas à compra de alimentos, diretamente para os administradores das escolas. Verificou-se, também, que no final da década dos 80, o PNAE, beneficiava, indevidamente, os alunos com maior renda per capita e matriculados nas escolas das regiões Sul e Sudeste (economicamente mais desenvolvidas). Nos anos 90, há modificação nessa tendência e o PNAE se revela melhor focalizado em relação à população que frequenta o ensino fundamental. Análises do consumo alimentar permitem inferir que a contribuição das refeições para o atendimento das recomendações do grupo é baixa, principalmente para a energia, vitaminas e minerais, com destaque para o cálcio e o ferro, sendo, bastante reduzida, também, a presença de frutas e hortaliças na pauta alimentar dos escolares. Quanto ao estado nutricional, a coexistência de duas problemáticas - déficits de crescimento e sobrepeso revela um quadro nutricional complexo de superposição, o que demanda intervenções diferenciadas para essas realidades muito distintas

A questäo alimentar-nutricional na "Nova República": discurso e prática

Objetiva contribuir para avaliar temas e problemas relacionados ao planejamento e à execuçäo das políticas de suplementaçäo alimentar e verificar se elas realmente estäo atendendo às necessidades nutricionais dos grupos vulneráveis. Conclui que os programas e açoes estatais destinados à suplementaçäo alimentar dos segmentos mais vulneráveis (gestantes, nutrizes e crianças de baixa renda) näo cumpriram os objetivos propostos e nem aliviaram a fome de sua clientela.

A trajetória da política de alimentaçäo e nutriçäo no Brasil: de 1889-1945 / The trajectory of nutrition and feeding policy in Brazil: from 1889 to 1945

O presente trabalho tem como objetivo analisar as propostas de políticas de alimentaçäo e nutriçäo no Brasil, adotadas pela República Velha e Estado Novo, em consequência das alteraçöes ocorridas no sistema sócio-econômico e político naquele período

Antecedentes históricos y perspectivas de la seguridad alimentarias infantil y familiar en Chile / Historical antecedence and perpectives of children and familiar food security in Chile

La situación alimentaria y nutricional de la población mundial se caracteriza por su frecuente deterioro, que se traduce a menudo en mal nutrición, y en ciertos lugares en hambre en las comunidades. En latinoamérica sólo un pequeño grupo de países, Chile entre ellos, constituyen la excepción a dicho respecto. Esto ha ocurrido a pesar de la existencia de condiciones de subdesarrollo económico-social, registrándose especialmente en el curos de las últimas décadas un progreso significativo en la nutrición de los niños y de las familias. Se ilustra acerca de la situación actual y prospectiva de la seguridad alimentaria infantil y familiar en Chile, en un contexto histórico. Se destacan algunos de los avances pertinentes registrados en la menor edad, los que se han traducido en una decreciente prevalencia de la desnutrición, la que en 1985 fue de 8,7% en menores de 5 años de edad, siendo en la mayoría de los casos leve. Se señala que los hechos mencionados han ocurrido en concomintancia con avances simultáneos registrados especialmente en el ámbito de la salud, habiendo llegado en la fecha aludida la mortalidad infantil a 19,4%, y observándose asimismo progresos simultáneos en las áreas de educación, la vivienda, el saneamiento ambiental y en general el desarrollo social. Los hechos reseñados han ocurrido en un notorio desfase con el crecimiento económico del país cuyo producto per cápita es de alrededor de $EUA 2.000, y alcanzando la disponibilidad alimentaria en la actualidad a un promedio de 2.620 calorías y 83 gramos de proteínas. La permanencia de los logros obtenidos y la configuración de la Seguridad Alimentaria, exige la ejecución de Políticas de Alimentación y Nutrición insertas en los Planes de Desarrollo Global, lo que incluye fortalecer los actuales programas de Educación Sanitaria, Alimentación Complementaria y de participación de la comunidad. Ello exige contar con el apoyo de selectos profesionales de la salud, en particular de los pediatras y de sus colaboradores próximos