Challenges to the development of taxation policies for sugar-sweetened beverages in Colombia.

Frequent consumption of sugar sweetened beverages (SSB) is related to the risks of developing overweight, obesity, cavities, diabetes and other diseases. Policies to significantly increase taxes on SSB have proven to be effective in reducing their consumption. The political debate on implementing these taxes in Colombia shows a series of barriers to placing this policy on the political agenda, and therefore, to its approval. This work analyses the political process involved in the struggle for the approval of an SBB tax in Colombia, as well as barriers and opportunities to putting it on the political agenda. This is done through a policy analysis with three research methods: a documentary analysis, political mapping of actors and semistructured interviews with key actors. Among the main findings, we have that actors who are in favour of the SSB tax stated that it is needed due to the health problems caused by SSB consumption, while those who opposed it argue that Colombia regulations are sufficient and already inform and educate consumers on excessive sugar consumption and its health implications. The Colombian political context is a barrier to SSB taxation, as the government favours and has a close connection with the food and SSB industry. In short, the policy issue has been reaching the agenda intermittently throughout the years. Nevertheless, new opportunities are arising after the COVID-19 pandemic and the 2022 administrative changes and further efforts from policy entrepreneurs are required to make this initiative progress in the political agenda.

Barriers to Overcoming Child Hunger and Malnutrition: Applying a Human Rights Approach to Improve Policy and Action.

Objective: Analyze key barriers to achieving children's right to food under Colombia's food and nutrition security policies and programs. Methods: A literature review was conducted along with 17 semi-structured expert interviews. The law framework on the right to food was applied to analyze findings. Results: Four key barriers were found. First, a reductionist approach prevails in the political narrative. This focuses on ensuring personal food access overlooking societal and environmental impacts. Second, the implementation of policies and programs is passed on to third parties, preventing civic participation and accountability. Third, there are insufficient national data sources and indicators to monitor the impact of interventions and funding. Fourth, program implementation is unequal and inadequate, which inadvertently supports illicit economies that thrive on conditions of hunger and poverty. Conclusion: Children's food and nutrition are reliant on organizations that focus on personal food supply without strengthening civic participation. Strengthening participation requires a human rights approach. International organizations can help the government to engage communities in policy and program improvement and oversight.

Current perspectives on food: from nutritionism to healthy, supportive, and sustainable food / Perspectivas actuales sobre alimentación: del nutricionismo a la alimentación saludable, solidaria y sustentable

Abstract Of the many discourses on nutrition and food, two opposing perspectives stand out. On the one hand, "nutritionism" emerged strongly in the last decades, reducing the concept of food to the presence or absence of nutrients and the concept of health to the absence of diseases, a discourse that has influenced modern nutritional and food sciences, as well as the conceptualization of the current corporate food regime. On the other hand, "healthy, supportive, and sustainable food" is a re-emerging perspective associated with the traditional ancestral food system and is founded on the principle of common good since millennia ago. This paper presents a reflection on these two perspectives, taking into account the historical scenario and the socio-political context that characterize them, in order to contribute to the recognition of a food paradigm consistent with the Millennium Development Goals and the human right to food. In addition, this reflection aims to assess the progress that has been made in Colombia to achieve healthy, supportive, and sustainable eating practices in the general population.

Resumen Entre los múltiples discursos sobre nutrición y alimentación, hay dos perspectivas opuestas que se destacan: por una parte, el "nutricionismo", que emergió con gran protagonismo en las últimas décadas y reduce el concepto de alimentación a la presencia o no de nutrientes, y el de salud, a la ausencia de enfermedades, discurso que ha influenciado las ciencias nutricionales y alimentarias modernas y la conceptualización del actual régimen alimentario corporativo, y por otra parte, la "alimentación saludable, solidaria y sustentable", una perspectiva reemergente asociada al sistema alimentario tradicional ancestral constituido a partir de la ética del bien común desde hace miles de años. El presente artículo presenta una reflexión sobre estas dos perspectivas, teniendo en cuenta el panorama histórico y el entorno sociopolítico que las caracterizan, con el propósito de contribuir al reconocimiento de un paradigma alimentario que esté en línea con los objetivos de desarrollo del milenio y con el derecho humano a la alimentación. Además, esta reflexión pretende valorar los avances que se han realizado en Colombia para lograr una alimentación saludable, solidaria y sustentable en la población general.

'I had never seen so many lobbyists': food industry political practices during the development of a new nutrition front-of-pack labelling system in Colombia.

