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We thank the commentators’ help in qualifying Brazilian National Food and Nutrition Policy (PNAN) historical analysis. A few comments added information on guidelines that, considering the study goal and space limitation, were not sufficiently explored. Others developed themes unrelated to our study contents. Overall, all comments recognized PNAN’s role (from 1999 until today) and indicates a few challenges.

Carvalho 11. Carvalho MFCC. Avanços e desafios da formação e qualificação dos profissionais e gestores do Sistema Único de Saúde em alimentação e nutrição. Cad Saúde Pública 2021; 37 Suppl 1:e00035321., experienced in federal management, warned of the strategic role played - in different administrative spheres - by qualification programs training public servants and administrators (guideline 6). She stressed that evaluating the varying technical, administrative, and political capacities, professionals of these spheres may have a challenge in management training. This issue was referenced in our study in association with the area fragile institutionalization in states and municipalities; though not all the results were presented in this study 22. Reis CS. Avaliação da utilização do repasse fundo a fundo para estruturação e implementação das ações de alimentação e nutrição [Dissertação de Mestrado]. Brasília: Universidade de Brasília; 2015.,33. Souza LMS, Santos SMC. Política Nacional de Alimentação e Nutrição: avaliação da implantação de programas em municípios baianos. Demetra (Rio J.) 2017; 12:137-55.. She praised the work done by the Collaborating Centers on Food and Nutrition (CECAN). These points suggest a study program and foster the debate on the area necessary institutionalization in all governmental spheres.

Fagundes et al. 44. Fagundes AA, Damião JJ, Ribeiro RCL. Reflexões sobre os processos de descentralização da Política Nacional de Alimentação e Nutrição nos seus 20 anos. Cad Saúde Pública 2021; 37 Suppl 1:e00038421. pointed out, without mentioning specific guidelines, the challenge of decentralization in implementing PNAN. They mentioned obstacles in state and municipal management, highlighting the urgency of advancing policies aimed at local needs and priorities. The authors highlighted problems with institutional frailties and setbacks, especially in the funding the Family Health Support Center and Primary Care (NASF-AB). We highlight Massuda’s adequate analysis 55. Massuda A. Mudanças no financiamento da atenção primária à saúde no sistema de saúde brasileiro: avanço ou retrocesso? Ciênc Saúde Colet 2020; 25:1181-8. supporting these comments. In line with the Brazilian Unified National Health System (SUS), decentralizing governance capacity is relevant to PNAN’s consolidation. The theme of institutionalization constitutes an especially strategic political agenda.

In their commentary, Mendes et al. 66. Mendes LL, Cardoso LO, Menezes MC, Pessoa MC. A incorporação dos ambientes alimentares na Política Nacional de Alimentação e Nutrição: uma abordagem de possibilidades, avanços e desafios. Cad Saúde Pública 2021; 37 Suppl 1:e00038621. dialogued with our study by looking at the approach gap on the issue of food environment. Based on a consistent literature, the authors located in two PNAN guidelines conceptual elements coalescing with the academic conception of a food environment. They recognized how incipient the subject’s discussion was in Brazil at the time of PNAN’s elaboration, but by highlighting approximations to aspects of food environment and systems, pointed out its potential to promote intersectoriality. We understand that this occurs, above all, after the recognition of the global syndemic of malnutrition, obesity, and climate change 77. Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet 2019; 393:791-846..

Batista Filho 88. Batista Filho M. Análise da Política de Alimentação e Nutrição no Brasil: 20 anos de história. Cad Saúde Pública 2021; 37 Suppl 1:e00038721. began his comment with the relevant academic provocation of the pertinence of using the approach of a public policy cycle as a methodological instrument for policy analysis. In fact, the complex field of public policy analysis faces the circulation of often conflicting, often complementary and concordant theories. With his academic expertise and long experience in the field, he emphasizes the significance of rescuing the milestones that preceded and enabled the accumulation of the scientific knowledge that produced the last 20 years historical-social construction and implementation of PNAN. We make much of his contextualization of the political and social setbacks that announce the return of chronic malnutrition, alongside the obesity issue hindering the achievement of United Nation’s 2030 Agenda’s objectives, especially concerning the elimination of poverty. By also considering the effects of the coronavirus pandemic, the author outlined significant challenges for PNAN.

