History and challenges of Brazilian social movements for the achievement of the right to adequate food

The INFORMAS healthy food environment policy index in Brazil: Benchmarking, current policies, and determining priorities for the future

INTRODUCTION

Obesity and non-communicable diseases are the most important cause of death and inability in Brazil and worldwide. Public policies are an important strategy to prevent obesity. This study analysed the scope of Brazilian public policies for preventing and controlling obesity using the INFORMAS/Food-EPI protocol.

METHODS

The public policies evaluation was conducted based on the INFORMAS/Food-EPI protocol. Experts from academia, civil society, and government assessed the level of implementation of food policies compared with international best practices and proposed new actions to be developed nationally. The protocol consisted of five phases: (1) A comprehensive review of the implementation of food environment-related public policies; (2) validation with experts; (3) comparison of the national actions with the international best practice and due to the level of implementation; (4) list a set of actions to improve the current policies; and (5) evaluation of the actions due to their importance and achievability.

RESULTS

Brazilian actions were focused on monitoring, leadership, governance, and resources and financing domains.

CONCLUSION

The results will provide elements to support and improve the national policies that aim at the promotion of a healthy food environment and obesity prevention.

Intersectorality in a conditional cash transfer programme: Actors, convergences and conflicts

This study aimed to analyse intersectoral arrangements among the health, education and social assistance sectors in the operationalization of the Bolsa Família Program (BFP). A qualitative approach was carried out, in a peripheral region of a large urban centre of Southeast Brazil. Data content analysis was performed on the basis of reference in the Actor-Network Theory (ANT) using statements by the actors and considering ideas in dispute and work processes in the geopolitical territorial context. Seventeen managers of Municipal Secretariats of Health, Education and Social Assistance were interviewed, as were basic education, primary health care and social assistance professionals. One-off, episodic and discontinuous intersectoral actions were identified, with limited integration among sectors. Convergences and conflicts were found with respect to the institutional processes of BFP. The convergences referred to the conceptions shared among the actors about the role of intersectoral collaboration, as they recognize themselves as providing care to the same vulnerable population. Considering the multiple vulnerabilities of these families, the convergence of actions from different sectors can impact factors that condition inequalities. The conflicts were related to institutional conditions, to sectorized work processes and to a lack of understanding by professionals about the duties of their respective sectors.

Gender, skin color, and household composition explain inequities in household food insecurity in Brazil

It is well known that female-headed households (FHHs) are more likely to experience food insecurity (FI) than male-headed households (MHHs), however there is a dearth of evidence on how gender intersects with other social determinants of FI. Thus, this paper investigated changes in the prevalence of household FI in Brazil from 2004 to 2018 by the intersection of gender, race/skin color and marital status of the household reference person. Data from three cross-sectional nationally representative surveys that assessed the status of FI using the Brazilian Household Food Insecurity Measurement Scale were analyzed (N2004 = 107,731; N2013 = 115,108, N2018 = 57,204). Multinomial logistic regression models were used to examine the relationship between profiles of gender, race/skin color, marital status of the head of the household with household FI stratified by the presence of children <5 years of age. Over time, FHHs had a higher prevalence of mild and moderate/severe FI than did households headed by men. Food security prevalence increased from 2004 to 2013 and decreased between 2013 and 2018 for households headed by men and women. In 2018, households headed by black/brown single mothers with children < 5 years of age were at the highest FI risk. The probability of reporting moderate/severe FI in these households were 4.17 times higher (95% CI [2.96-5.90]) than for households headed by married white men. The presence of children in the household was associated with a higher probability of moderate/severe FI, especially for households headed by black/brown individuals regardless of the reference person's gender. The results suggest that gender inequities combined with darker skin color and the presence of children at home potentiate the risk of moderate/severe FI. Policy makers need to consider the principles of intersectionality when investing in codesigning, implementing, evaluating, and scaling up evidence-based programs to reduce FI.

Public infrastructure for food and nutrition security in brazil: fufilling the constitutional commitment to the human right to adequate food

Food insecurity is a critical global problem with social and public health consequences. In Brazil, access to adequate food is a fundamental human right guaranteed under the country’s Constitution since 2010. As such, the State assumes the distinct and complementary obligations to respect, protect, promote and provide the Right to Adequate Food. The aim of this study is to present actions related to the “provision” dimension that have been developed as part of a network of public infrastructure strategies for food and nutrition security in Brazil. Through an exploratory, analytical literature review, the paper focuses on the operational designs and logistics of three main strategies: Food Banks, Community Kitchens, and Popular Restaurants. The Brazilian experience indicates that public actions are necessary, especially considering the urgency for those groups living with hunger and poverty. While similar programs can be found in other countries in South and North America, they are mostly offered by civil society organizations, and have not advanced toward public institutionalization. In fact, private programs are criticized for negating governments’ obligation and responsibility in this area. Brazil’s experience sheds light on public initiatives in meeting the State’s obligations towards the Right to Adequate Food.