OBJECTIVE: To identify and monitor food industry use of political practices during the adoption of nutrition warning labels (WL) in Colombia. DESIGN: Document analysis of publicly available information triangulated with interviews. SETTING: Colombia. PARTICIPANTS: Eighteen key informants from the government (n 2), academia (n 1), civil society (n 12), the media (n 2) and a former food industry employee (n 1). RESULTS: In Colombia, the food industry used experts and groups funded by large transnationals to promote its preferred front-of-pack nutrition labelling (FOPL) and discredit the proposed warning models. The industry criticised the proposed WL, discussing the negative impacts they would have on trade, the excessive costs required to implement them and the fact that consumers were responsible for making the right choices about what to eat. Food industry actors also interacted with the government and former members of large trade associations now in decision-making positions in the public sector. The Codex Alimentarius was also a platform through which the industry got access to decision-making and could influence the FOPL policy. CONCLUSIONS: In Colombia, the food industry used a broad range of political strategies that could have negatively influenced the FOPL policy process. Despite this influence, the mandatory use of WL was announced in February 2020. There is an urgent need to condemn such political practices as they still could prevent the implementation of other internationally recommended measures to improve population health in the country and abroad, nutrition WL being only of them.

Recomendaciones de política pública como estrategia reflexiva en los estudios de políticas alimentarias y nutricionales en Colombia 2000-2015 / Public Policy Recommendations as a Reflexive Strategy in Studies of Food and Nutrition Policies in Colombia 2000-2015

Resumen Antecedentes: existe una deuda histórica con el análisis de las políticas públicas alimentarias y nutricionales que permita su reubicación en una nueva lógica que aporte a la consolidación de un sistema de garantía progresiva del derecho humano a la alimentación. Objetivo: abordar las recomendaciones de política pública de estudios de políticas alimentarias y nutricionales colombianas ubicadas en el periodo 2000-2015. Materiales y métodos: diseño metodológico de corte cualitativo basado en el análisis de 36 documentos que contienen aportes analíticos para la formulación, implementación y evaluación de políticas públicas del campo alimentario y nutricional. Resultados: se ubicaron tres tipos de recomendaciones técnicas: 1) las que proponen el abordaje e intervención de cuestiones estructurales que trascienden a los tomadores de decisiones y se relacionan con atributos macro de los problemas públicos; 2) las concentradas en la redefinición de los problemas públicos; y 3) las que enfatizan en la recomposición de procesos, instituciones y diseño de instrumentos de política pública. Conclusiones: abogar por los problemas públicos desde los determinantes sociales de la salud, alimentación y nutrición, y modificar el referencial de las políticas públicas al promover nuevas escuelas de pensamiento, académico, político y social; giros conceptuales y metodológicos que son necesarios para reubicar estas políticas públicas.

Abstract Background: There is a historical lack of analyses of dietary and nutritional public policies that now allows for a repositioning and new logic to contribute to the consolidation of a progressive system that guarantees the right to food. Objective: Address public policy recommendations in studies of Colombian food and nutrition policies during the years 2000-2015. Materials and Methods: Qualitative methodological design based on the analysis of 36 documents containing analytical contributions to the formulation, implementation, and evaluation of public policies in the food and nutrition field. Results: Three types of technical recommendations were discovered: 1) those that propose the approach and intervention of structural issues that transcend decision makers and are related to macro attributes of public problems; 2) those focused on the redefinition of public problems; and 3) those that emphasize the recomposition of institutional processes and the design of public policy instruments. Conclusions: Advocate for public problems from the purvue of social determinants of health, food, and nutrition, and modify public policies by promoting new schools of thought-academic, political and social. These conceptual and methodological paradigm shifts are necessary to reposition these public policies.

"The architecture of the state was transformed in favour of the interests of companies": corporate political activity of the food industry in Colombia.

