Open-access Food and Nutrition: Interface of Brazilian National Health System (SUS) and Food and Nutritional Security Public Policies for the 2030 Agenda

Abstract

The Sustainable Development Goals (SDGs) of the 2030 Agenda, published by the United Nations, provide the foundation for worldwide sustainable development. This study aimed to relate the national public health and nutrition programs and policies of the Brazilian National Health System (SUS) and Food and Nutritional Security, in force over the last decade, to the proposed targets of SDGs 2 (Zero Hunger and Sustainable Agriculture) and 3 (Health and Well-being). The method employed involved documentary research on the official platforms of relevant authorities. A relational framework of nutrition and feeding policies and the proposed SDG targets was developed, illustrating the country's commitment to fulfilling the 2030 Agenda. However, setbacks in achieving these targets were observed, despite the presence of diverse national public policies, programs, and strategies in the food sector.

Keywords
Nutrition; Public policy; Sustainable development goals; SUS; Food security


Resumo

Os Objetivos de Desenvolvimento Sustentável (ODS) da Agenda 2030, publicados pela Organização das Nações Unidas, fornecem as bases para o desenvolvimento sustentável em nível mundial. Este estudo teve por objetivo relacionar os programas e políticas públicas nacionais de alimentação e nutrição do Sistema Único de Saúde (SUS) e de Segurança Alimentar e Nutricional, vigentes na última década, às metas propostas dos ODS 2 (Fome Zero e Agricultura Sustentável) e 3 (Saúde e Bem-Estar), utilizando como método a pesquisa documental nas plataformas on-line dos órgãos oficiais. Elaborou-se um quadro relacional das políticas de alimentação e nutrição e as metas propostas dos ODS, demonstrando encaminhamento do país ao cumprimento da Agenda 2030. No entanto, observou-se um retrocesso em relação às metas, apesar da presença de diversas políticas públicas, programas e estratégias nacionais na área alimentar.

Palavras-chave
Nutrição; Política pública; Objetivos de desenvolvimento sustentável; SUS; Segurança alimentar e nutricional


Resumen

Los objetivos de Desarrollo Sostenible (ODS) de la Agenda 2030, publicados por la Organización de las Naciones Unidas, proporcionan las bases para el desarrollo sostenible en ámbito mundial. El objetivo de este estudio fue relacionar los programas y políticas públicas nacionales de alimentación y nutrición del Sistema Brasileño de Salud (SUS) y de Seguridad Alimentaria y Nutricional, en vigor en la última década, con las metas propuestas de los ODS 2 (Hambre Cero y Agricultura Sostenible) y 3 (Salud y Bienestar), utilizando como método la investigación documental en las plataformas online de los órganos oficiales. Se elaboró un cuadro relacional de las políticas de alimentación y nutrición y las metas propuestas de los ODS, demostrando el direccionamiento del país para el cumplimiento de la Agenda 2030. Sin embargo, se observó un retroceso con relación a las metas, a pesar de la presencia de diversas políticas públicas, programas y estrategias nacionales en el área alimentaria.

Palabras clave
Nutrición; Política pública; Objetivos de desarrollo sostenible; SUS; Seguridad alimentaria y nutricional


Introduction

Obesity, malnutrition, and climate change are critical points in the creation of public health policies, with food and nutrition being basic requirements for the promotion and protection of health. Currently, approximately 33.1 million people in Brazil suffer from hunger1, while 41 million are classified as obese. These data provide insight into the inequalities in the country, illustrating the simultaneous rise in cases of obesity, hunger, and undernutrition2.

In addition to the pandemics of obesity and malnutrition, climate change progresses on a continuous path of factors and events that threaten human life. In the current context, where the health crisis caused by the SARS-CoV-2 virus compounded an earlier economic crisis, there has been a notable manifestation and worsening of pre-existing socioeconomic inequalities, particularly observed through the increase in vulnerable families facing food insecurity (FI). The poor management of the COVID-19 pandemic, along with the dismantling or alteration of social welfare policies and the weakening of institutions in recent years, has contributed to greater social wear and tear and the vulnerability of certain populations, particularly those most exposed, such as indigenous and residents of remote areas1.

In pursuit of social development associated with the concept of sustainability, the United Nations (UN) has established international agreements in an effort to unite various countries in combating and eradicating major societal issues, such as war, climate change, and hunger. Since 2015, the UN has implemented a new agenda known as the 2030 Agenda, to be followed by its member countries, with sustainable development at its core3.