Ferreira 99. Ferreira RA. Interfaces entre a vigilância sanitária de alimentos e a Política Nacional de Alimentação e Nutrição. Cad Saúde Pública 2021; 37 Suppl 1:e00038921. commented on the intersectoriality and multidisciplinarity between the food health surveillance and PNAN. By establishing the intra and intersectoral dissonance within federal public management - providing the Dietary Guidelines for the Brazilian Population as an example - she emphasized the tensions surrounding the implementation of policies which oppose private interests. She sheds light on the role that the civil society plays in defending the Guide. We agree with the idea that this conflict of interests in regulating healthy food may open the path to PNAN’s consolidation; including research and training.

Campos & Fonseca 1010. Campos DS, Fonseca PC. A vigilância alimentar e nutricional em 20 anos da Política Nacional de Alimentação e Nutrição. Cad Saúde Pública 2021; 37 Suppl 1:e00045821. discussed the Food and Nutrition Surveillance System (SISVAN) and its use in nutritional care. They identify advances in the Brazilian food and nutrition surveillance, while stating that the generated information lacks full integration to the planning and management system. On the other hand, Batista Filho 88. Batista Filho M. Análise da Política de Alimentação e Nutrição no Brasil: 20 anos de história. Cad Saúde Pública 2021; 37 Suppl 1:e00038721. celebrated SISVAN’s advance as a work tool urging, unlike the commentaries and study authors, the need for improving SISVAN and food and nutrition surveillance, especially by training professionals and public management. We agree with the authors that we should consider mobilizing intersectoral actions by widening the dissemination of system generated data via bulletins and other means of information.

Alves et al. 1111. Alves KPS, Santos CCS, Lignani JB, Albuquerque RM. Entre intenções e contingências, antigos programas e demandas por novas práticas de atenção nutricional no Sistema Único de Saúde. Cad Saúde Pública 2021; 37 Suppl 1:e00050221. claimed that our study - which, they say, “analyzes production in the technical management area” - fails to explore certain aspects of the field. We took management reports as relevant data sources and added to them an extensive research of the scientific literature. Consequently, we find that the scientific community needs to study the processes and results of PNAN’s formulation and implementation. The authors evaluated the lack of broader analyses on the various contexts that favored or hindered General-Coordination of the Food and Nutrition Policy/General-Coordination of Food and Nutrition (CGPAN/CGAN) achievements. As pointed out in our study, since its emergence under the aegis of the Minimal State, PNAN constituted itself as the conjunctural product of the correlation of social forces and multiple interests. We recognize that these disputes, presently worsened, strain national social policies.

Amparo-Santos & Diez-Garcia’s 1212. Amparo-Santos L, Diez-Garcia RW. Tessituras entre a Política Nacional de Alimentação e Nutrição e a educação alimentar e nutricional. Cad Saúde Pública 2021; 37 Suppl 1:e00077621. dialogue with our study approaches the relation between PNAN, the food and nutritional education, and its analytical axis, the Food and Nutritional Education Landmark of Reference for Public Policies1313. Ministério do Desenvolvimento Social e Combate à Fome. Marco de referência de educação alimentar e nutricional para as políticas públicas. Brasília: Ministério do Desenvolvimento Social e Combate à Fome; 2012.. We deem appropriate the claim that the Landmark breathes life into PNAN since it reinstates the fundamental promoting actions of healthy and adequate food, as well as the autonomy, the self-care, and the sustainability of these relationships. We follow the authors’ understanding that PNAN and food and nutritional education potentialized the constant search for articulation between SUS, Food and Nutritional Security System (SISAN) and Unified System of Social Assistance.

At this time, it is important to ponder over the tortuous journey Brazil undertook since 2016; and its breakdown of policies of social protection affecting, among others, PNAN. The neoliberal economic policy which adopted measures such as the Constitutional Amendment n. 95, labor reform, privatization of state-owned enterprises; together with the effect caused by the COVID-19 pandemic increased unemployment, reduced and/or froze wages, reinstated inflation, and expanded poverty, social inequalities and hunger in the country 1414. Neves JA, Machado ML, Oliveira LDA, Moreno YMF, Medeiros MAT, Vasconcelos FAG. Unemployment, poverty, and hunger in Brazil in COVID-19 pandemic times. Rev Nutr 2021; 34:e200170.,1515. Ribeiro-Silva RC, Santos MP, Campello T, Aragão E, Guimarães JMM, Ferreira A, et al. Implicações da pandemia COVID-19 para a segurança alimentar e nutricional no Brasil. Ciênc Saúde Colet 2020; 25:3421-30.. This scenario also includes the political embarrassment to civil society’s organization and mobilization symbolized by the closure of the Brazilian National Council for Food Safety (CONSEA) and the subsequent non-convening of its 6th National Conference 1515. Ribeiro-Silva RC, Santos MP, Campello T, Aragão E, Guimarães JMM, Ferreira A, et al. Implicações da pandemia COVID-19 para a segurança alimentar e nutricional no Brasil. Ciênc Saúde Colet 2020; 25:3421-30..