BACKGROUND: In Colombia, public health policies to improve food environments, including front-of-pack nutrition labelling and marketing restrictions for unhealthy products, are currently under development. Opposition to these policies by the food industry is currently delaying and weakening these efforts. This opposition is commonly known as 'corporate political activity' (CPA) and includes instrumental (action-based) strategies and discursive (argument-based) strategies. Our aim was to identify the CPA of the food industry in Colombia. METHODS: We conducted a document analysis of information available in the public domain published between January-July 2019. We triangulated this data with interviews with 17 key informants. We used a deductive approach to data analysis, based on an existing framework for the CPA of the food industry. RESULTS: We identified 275 occurrences of CPA through our analysis of publicly available information. There were 197 examples of instrumental strategies and 138 examples of discursive strategies (these categories are not mutually exclusive, 60 examples belong to both categories). Interview participants also shared information about the CPA in the country. The industry used its discursive strategies to portray the industry in a 'better light', demonstrating its efforts in improving food environments and its role in the economic development of the country. The food industry was involved in several community programmes, including through public private initiatives. The industry also captured the media and tried to influence the science on nutrition and non-communicable diseases. Food industry actors were highly prominent in the policy sphere, through their lobbying, close relationships with high ranking officials and their support for self-regulation in the country. CONCLUSIONS: The proximity between the industry, government and the media is particularly evident and remains largely unquestioned in Colombia. The influence of vulnerable populations in communities and feeling of insecurity by public health advocates is also worrisome. In Colombia, the CPA of the food industry has the potential to weaken and delay efforts to develop and implement public health policies that could improve the healthiness of food environments. It is urgent that mechanisms to prevent and manage the influence of the food industry are developed in the country.

La comprensión de la salud como metacapacidad en el Programa Familia, Mujer e Infancia / The understanding of health as metacapability in the family, woman and childhood program / A compreensão da saúde como metacapacidade no programa familia, mulher e infância

Objetivo: Comprender el enfoque de la promoción del desarrollo humano en el Programa Familia Mujer e Infancia (FAMI), del centro zonal nororiental del Instituto Colombiano de Bienestar Familiar, seccional Medellín (Antioquia), analizando los aportes que esta promoción puede hacer a las teorías y prácticas de salud pública. Materiales y métodos: Estudio cualitativo con sustento teórico en el enfoque de capacidades humanas de Martha Nussbaum y de la salud como metacapacidad de Sridhar Venkatapuram, así como metodológico en técnicas etnográficas. En esta investigación se realizaron entrevistas en profundidad a madres comunitarias, madres usuarias y profesionales del programa. Asimismo, se hizo observación participante en distintos escenarios comunitarios. Resultados: Los resultados se relacionan con un grupo de siete capacidades centrales suscitadas desde el programa FAMI. Conclusión: las siete capacidades identificadas entre las madres del programa FAMI, interactúan de manera sinérgica para potencializar la salud como metacapacidad para el logro de una vida digna

Objetive: To understand the promotion of human development approach in the Family, Woman and Childhood Program (FAMI by its acronym in Spanish) in the Northeastern zonal service of the Colombian Family Welfare Institute (ICBF by its acronym in Spanish), Medellin (Antioquia) branch, analyzing the contributions that such a promotion can provide to the theory and practice of public health. Materials and Methods: Qualitative study with theoretical support on the human capabilities approach by Martha Nussbaum and of health as metacapability by Sridhar Venkatapuram and methodologically based on ethnographic techniques. In-depth interviews with community mothers, user mothers and professionals of the program were conducted in this research, and participant observation in various community settings was also carried out. Results: The findings are related to a group of seven core capabilities arising from the FAMI program. Conclusion: The seven capacities identified among mothers in the FAMI program interact synergistically to potentiate health as metacapability aimed to achieve decent living.

Objetivo: Compreender o enfoque da promoção do desenvolvimento humano no Programa Família Mulher e Infância (FAMI), do centro zonal nordeste do Instituto Colombiano de Bem estar Familiar, seccional Medellín (Antioquia), analisando os aportes que esta promoção pode fazer às teorias e práticas de saúde pública. Materiais e métodos: Estudo qualitativo com sustento teórico no enfoque de capacidades humanas de Martha Nussbaum e da saúde como meta-capacidade de Sridhar Venkatapuram, assim como metodológico em técnicas etnográficas. Nesta pesquisa se realizaram entrevistas em profundidade as mães comunitárias, mães usuárias e profissionais do programa. Mesmo assim, se fiz observação participante em diferentes cenários comunitários. Resultados: Os resultados se relacionam com um grupo de sete capacidades centrais suscitadas desde o programa FAMI. Conclusão: as sete capacidades identificadas entre as mães do programa FAMI, interatuam de maneira sinérgica para potencializar a saúde como meta capacidade para o logro de uma vida digna.