The 2030 Agenda aims to strengthen peace and prosperity, recognizing that eradicating poverty is essential for a society’s growth. In the Agenda, 17 Sustainable Development Goals (SDGs) were proposed, accompanied by 169 targets that seek to ensure human rights and guide humanity until the year 2030. These objectives encompass the three dimensions of sustainable development (economic, social, and environmental), providing space for different perspectives and addressing various issues4.

According to the Food and Agriculture Organization of the United Nations (FAO), improvements in a country’s nutrition have direct impacts on various SDGs, such as the fight against all forms of malnutrition and hunger (SDG 2) and the guarantee of health and well-being5 (SDG 3). Thus, nutrition is considered a priority in discussions and organization of food systems, as well as in the implementation of actions and strategies within the Brazilian National Health System (SUS) related to health care6.

There is a vast literature on this topic; however, there is a notable lack of relational studies discussing the public policies of food and nutrition within the SUS and the SDGs. In this regard, the objective of this article is to relate the current food and nutrition public policies and programs in activity since the past decade to the targets proposed by the UN under SDG 2 (Zero Hunger) and SDG 3 (Good health and well-being) of the 2030 Agenda.

Methodology

A descriptive, qualitative study was conducted, analyzing records and reports on food and nutrition policies and programs under the SUS and Food and Nutritional Security (SAN) implemented over the past decade (2012–2022). For data collection, policies and programs related to the goals proposed in SDG 2 (end hunger, achieve food security and improved nutrition and promote sustainable agriculture) and SDG 3 (ensure healthy lives and promote well-being for all at all ages) were selected (see Frame 1).

Frame 1
Sustainable Development Goals 2 and 3 Targets.

The research involved exploring the official online platforms of Federal Government bodies, such as the Ministries of Health, Education, Social Development, Family and Fight Against Hunger, and Agriculture and Livestock, during May 2022. After the stage of documentary research, a matrix was created with the selected policies and programs to standardize the information that was analyzed. The matrix was constructed using Microsoft Excel 365© software, with public policies listed in rows and information on these policies (such as their guidelines, objectives, target audience, start date, responsible ministry, legislative act, and other relevant data) in columns (supplementary material).

The guidelines and objectives of the existing policies and programs were analyzed to identify correlations with the SDG targets related to food and nutrition. The objectives and guidelines of each policy and program were individually examined to establish connections with the general and specific targets of each SDG studied. This classification was carried out qualitatively, analyzing the alignment of public policy actions with the proposed targets of SDGs 2 and 3. For example, the National Policy on Food and Nutrition (PNAN) was linked to SDG 2 (Zero Hunger), where the "Cooperation and coordination for Food and Nutritional Security" is an PNAN guideline which implies the "right of everyone to regular and permanent access to quality food in sufficient quantities". This directly relates to the first target proposed under SDG 2, which emphasizes the need to "end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round". This analysis allowed for the creation of associations, their categorization, and subsequent evaluation using a frequency distribution technique.

To better understand the connections, both frameworks (of policies and SDG targets) were schematically represented in a single diagram, allowing for improved visualization of the links between policies, programs and SDG goals.

Results

Considering SDGs 2 and 3, 20 national policies and programs from SUS and SAN were highlighted for their greater alignment with the objectives and targets of these SDGs, which contribute to the achievement of these goals in some form. Among the 20 items selected, there were 4 public policies, 12 programs, and 4 national strategies (see Frame 2). The targets studied were 1, 2, 3, and 4 from SDG 2 and targets 2 and 4 from SDG 3.

Frame 2
SUS and SAN Public Policies and Sustainable Development Goals 2 and 3.

The network of connections illustrated in Figure 1 highlights the concentration of links around specific SDG targets. Regarding SDG 2 (Zero Hunger and Sustainable Agriculture), it was observed that the majority of the studied policies and programs are related to targets 1 and 2, which concern hunger and malnutrition, respectively. Target 1 of SDG 2 was associated with 11 policies/programs and one strategy, while target 2 of SDG 2 was linked to 13 policies/programs and 3 strategies. This indicates that these targets are better addressed by national policies and programs, especially those focused on income distribution and access to food, which are numerous in Brazil and primarily aim to ensure healthy food and nutritional security (SAN) for the Brazilian population. On the other hand, targets 3 and 4 of SDG 2, related to food production, were only associated with four and five policies/programs, respectively, indicating a possible gap in food production policies.

Figure 1
Relationship between SUS and SAN public policies and the Sustainable Development Goals.

In the case of SDG 3 (Health and Well-being), it was found that only five policies are related to target 2, which addresses neonatal mortality. In contrast, eight policies and three strategies are linked to target 4 of SDG 3, which focuses on non-communicable chronic diseases (NCDs). This is particularly relevant since chronic diseases are the leading causes of death among adults and the elderly in Brazil.

