SciELO - Scientific Electronic Library Online

vol.24 número7Perfil dos municípios brasileiros, a presença de tuberculosee sua forma drogarresistente índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados




Links relacionados


Ciência & Saúde Coletiva

versão impressa ISSN 1413-8123versão On-line ISSN 1678-4561

Ciênc. saúde coletiva vol.24 no.7 Rio de Janeiro jul. 2019  Epub 22-Jul-2019 


Malnutrition, inequity and the guarantee of the human right to adequate food

Inês Rugani Ribeiro de Castro1

1 Instituto de Nutrição, Universidade do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil.

Malnutrition in all its forms is one of the major public health problems of this day and age. Obesity, malnutrition and climate change (and the effects on the health of the people and on the natural systems upon which we depend) are now acknowledged as a global syndemic that affects the majority of people in all countries around the world1. Food systems are one of the main determinants of this syndemic. They encompass three fundamental components: the food chains that range from the production to the marketing of food, food environments and food practices2. Food environments can be defined as the physical, economic, political and sociocultural contexts in which each consumer relates to the food system and influences his/her food choices and nutritional status. These are the mediators between the food system and food practices. Depending on how they are organized, they can exacerbate or alleviate social and health inequities.

Global efforts to curb the increase in obesity, which is a central element of this syndemic, have not proved effective. The main reasons have been: the strong opposition of the private commercial sector to the implementation of public policies that prejudice its economic interests; the lack of political ability and/or political will and/or leadership of the governments to implement measures directed at the determinants of this problem; and the ineffectiveness (or lack) of pressure from civil society to push for the implementation of policies1,3.

Brazil, a country marked by profound inequalities (social, economic, race, gender and others) and with a history of marked prevalence of hunger, malnutrition and other nutritional deficiencies, has also been recording the rapid increase in obesity among the population in all age and income brackets. In the last decades, the country has sought to respond to the various forms of malnutrition in a pioneering and comprehensive manner. Taking the guarantee of the human right to adequate food as a basic principle, in a growing process of acknowledgement of malnutrition and obesity as distinct expressions of food and nutritional insecurity, structural public policies were implemented to overcome poverty and malnutrition and intersectoral approaches were conducted to seek to tackle the epidemic of obesity. These initiatives were in the midst of the establishment of the Food and Nutrition Security System (SISAN)4, which invested in concerted and convergent public policies between the various sectors and also in governance mechanisms that included opportunities for dialogue to attempt to overcome the barriers of sectoral policies. Characteristics of this process are the commitment of leaders to move forward with this agenda, the action of a plural civil society and the existence of possibilities of social participation and control. As a result, improvements in indicators of poverty, food insecurity, child malnutrition, income and race inequalities, and virtuous processes to tackle obesity, have gained momentum in the sphere of public policy.

A reversal in this process began in 2016 and has been intensifying ever since the presidential election of 2018. Public policies to guarantee rights, protect vulnerable groups, strengthen sustainable food systems and healthy food environments are losing ground or being dismantled; mechanisms of coping with obesity are being questioned; and social and health indicators already point to a deterioration of living conditions and an increase in poverty. There is an urgent need to produce evidence on this scenario and to maintain and enhance public policies aimed at guaranteeing the Human Right to Adequate Food and food and nutritional security, and at the reduction of inequalities.


1. Swinburn B, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, Calvillo A, De Schutter O, Devarajan R, Ezzati M, Friel S, Goenka S, Hammond RA, Hastings G, Hawkes C, Herrero M, Hovmand PS, Howden M, Jaacks LM, Kapetanaki AB, Kasman M, Kuhnlein HV, Kumanyika SK, Larijani B, Lobstein T, Long MW, Matsudo VKR, Mills SDH, Morgan G, Morshed A, Nece PM, Pan A, Patterson DW, Sacks G, Shekar M, Simmons GL, Smit W, Tootee A, Vandevijvere S, Waterlander WE, Wolfenden L, Dietz WH. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Lancet 2019; 393(10173):791-846. [ Links ]

2. High Level Panel of Experts on Food Security and Nutrition (HLPE). Nutrition and food systems. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security. Rome: HLPE; 2017. [ Links ]

3. Roberto CA, Swinburn B, Hawkes C, Huang TT, Costa SA, Ashe M, Zwicker L, Cawley JH, Brownell KD. Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. Lancet 2015; 385(9985):2400-2409. [ Links ]

4. Leão M, Maluf RS. A construção social de um sistema público de segurança alimentar e nutricional: a experiência brasileira. Brasília: ABRANDH; 2012. [ Links ]

Creative Commons License  This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.