Canasta básica de alimentos real en hogares beneficiarios de la Fundación Ximena Rico Llano de Medellín-Colombia / Basic foods in households receiving benefits from Ximena Rico Llano Foundation, Medellín-Colombia

Objetivo: establecer la composición de la canasta básica de alimentos real, el hábito de compra y el costo de los productos no alimentarios en hogares beneficiarios de la Fundación Ximena Rico Llano de Medellín-Colombia, en el año 2007. Materiales y métodos: estudio transversal en una muestra representativa y aleatoria de 91 hogares de la Fundación. Se aplicó una encuesta estructurada que permitió definir la canasta básica de alimentos real a partir de la disponibilidad mensual de alimentos y la determinación del hábito de compra, volumen de compra, costo, aporte de energía y aporte de proteínas provenientes de los productos alimentarios. Adicionalmente se definió la disponibilidad y costos de los productos no alimentarios adquiridos en los hogares. Resultados: la canasta básica de alimentos estuvo constituida en promedio por 30 alimentos distribuidos en doce grupos; sin embargo 16% de las familias no disponía en su canasta básica de alimentos como carne y vísceras, sustitutos de la carne, leguminosas, lácteos, bebidas, frutas y verduras. El costo de la canasta básica de alimentos fue de $448.623 (US$216), equivalente a 1,03 salarios mínimos mensuales legales vigentes. El costo de los productos no alimenticios equivalía al 14,03% del gasto mensual de los hogares en la canasta. Conclusiones: la canasta básica de alimentos de los hogares de la Fundación Ximena Rico Llano estuvo conformada por 30 alimentos, presentando poca variedad en la compra y comprometiendo el aporte nutricional de la dieta. La adquisición de productos no alimentarios (artículos para aseo personal y del hogar) representa un rubro importante dentro de los gastos mensuales, lo que puede comprometer la compra de alimentos.

Objective: to determine in the households receiving benefits from Ximena Rico Llano foundation Medellin-Colombia, the composition of consumed food, what foods these families use to buy and the cost for no nutritious food. Materials and methods: cross sectional study. Randomized and representative sample of 91 families from the foundation were selected. An structured survey was applied to define the basic foods consumed according the accessibility and to determine what type and how much food families buy, and also the cost, calories and proteins content of these foods. Moreover the cost and the accessibility for no nutritious food were also identified. Results: the basic meals consumed for families were represented for 30 aliments distributed in 12 groups; however 16% of the families didn’t have access to staple food like meat, legumes, dairy products, fruits and vegetables. The cost of the basic food was about $448.623 (US$216), it was the equivalent to 1,03 basic wage. The cost for no nutritious food represented 14% of the total Money spending in food per month. Conclusions: the basic foods of the families from Ximena Rico Llano Foundation consisted of 30 aliments, and no variety was observed. These families didn’t meet the nutritional requirements. Acquisition of products different to food represented another important investments that restrain families to spent more in staple food.

Relación entre malaria, desnutrición, inseguridad alimentaria y condiciones socioeconómicas, en niños de Turbo, Colombia / Relationship between malaria, malnutrition, food insecurity and low socioeconomical

Objetivo: asociar malaria con estado nutricional, seguridad alimentaria y factores socioeconómicos. Materiales y métodos: estudio transversal, en niños de 2 a 14 años, del corregimiento El Tres, Turbo (Colombia), distribuidos en dos grupos, con malaria (76) y sin malaria (147). Se analizó estado nutricional, seguridad alimentaria y factores socioeconómicos. Resultados: las prevalencias en el grupo con malaria versus el grupo sin malaria fueron respectivamente: 39,5% y 25,2% (p= 0,028) de desnutrición crónica en los niños; 94,7% y 92,5% de inseguridad alimentaria en sus hogares y la escolaridad de la madre 3±3 y 4±3 años (0,041), respectivamente. El riesgo de pertenecer al grupo con malaria se incrementó por desnutrición crónica de los niños (OR:1,94; IC95%1,07-3,50) y por habitar viviendas precarias, con mala calidad de techos (OR:5,95;IC95%2,28-15,55), pisos (OR:2,05;IC95%1,06-3,82) y carencia de electricidad OR:3,85;IC95%2,10-6,90). Conclusiones: se encontraron altas prevalencias de inseguridad alimentaria, condiciones socioeconómicas desfavorables y desnutrición crónica, esta última y las condiciones precarias de las viviendas se asociaron positivamente con malaria, la escolaridad de las madres fue menor en el grupo con malaria. Este es el primer estudio colombiano que asocia malaria, desnutrición y condiciones socioeconómicas adversas en niños.