Some programs and policies, such as the National Policy on Food and Nutritional Security (PNSAN) and the PNAN, showed interconnections with multiple SDG targets, suggesting a multisectoral approach in these policies (see Frame 2).

Discussion

Based on the documentary research conducted, a variety of policies align with the different targets proposed in SDGs 2 and 3. When addressing hunger reduction in the country and the promotion of healthy and adequate food, policies related to guaranteeing food for vulnerable populations stand out, alongside income distribution programs and strategies aimed at ensuring SAN (SDG 2). Regarding the improvement of health and promotion of well-being within the context of food and nutrition, public policies and strategies within the SUS that focus on preventing NCDs and their risk factors, such as diabetes and obesity, as well as reducing childhood malnutrition, decreasing child mortality rates for those under five years old, are notable (SDG 3).

In Brazil, over the last few decades, the fight against hunger (SDG 2) has been one of the central focuses in addressing inequality. The effectiveness of these strategies was demonstrated in 2014 when Brazil was removed from the UN Hunger Map. Among the selected programs and policies, some began before the 2000s, such as the National School Feeding Program (PNAE)29 and the Workers’ Feeding Program (PAT)30, two of the oldest programs which still in activity. Both programs have contributed for many years to promoting the health of school children and workers by ensuring the right to food and promoting health. Over the decades, these programs have undergone changes, such as the update of PNAE with Resolution No. 6 of 2020, which modified its regulations regarding the restriction of ultra-processed foods in schools according to the recommendations of the Brazilian Dietary Guidelines31.

During the last government plan, which began in 2018, certain policies were changed. For instance, the Family Allowance (Bolsa Família) program was replaced by the Brazil Aid (Auxílio Brasil) program, and the Food Acquisition Program (PAA) was replaced by the Feed Brazil (Alimenta Brasil) program in 2021. Brazil Aid went under modifications, mainly concerning the target audience, which impacted the number of beneficiaries by altering the eligibility criteria. The Feed Brazil program, when compared to the PAA, excluded goals related to family farming and the promotion of SAN, such as the stimulation of organic production, biodiversity appreciation, and encouragement of local food consumption.

Additionally, during the last government plan, certain programs were discontinued, such as the National Milk Program for Needy Children (Programa Nacional de Leite para Crianças Carentes), which was not replaced by any other initiative, leaving a gap in nutritional assistance for children. Moreover, the dissolution of the National Council on Food and Nutritional Security (CONSEA) represented a setback in public participation and social oversight of food security policies32. Although, documentarily, there was no hindrance in fulfilling the proposed objectives, the altered programs and policies maintained similar focuses and guidelines to those previously in place. These changes can be seen as significant losses in terms of social participation and effective access to healthy and adequate food.

Among the policies studied, SDG 2’s targets 3 and 4, which refer to agricultural practices and productivity, are mainly supported by large national policies such as the National Food and Nutrition Policy (PNAN) and the National Policy on Food and Nutritional Security (PNSAN), as well as by the PRONAF, which specifically targets family farming. According to the National Bank for Economic and Social Development (BNDES), PRONAF’s requests have been suspended due to budget constraints33. Many policies related to agriculture and sustainability were found during the documentary research, however, they were not selected as they diverged from the proposed study scope.

Regarding the policies related to SDG 3, it is understood that target 2 focuses on micronutrient deficiencies, seeking to reduce preventable infant mortality, while target 4 is associated with policies aimed at preventing childhood obesity and NCDs.

In Brazil, the fight against obesity is a relatively recent issue, given the previous scenario of malnutrition, although this topic has been discussed since the creation of PNAN in 1999. Since then, various documents, programs, and strategies have pointed to the need to prevent obesity, such as the 2014 Brazilian Dietary Guidelines, which linked obesity to the consumption of ultra-processed foods. Programs specifically focused on childhood obesity have only been initiated in recent decades, such as the Healthy Growth Program (Programa Crescer Saudável), launched in 2017, and the National Strategy for Prevention and Attention to Childhood Obesity (Estratégia Nacional para a Prevenção e Atenção à Obesidade Infantil), which was implemented in 2021.

The selection of programs and policies in this work was focused on food and nutrition, addressing only a portion of the targets under SDG 3. This factor explains the smaller number of programs associated with this objective compared to SDG 2.