Thus, overall, this study and its commentary constitute an interest in the governmental institutionalization of management policies and the inclusion of themes which would configure significant borders to PNAN’s activity.

  • 1
    Carvalho MFCC. Avanços e desafios da formação e qualificação dos profissionais e gestores do Sistema Único de Saúde em alimentação e nutrição. Cad Saúde Pública 2021; 37 Suppl 1:e00035321.
  • 2
    Reis CS. Avaliação da utilização do repasse fundo a fundo para estruturação e implementação das ações de alimentação e nutrição [Dissertação de Mestrado]. Brasília: Universidade de Brasília; 2015.
  • 3
    Souza LMS, Santos SMC. Política Nacional de Alimentação e Nutrição: avaliação da implantação de programas em municípios baianos. Demetra (Rio J.) 2017; 12:137-55.
  • 4
    Fagundes AA, Damião JJ, Ribeiro RCL. Reflexões sobre os processos de descentralização da Política Nacional de Alimentação e Nutrição nos seus 20 anos. Cad Saúde Pública 2021; 37 Suppl 1:e00038421.
  • 5
    Massuda A. Mudanças no financiamento da atenção primária à saúde no sistema de saúde brasileiro: avanço ou retrocesso? Ciênc Saúde Colet 2020; 25:1181-8.
  • 6
    Mendes LL, Cardoso LO, Menezes MC, Pessoa MC. A incorporação dos ambientes alimentares na Política Nacional de Alimentação e Nutrição: uma abordagem de possibilidades, avanços e desafios. Cad Saúde Pública 2021; 37 Suppl 1:e00038621.
  • 7
    Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet 2019; 393:791-846.
  • 8
    Batista Filho M. Análise da Política de Alimentação e Nutrição no Brasil: 20 anos de história. Cad Saúde Pública 2021; 37 Suppl 1:e00038721.
  • 9
    Ferreira RA. Interfaces entre a vigilância sanitária de alimentos e a Política Nacional de Alimentação e Nutrição. Cad Saúde Pública 2021; 37 Suppl 1:e00038921.
  • 10
    Campos DS, Fonseca PC. A vigilância alimentar e nutricional em 20 anos da Política Nacional de Alimentação e Nutrição. Cad Saúde Pública 2021; 37 Suppl 1:e00045821.
  • 11
    Alves KPS, Santos CCS, Lignani JB, Albuquerque RM. Entre intenções e contingências, antigos programas e demandas por novas práticas de atenção nutricional no Sistema Único de Saúde. Cad Saúde Pública 2021; 37 Suppl 1:e00050221.
  • 12
    Amparo-Santos L, Diez-Garcia RW. Tessituras entre a Política Nacional de Alimentação e Nutrição e a educação alimentar e nutricional. Cad Saúde Pública 2021; 37 Suppl 1:e00077621.
  • 13
    Ministério do Desenvolvimento Social e Combate à Fome. Marco de referência de educação alimentar e nutricional para as políticas públicas. Brasília: Ministério do Desenvolvimento Social e Combate à Fome; 2012.
  • 14
    Neves JA, Machado ML, Oliveira LDA, Moreno YMF, Medeiros MAT, Vasconcelos FAG. Unemployment, poverty, and hunger in Brazil in COVID-19 pandemic times. Rev Nutr 2021; 34:e200170.
  • 15
    Ribeiro-Silva RC, Santos MP, Campello T, Aragão E, Guimarães JMM, Ferreira A, et al. Implicações da pandemia COVID-19 para a segurança alimentar e nutricional no Brasil. Ciênc Saúde Colet 2020; 25:3421-30.

Publication Dates

  • Publication in this collection
    29 Oct 2021
  • Date of issue
    2021

History

  • Received
    13 July 2021
  • Accepted
    16 July 2021
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