Background: malaria, malnutrition and household food insecurity are public health problems in Colombia that should be studied all an integrated way Objective: to study the association between malaria nutritional status, household food insecurity and socio-economic factors. Materials and methods: cross sectional study was carried out in a place called “El Tres”, Turbo-Colombia. Children 2-14 year old were divided in two groups: one group with malaria (76) and the other one without malaria (147). Nutritional status, food accessibility and socio-economic factors were analyzed. Results: prevalence of chronic malnutrition in children with malaria versus children with no malaria were: 39,5% and 25,2%, food insecurity was 94,7% and 92,5%, and mother’s scholar level was 3±3 y 4±3 (p=0,041), respectively. The risk to have malaria is increased in chronic malnutrition (OR:1,94;IC95%1,07-3,50) and by poor housing conditions as bad roof quality (OR:5,95;IC95%2,28-15,55), bad floor quality (OR:2,05;IC95%1,06-3,82) and not have electricity (OR:3,85;IC95%2,10-6,90). Conclusion: food insecurity was common in studied subjects, socio-economic conditions were low and the prevalence of chronic malnutrition was high. All these issues were strong associated with malaria. This is the first study carried out in Colombia that explores the association of malaria with child malnutrition and household food insecurity.

Malaria, desnutrición en niños e inseguridad alimentaria en sus hogares: una revisión / Malaria and malnutrition in children and household food insecurity: a review

Antecedentes: la malaria, la desnutrición y la inseguridad alimentaria, son problemas de salud pública en Colombia, que deben estudiarse integradamente. Objetivo: describir la relación entre morbimortalidad por malaria con desnutrición proteico-calórica, anemia y deficiencia de vitamina A y de zinc en los niños e inseguridad alimentaria en sus hogares, al igual que el efecto de los suplementos poblacionales de retinol, hierro y zinc sobre morbimortalidad por malaria. Metodología: se consultaron Medline y otras bases biográficas. Resultados: la desnutrición proteico-calórica y las deficiencias de vitamina A y zinc, aumentan la morbimortalidad por malaria. Los estudios sobre los efectos de los suplementos poblacionales de micronutrientes en niños sobre morbimortalidad por malaria por P. falciparum muestran: los de vitamina A, sugieren efecto protector, los de zinc no tienen resultados concluyentes frente a la malaria pero otros beneficios y los de hierro, tienen efecto perjudicial. Los estudios sobre los efectos de tales suplementos sobre la mobimortalidad por malaria por P. vivax son incipientes y en el caso del hierro, parecen estar influenciados por la edad de los niños y si se usan solos o combinados con zinc. La malaria coexiste con la inseguridad alimentaria en el hogar y la prevención de esta última contribuye a reducir la desnutrición infantil y posiblemente la morbimortalidad por malaria. Conclusión: reducir la inseguridad alimentaria disminuirá la desnutrición infantil y las deficiencias de micronutrientes, así contribuirá a reducir la morbi-mortalidad por malaria. En zonas endémicas para P. falciparum, los suplementos poblacionales de vitamina A tienen resultados promisorios: los efectos de los suplementos de zinc no son claros aún y los de hierro son perjudiciales.

Background: malaria and household food insecurity are public health problems in Colombia that should be studied in an integrated approach Objective: to describe the relationship between malaria and malnutrition, deficiencies of vitamin A, zinc and anaemia in children; and household food insecurity, as well as the effect of retinol, iron and zinc supplements on morbidity and mortality in children with malaria infection. Methodology: Medline and other databases were searched. Results: the articles showed that protein-caloric malnutrition and deficiencies of both vitamin A and Zinc increase morbidity and mortality associated to Malaria infection. Studies of the effects of micronutrient supplements on morbidity and mortality associated to Malaria caused by P. falciparum confirmed that vitamin A supplements’ may has a protective effect; studies of zinc on malaria are no conclusive, although it has other benefits; and supplement of iron could presents a deleterious effects, an it seems to be influenced by children age and if it is administer alone o combined with zinc. There is a strong relationship between Household food insecurity and malaria. Prevention of household food insecurity should contribute to decrease children malnutrition and to reduce the morbidity and mortality associated to malaria. Conclusion: Improving household security could help to reduce malnutrition and micronutrients deficiencies in children, contributing to reduce morbidity and mortality associated to malaria. In endemic areas for P. falciparum vitamin A population supplementation has promising results. Studies of zinc are not conclusive and iron has deleterious effects.