Regarding the country’s performance in fulfilling the 2030 Agenda, according to the VI Civil Society Shadow Report on the 2030 Agenda for Sustainable Development, published in 2022, Brazil is regressing in relation to most of the proposed SDG targets34. The exorbitant rise in families experiencing food insecurity, reaching 125.2 million people, and the increase in unemployment, exacerbated by the COVID-19 pandemic, have created a social tragedy in the country, threatening the fulfillment of the 2030 Agenda1.

For example, SDG 2 has seen targets 1 through 4 regress since 2020, with the incidence of hunger in the country directly affecting target 2.1. For target 2.2, an increase in hunger was observed in households with children under the age of 10, rising from 9.4% to 18.1%, and the number of children with growth delays also increased. Targets 2.3 and 2.4, which focus on agriculture, suffer not only from informational gaps and reduced public investment in family farming policies but also from political and budgetary dismantling intended to weaken family farming in favor of agribusiness. For example, between 2020 and 2021, even with a significant increase in hunger, soybean production increased by 8.6%, setting a record with 86.1 million tons34 exported, while the production of staple foods such as rice, beans, and cassava declined — a trend observed over the past decad35.

It is observed that there is still a shortage of indicators to assess whether policies could influence the establishment and achievement of all the SDG targets. In Brazil, out of the 212 SDG indicators, 72 are still in progress, and 51 have no available data, highlighting the difficulty of analysis36. In the ideal field of eradicating hunger and malnutrition in the country, public policies should support integrated approaches that address the root causes of these problems and, in doing so, require significant government commitment and collaboration across different sectors to achieve such a goal. Some examples of programs, policies, and actions that should be strengthened and better integrated to eradicate hunger span the entire food system, such as support for family and sustainable agriculture, increasing access to and local production of food; restructuring the infrastructure and logistics of food distribution, reducing transportation costs, food waste, and improving the supply to remote areas; Social Protection Programs, promoting income transfer initiatives and providing immediate relief to vulnerable populations; increased funding dedicated to Food and Nutritional Security, thus making SAN a priority on the national agenda; greater investment in nutritional education programs, aiming to foster healthier habits among the population, among others.

For SDG 3, targets 2 and 4 were also threatened due to the pandemic and the collapse of the healthcare system seen in 2021. In 2020, there were 11.51 deaths of children under 1 year old for every 1,000 live births, with significant regional disparities, as the North and Northeast regions had the highest infant mortality rates, directly affecting the performance of target 3.2. The reduction in deaths from NCDs, targeted by 3.4, went from stagnant to threatened, considering that deaths have increased since 2019, and during the pandemic, exposure to risk factors such as physical inactivity, smoking, alcohol use, and unhealthy eating, with high consumption of ultra-processed foods, worsened34. In 2021, there were over 230,000 deaths from cardiovascular diseases, also caused by reduced access to healthcare services during the pandemic37.

Despite the availability of policy and program monitoring on online platforms such as e-Gestor Atenção Básica, through the Freedom of Information Act (FOI), in the Multi-Year Plans, and in Management Reports, such as those from the General Coordination of Food and Nutrition (CGAN) of the Ministry of Health, there is notable asymmetry in access to information and complexity in data collection and usage, limiting the work’s ability to evaluate all existing food and nutrition policies and programs.

Final considerations

This study demonstrated that the presence of food and nutrition public policies aimed at fulfilling SDG targets is a relevant factor in advancing the country toward achieving the 2030 Agenda. However, recent changes in Brazilian politics and the global crises, such as the COVID-19 pandemic, have led Brazil to regress in its fight against hunger and inequality, as evidenced by the increasing rates of malnutrition and hunger in the country.

A variety of public policies, programs, and strategies addressing various SDG targets were identified. However, it is important to evaluate how these actions are being implemented and monitored at the three levels of government. Previously, Brazil was recognized for its exemplary fulfillment of the Millennium Development

Goals established by the UN in 2000, but for success in the 2030 Agenda, governments need to invest in record-keeping, data collection to monitor objectives, the valorization of the SUS and strengthening social participation.

This study does not intend to exhaustively cover all policies and programs related to food and nutrition but rather to shed light on the actions being developed, particularly within the scope of SUS and Food and Nutritional Security, in relation to the SDGs, having in mind that these connections can assist managers in improving public policies and programs.

Acknowledgments

The authors would like to thank Brena Barreto Barbosa for her support in the preparation of the article and the School of Public Health at USP for its institutional support.

Supplementary material SUS and SAN Public Policies and Sustainable Development Goals.