Direito humano à alimentação adequada e objetivos do desenvolvimento sustentável: interferências coletivas com crianças em periferias vulnerabilizadas

Resumo Este artigo teve como objetivo analisar as relações entre o Direito Humano à Alimentação Adequada (DHAA) e os Objetivos do Desenvolvimento Sustentável (ODS) que emergem de ações dialógicas com crianças e adolescentes em periferias urbanas vulnerabilizadas de São Vicente, São Paulo. Utilizando referencial metodológico das pesquisas participativas, a observação e registros de assembleias comunitárias e da parceria entre universidade pública e movimento social apontam para espaços de acolhimento às crianças e adolescentes que viabilizam leituras diagnósticas coletivas sobre a alimentação. Esses processos dialógicos permitem problematizar as dimensões do DHAA a partir da cadeia de produção, comercialização e consumo de alimentos, além da instabilidade a que essas crianças e adolescentes estão submetidos, em uma complexa rede de determinantes que produzem má-nutrição nos territórios onde vivem. Os resultados apontam que estas dimensões dialogam com todos os ODS, na medida em que demandam a sustentabilidade cultural, econômica, social e ambiental da alimentação. A parceria e a integração entre universidade e sociedade fortalece e potencializa os espaços de controle social e formação dos atores para a luta pelo DHAA, e pode também produzir efeitos de transformação nas desigualdades nos territórios e reconhecer a criança como sujeito de direitos com profundo rigor ético na construção de escutas inclusivas e de práticas qualificadas.

The human right to adequate food and sustainable development goals: collective interferences with children in vulnerable urban peripheries

Abstract This study aimed to analyze the relation between the Human Right to Adequate Food (HRAF) and Sustainable Development Goals (SDG) resulting from a dialogic experience with children and adolescents in the periphery of São Vicente, São Paulo. Using the methodological framework of participatory research, community assemblies observation, and the partnership between the university and social movements point to a caring place for children/adolescents that enable collective diagnostic readings on food. Dialogical processes enable us to problematize HRAF dimensions based on the chain of food production, trading and consumption, and the instability to which those children/adolescents are subjected in a complex network of determinants that produce hunger and malnutrition in the territories in which they live. Results show that these dimensions dialogue with all the SDGs, as they demand cultural, economic, social, and environmental sustainability of food. The partnership and integration between university and society strengthens and enhances the spaces of social control and training of actors to advocate for the HRAF. It can also change inequalities in the territories and acknowledge children as subjects of rights with deep ethical commitment in the construction of inclusive listening and qualified practices.

Health services, intersectoriality and social control: a comparative study on a conditional income transfer program

The Bolsa Família Program (BFP) is one of the largest conditional cash transfer programs in the world, providing cash transfers and intersectoral actions. The aim of this study was to compare whether there is a difference in access to health services, intersectoral actions and social control, between families entitled or not, to the BFP. A cross-sectional study was carried out. A representative sample of a peripheral, socioeconomically vulnerable population from a large urban center in southeastern Brazil was calculated, totaling 380 families. Chi-square or Fisher's exact tests and multiple correspondence analysis were used to compare groups. Families entitled to the BFP had worse living conditions in general and greater access to health services, such as: medical care (p-value 0.009), community healthcare agent (p-value 0.001) and home visits (p-value 0.041). Being entitled or not affected the variability in the pattern of access to services by 31%; low access to intersectoral actions was identified in both groups; social control was incipient. There was an adequate focus on the program; greater access to health services was related to compliance with conditionalities; low access to intersectoral actions can restrict the interruption of the cycle of intergenerational transmission of poverty.

How is Brazil facing the crisis of Food and Nutrition Security during the COVID-19 pandemic?