Policy/Program Description Objectives Target Audience Start Date Ministry SDGs Source National Food and Nutrition Policy (PNAN) A set of public policies aiming to promote the right to health and food Improve the conditions of food, nutrition, and health of the Brazilian population by promoting healthy practices, monitoring food and nutrition, and providing comprehensive care for food and nutrition-related issues Brazilian population June 10, 1999 Ministry of Health SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 1 to 4 SDG 3 (Good Health and Well-being) - Targets 2 and 4 REGULATION No. 710, June 10, 1999; REGULATION No. 2.715, November 17, 2011 National Health Promotion Policy (PNPS) A set of strategies for health promotion at both individual and collective levels, with responsibilities across all federal entities Promote better living conditions, reducing health risks associated with social, economic, political, cultural, and environmental determinants Brazilian population March 30, 2006 Ministry of Health SDG 1 (No Poverty) SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 2 and 4 SDG 3 (Good Health and Well-being) - Targets 2 and 4 SDG 4 (Quality Education) SDG 10 (Reduced Inequalities) SDG 11 (Sustainable Cities and Communities) SDG 12 (Responsible Consumption and Production) SDG 16 (Peace, Justice, and Strong Institutions) REGULATION No. 1.190, July 14, 2005; REGULATION No. 687, March 30, 2006; REGULATION No. 2.446, November 11, 2014; CONSOLIDATION REGULATIONNo. 2, September 28, 2017 National Policy for Comprehensive Child Healthcare (PNAISC) A set of basic health actions aimed at providing comprehensive child healthcare, with a focus on preventive actions Promote children's health and breastfeeding, providing comprehensive and integrated care, especially for early childhood and vulnerable populations, aiming to reduce morbidity and mortality and ensure a dignified life and full development Children and adolescents up to the age of 15 August 5, 2015 Ministry of Health SDG 2 (Zero Hunger and Sustainable Agriculture) - Target 2 SDG 3 (Good Health and Well-being) - Targets 2 and 4 REGULATION No. 1.130, August 5, 2015 National School Meal Program (PNAE) Program providing school meals and nutrition education to students at all levels of public basic education Contribute to students' growth, biopsychosocial development, learning, academic performance, and formation of healthy eating habits through educational and nutritional actions and meals meeting their nutritional needs during school time Students in basic education (public preschools, elementary, middle, and adult education institutions) March 31, 1955 Ministry of Education (FNDE) SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 1 and 2 DECREE No. 37.106, March 31, 1955; FNDE - PNAE, https://www.fnde.gov.br/programas/pnae Worker’s Food Program (PAT) Non-wage benefit program providing meals at the workplace, food baskets, or meal vouchers Reduce nutritional issues among Brazilian workers, increase physical capacity, and reduce risks of work accidents and occupational diseases Low-income workers April 14, 1976 Ministry of Labor and Social Security; Ministry of Economy; Ministry of Health SDG 1 (No Poverty) SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 1 and 2 LAW No. 6.321, April 14, 1976; PROVISIONAL MEASURE No. 2.164-41, August 24, 2001; PROVISIONAL MEASURE No. 1.108, March 25, 2022 Family Farming Strengthening Program (PRONAF) Program aimed at promoting family farming and sustainable development Promote sustainable development in rural areas through family farming, increase productivity, job creation, and income improvement Family farmers living near or on the property with no land exceeding four fiscal modules June 28, 1996 Ministry of Agriculture and Livestock SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 3 and 4 DECREE No. 1.946, June 28, 1996; PRONAF SUSPENSION 2022, https://www.bndes.gov.br Community Kitchens Program Public equipment integrated within the National System of Food and Nutritional Security (SISAN) providing nutritionally adequate meals and food security. Equipment that requires at least 100 meals for its operation, 5 days a week or more. Provide healthy and adequate food for socially vulnerable individuals facing food insecurity, promote social inclusion, and strengthen community identity Vulnerable social groups such as low-income workers, the elderly, unemployed, family farmers from low-income communities, and underserved populations below the poverty line January 2003 Ministry of Social Development and Assistance, Family and Fight Against Hunger SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 1 and 2 COMMUNITY KITCHENS PROGRAM, https://www.gov.br/cidadania/pt-br/acesso-a-informacao/carta-de-servicos/desenvolvimento-social Popular Restaurant Program Public equipment in SISAN providing nutritionally adequate and affordable meals Increase access to nutritionally adequate, affordable meals for low-income populations and those facing food insecurity and social vulnerability, while promoting healthy eating and respecting regional habits Brazilian population, especially those facing food insecurity or social vulnerability January 2003 Ministry of Social Development and Assistance, Family and Fight Against Hunger SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 1 and 2 MANUAL POPULAR RESTAURANT PROGRAM - 2004; https://bvsms.saude.gov.br/bvs/publicacoes/projeto_logico_restaurante_popular.pdf National Vitamin A Supplementation Program (PNSVA) Prophylactic program offering vitamin A supplements to children and postpartum women who lack sufficient dietary intake Prevent/control hypovitaminosis A, mortality, and morbidity in children through supplementation Children aged 6 to 59 months and postpartum women May 13, 2005 Ministry of Health SDG 3 (Good Health and Well-being) - Targets 2 and 4 REGULATION No. 729, May 13, 2005 National Iron Supplementation Program (PNSF) Program providing free iron supplements to children, pregnant women, and postpartum women at SUS health units throughout Brazil Prevent iron deficiency anemia in childhood, pregnancy, and postpartum through supplementation Children aged 6 to 18 months, pregnant women from the 20th gestational week, and women up to the 3rd month postpartum May 13, 2005 Ministry of Health SDG 3 (Good Health and Well-being) - Targets 2 and 4 REGULATION No. 730, May 13, 2005 School Health Program (PSE) Health and education integration strategy to develop citizenship and improve Brazilian public policy Promote health through SUS actions in public education, supporting student development and addressing vulnerabilities that may impact educational progress Children, adolescents, young people, and adults in Brazilian public education December 5, 2007 Ministry of Health; Ministry of Education SDG 2 (Zero Hunger and Sustainable Agriculture) - Target 2 SDG 3 (Good Health and Well-being) - Target 4 SDG 4 (Quality Education) SDG 11 (Sustainable Cities and Communities) DECREE No. 6.286, December 5, 2007 National Food and Nutrition Security Policy (PNSAN) Policy created to promote Food and Nutritional Security, as per Article 3 of Law 11.346, September 15, 2006 Promote Food and Nutritional Security and ensure the right to adequate and healthy food nationwide, strengthening family farming and sustainable production Brazilian population August 25, 2010 SISAN agencies, entities and institutions; Ministry of Social Development and Assistance, Family and Fight Against Hunger SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 1 to 4 DECREE No. 7.272, August 25, 2010 Healthy Growth Program Program under the School Health Program aimed at preventing and controlling obesity among school-age children Address childhood obesity in the country through nutritional monitoring, healthy eating promotion, physical activity encouragement, and care for children with obesity Children enrolled in Early Childhood Education (preschools and kindergarten) and Elementary School I (1st to 5th grade) 2017 Ministry of Health   HEALTHY GROWTH PROGRAM INSTRUCTIONAL MANUAL 2019-2020 Brazil Aid Program Policy supporting the Unified Social Assistance System (SUAS) by providing direct and indirect cash transfers, early childhood development, and individual productivity support Ensure family income, reduce poverty, improve development of children and adolescents, and promote family independence Families in poverty or extreme poverty with pregnant women, breastfeeding mothers, children, or adults up to 21 years and a monthly per capita income below 210 reais October 20, 2003 (Family Allowance Program); August 9, 2021 