The goal of this commentary is to expose the situation of Food and Nutrition Security (FNS) in Brazil in the context of the COVID-19 pandemic by providing a critical analysis of this scenario and suggesting ways to move forward. When COVID-19 arrived in Brazil, a crisis scenario that incorporated economic, social and political aspects became highly visible. This scenario fostered unemployment, poverty and hunger. Besides that, it exposed multiple vulnerabilities that were getting worse over the past few years prior to the pandemic. In this context, COVID-19 found in Brazil a fertile ground for its dissemination and community transmission. The impacts of the suspension of many commercial activities and other economic sectors due to the pandemic were quickly felt socially and economically in Brazil. Some of the actions carried out by the Brazilian government included the emergency aid payment and exemption from payment of energy bills for vulnerable individuals, release of funds for programmes for the direct purchase of food from family farmers, delivery of school food kits directly to students despite the closure of schools and publication of sanitary rules for the operation of restaurants. However, these actions are still insufficient, slow and not sufficiently coordinated to contain the progress of the food and nutritional insecurity crisis in Brazil. The COVID-19 pandemic highlights the urgency for the Brazilian government to again prioritise the FNS agenda. This includes implementing mechanisms to ensure the Human Right to Adequate Food and expanding existing FNS programmes.

Signs and strategies to deal with food insecurity and consumption of ultra-processed foods among Amazonian mothers

Although food insecurity configures a public health issue in developing countries going through nutrition transition, there is still lack of evidence on how it is affected by social determinants and its relationship with ultra-processed food (UPF) consumption. Using qualitative methods, we investigated the experience of food (in)security among mothers living in the Brazilian Amazon area, identifying aspects of food insecurity promoting UPF consumption. In-depth interviews were performed with 40 women and inductive content analysis was used. Signs of food insecurity included difficulties in food affordability and irregular access to food. Strategies to deal with lack of food quantity took place during food production (growing foods and raising animals), acquisition (gaining food, shopping incentives and food substitutions) and preparation (creativity in cooking). Not being able to afford staple foods was the main aspect of food insecurity promoting UPF consumption, as fresh foods were substituted by UFP options. Our study contributes to the current literature by presenting explanatory insights about the inconclusive quantitative results on the relationship between food insecurity and UPF consumption. Additionally, it supports the need of policies and interventions focused on promoting sustainable food systems and the regional food culture, which may approach food insecurity through an intersectional perspective.

Social inequities and contemporary struggles for collective health in Latin America

As part of a planned series from Global Public Health aimed at exploring both the epistemological and political differences in diverse public health approaches across different geographic and cultural regions, this special issue assembles papers that consider the legacy of the Latin American Social Medicine and Collective Health (LASM-CH) movements, as well as additional examples of contemporary social action for collective health from the region. In this introduction, we review the historical roots of LASM-CH and the movement's primary contributions to research, activism and policy-making over the latter-half of the twentieth century. We also introduce the special issue's contents. Spanning 19 papers, the articles in this special issue offer critical insight into efforts to create more equitable, participatory health regimes in the context of significant social and political change that many of the countries in the region have experienced in recent decades. We argue that as global health worldwide has been pushed to adopt increasingly conservative agendas, recognition of and attention to the legacies of Latin America's epistemological innovations and social movement action in the domain of public health are especially warranted.

Character Disorders among Autocratic World Leaders and the Impact on Health Security, Human Rights, and Humanitarian Care

The development of autocratic leaders in history reveals that many share severe character disorders that are consistently similar across borders and cultures. Diplomats and humanitarians negotiating for access to populations in-need and security of their programs, especially in health, must understand the limitations placed on the traditional negotiation process. These shared character traits stem from a cognitive and emotional developmental arrest in both childhood and adolescence resulting in fixed, life-long, concrete thinking patterns. They fail to attain the last stage of mental and emotional development, that of abstract thinking, which is necessary for critical reasoning that allows one to consider the broader significance of ideas and information rather than depend on concrete details and impulses alone. These autocratic leaders have limited capacity for empathy, love, guilt, or anxiety that become developmentally permanent and guide everyday decision making. Character or personality traits that perpetuate the lives of autocratic leaders are further distinguished by sociopathic and narcissistic behaviors that self-serve to cover their constant fear of insecurity and the insatiable need for power. Human rights, humanitarian care, and population-based health security are examples of what has consistently been sacrificed under autocratic rule. Today, with the worst global loss of democratic leadership ever seen since WWII, leaders with these character traits now rule in major countries of the world. While history teaches us of battles and conflicts that result from such flawed leadership, it lacks explanations of why autocratic behaviors consistently emerge and dominate many societies. Building multidisciplinary capacity and capability in societies among democracies to limit or cease such authoritarian dominance first begins with a developmental understanding of why autocrats exist and persist in externalizing their pathological behaviors on unsuspecting and vulnerable populations, and the limitations they place on negotiations."…once in power, a leader with an Antisocial Personality Disorder thrives on continuing conflict and never seeks peace." Daedalus Trust, London, 2016BurkleFMJr.Character disorders among autocratic world leaders and the impact on health security, human rights, and humanitarian care. Prehosp Disaster Med. 2019;34(1):2-7.