Ministry of Social Development and Assistance, Family and Fight Against Hunger SDG 3 (Good Health and Well-being) - Target 4 PROVISIONAL MEASURE No. 132, October 20, 2003; LAW No. 10.836, January 9, 2004; PROVISIONAL MEASURE No. 1.061, August 9, 2021; LAW No. 14.284, December 29, 2021 Brazil Food Program (PAB) New food acquisition program enabling public purchases from family farmers, aimed at supplying quality food to families facing food insecurity, schools, health units, etc. Encourage family farming by promoting economic and social inclusion, supporting consumption of produced food, and establishing cooperative food stocks Family farmers' cooperatives and associations; population facing food insecurity July 2, 2003 (PAA); August 9, 2021 Ministry of Social Development and Assistance, Family and Fight Against Hunger SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 1 to 4 LAW No. 10.696, July 2, 2003; LAW No. 12.512, October 14, 2011; PROVISIONAL MEASURE No. 1.061, August 9, 2021; LAW No. 14.284, December 29, 2021 National Milk Program for Underprivileged Children (PNLCC) State program distributing a liter of vitamin-enriched pasteurized whole milk daily to low-income families Provide safe, high-nutritional-value milk as a dietary supplement for low-income children, support dairy farmers, and enhance the quality of milk processing Children up to age seven from families with a monthly income of up to two minimum wages August 18, 1986 Ministry of Health SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 1 and 2 DECREE No. 93.120, August 18, 1986; DECREE of January 17, 1991; DECREE No. 10.930, January 7, 2022 NutriSUS Yearly strategy within public or public-affiliated daycares where micronutrients are added to children's meals in a controlled manner Enhance child development, prevent and control iron deficiency anemia, and address other specific nutritional deficiencies Children aged 6 to 48 months March 2015 Ministry of Health SDG 2 (Zero Hunger and Sustainable Agriculture) - Target 2 SDG 3 (Good Health and Well-being) - Target 4 PRIMARY HEALTH CARE SECRETARIAT, https://aps.saude.gov.br/ape/pcan/nutrisus National Strategy for Prevention and Care for Childhood Obesity (PROTEJA) Brazilian intersectoral strategy requiring local coordination involving sectors such as education, social assistance, agriculture, food and nutritional security Slow down childhood obesity and contribute to improved health and nutrition for children Overweight children or children with obesity, and pregnant women facing vulnerability August 10, 2021 Ministry of Health SDG 2 (Zero Hunger and Sustainable Agriculture) - Target 2 SDG 3 (Good Health and Well-being) - Target 4 PRIMARY HEALTH CARE SECRETARIAT; REGULATION GM/MS No. 1.862, August 10, 2021 Brazilian Food Bank Network Network aimed at strengthening and integrating food banks Strengthen and qualify food banks, promote educational actions on Food and Nutritional Security, reduce food waste, and stimulate research, policies, and public actions concerning food banks Educational institutions, social assistance providers, children and adolescent shelters, penitentiaries, health facilities, and nutrition units September 17, 2020 Ministry of Social Development and Assistance, Family and Fight Against Hunger SDG 2 (Zero Hunger and Sustainable Agriculture) - Targets 1 and 2 DECREE No. 10.490, September 17, 2020 Regulatory - Labeling Regulates and facilitates the understanding of nutritional information on packaged foods for the general public, aiding consumer decision-making Regulate and ensure easy comprehension of the nutritional content of packaged foods to support informed consumer choices Brazilian population October 8, 2020 Ministry of Health; National Health Surveillance Agency SDG 3 (Good Health and Well-being) - Target 4 RDC No. 429, October 8, 2020 Regulatory - Advertising Resolution regulating practices in the promotion and advertising of foods with high sugar, sodium, saturated and trans fats, and low nutritional beverages Ensure that information aligns with health preservation standards, particularly for children, discouraging excessive consumption of the mentioned foods and drinks Brazilian population June 15, 2010 National Health Surveillance Agency SDG 3 (Good Health and Well-being) - Target 4 RDC No. 24, June 15, 2010

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  • 7 Instituto de Pesquisa Econômica Aplicada. ODS: Metas Nacionais dos Objetivos de Desenvolvimento Sustentável [Internet]. Brasília: IPEA; 2018 [citado 28 Maio 2022]. Disponível em: https://www.ipea.gov.br/portal/images/stories/PDFs/livros/livros/180801_ods_metas_nac_dos_obj_de_desenv_susten_propos_de_adequa.pdf
    » https://www.ipea.gov.br/portal/images/stories/PDFs/livros/livros/180801_ods_metas_nac_dos_obj_de_desenv_susten_propos_de_adequa.pdf
  • 8 Brasil. Ministério da Saúde. Política Nacional de Alimentação e Nutrição (PNAN) [Internet]. Brasília: Ministério da Saúde; 2013 [citado 15 Ago 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_alimentacao_nutricao.pdf
    » https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_alimentacao_nutricao.pdf
  • 9 Brasil. Portaria nº 2.715, de 17 de Novembro de 2011. Atualiza a Política Nacional de Alimentação e Nutrição. Diário Oficial da União. 17 Nov 2011.
  • 10 Brasil. Ministério da Saúde. Política Nacional de Promoção da Saúde (PNPS) [Internet]. Brasília: Ministério da Saúde; 2018 [citado 15 Ago 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_promocao_saude.pdf
    » https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_promocao_saude.pdf
  • 11 Brasil. Portaria nº 1.130, de 5 de Agosto de 2015. Institui a Política Nacional de Atenção Integral à Saúde da Criança (PNAISC) no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União. 5 Ago 2015.
  • 12 Brasil. Ministério da Educação. Programa Nacional de Alimentação Escolar (PNAE) [Internet]. Brasília: Ministério da Saúde; 2022 [citado 15 Ago 2022]. Disponível em: https://www.fnde.gov.br/programas/pnae
    » https://www.fnde.gov.br/programas/pnae
  • 13 Brasil. Lei nº 14.442, de 2 de Setembro de 2022. Dispõe sobre o pagamento de auxílio-alimentação ao empregado e altera a Lei nº 6.321, de 14 de Abril de 1976, e a Consolidação das Leis do Trabalho, aprovada pelo Decreto-Lei nº 5.452, de 1º de Maio de 1943. Diário Oficial da União. 5 Set 2022.
  • 14 Brasil. Lei nº 12.512, de 14 de Outubro de 2011. Institui o Programa de Apoio à Conservação Ambiental e o Programa de Fomento às Atividades Produtivas Rurais; altera as Leis nºs 10.696, de 2 de Julho de 2003, 10.836, de 9 de Janeiro de 2004, e 11.326, de 24 de Julho de 2006. Diário Oficial da União. 17 Out 2011.
  • 15 Brasil. Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome. Programa Cozinha Comunitária [Internet]. Brasília: Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome; 2022 [citado 19 Ago 2022]. Disponível em: https://www.gov.br/mds/pt-br/acoes-e-programas/equipamentos-de-seguranca-alimentar-e-nutricional/cozinha-comunitaria
    » https://www.gov.br/mds/pt-br/acoes-e-programas/equipamentos-de-seguranca-alimentar-e-nutricional/cozinha-comunitaria
  • 16 Brasil. Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome. Programa Restaurante Popular [Internet]. Brasília: Ministério do Desenvolvimento e Assistência Social, Família e Combate à Fome; 2022 [citado 19 Ago 2022]. Disponível em: https://www.gov.br/cidadania/pt-br/acesso-a-informacao/carta-de-servicos/desenvolvimento-social/inclusao-social-e-produtiva-rural/programa-restaurante-popular
    » https://www.gov.br/cidadania/pt-br/acesso-a-informacao/carta-de-servicos/desenvolvimento-social/inclusao-social-e-produtiva-rural/programa-restaurante-popular
  • 17 Brasil. Portaria nº 729, de 13 de Maio de 2005. Institui o Programa Nacional de Suplementação de Vitamina A e dá outras providências. Diário Oficial da União. 13 Maio 2005.
  • 18 Brasil. Portaria nº 730, de 13 de Maio de 2005. Institui o Programa Nacional de Suplementação de Ferro, destinado a prevenir a anemia ferropriva e dá outras providências. Diário Oficial da União. 13 Maio 2005.
  • 19 Brasil. Decreto nº 6286, de 5 de Dezembro de 2007. Institui o Programa Saúde na Escola - PSE, e dá outras providências. Diário Oficial da União. 6 Dez 2007.
  • 20 Brasil. Decreto nº 7272, de 25 de Agosto de 2010. Regulamenta a Lei nº 11.346, de 15 de Setembro de 2006, que cria o Sistema Nacional de Segurança Alimentar e Nutricional - SISAN com vistas a assegurar o direito humano à alimentação adequada, institui a Política Nacional de Segurança Alimentar e Nutricional - PNSAN, estabelece os parâmetros para a elaboração do Plano Nacional de Segurança Alimentar e Nutricional, e dá outras providências. Diário Oficial da União. 26 Ago 2010.
  • 21 Brasil. Ministério da Saúde. Instrutivo Programa Crescer Saudável [Internet]. Brasília: Ministério da Saúde; 2019 [citado 30 Ago 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/instrutivo_programa_crescer_saudavel_2021_2022.pdf
    » https://bvsms.saude.gov.br/bvs/publicacoes/instrutivo_programa_crescer_saudavel_2021_2022.pdf
  • 22 Brasil. Lei nº 10.836, de 9 de Janeiro de 2004. Cria o Programa Bolsa Família e dá outras providências. Diário Oficial da União. 12 Jan 2004.
  • 23 Brasil. Lei nº 14.284, de 29 de Dezembro de 2021. Institui o Programa Auxílio Brasil e o Programa Alimenta Brasil; define metas para taxas de pobreza; altera a Lei nº 8.742, de 7 de Dezembro de 1993; revoga a Lei nº 10.836, de 9 de janeiro de 2004, e dispositivos das Leis nos 10.696, de 2 de Julho de 2003, 12.512, de 14 de Outubro de 2011, e 12.722, de 3 de Outubro de 2012; e dá outras providências. Diário Oficial da União. 30 Dez 2021.
  • 24 Brasil. Decreto nº 93120, de 18 de Agosto de 1986. Dispõe sobre a execução do Programa Nacional de Leite para Crianças Carentes. Diário Oficial da União. 19 Ago 1986.
  • 25 Brasil. Ministério da Saúde. Fortificação da alimentação infantil com micronutrientes em pó - NutriSUS [Internet]. Brasília: Ministério da Saúde; 2015 [citado 30 Ago 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/nutrisus_estrategia_fortificacao_alimentacao_infantil.pdf
    » https://bvsms.saude.gov.br/bvs/publicacoes/nutrisus_estrategia_fortificacao_alimentacao_infantil.pdf
  • 26 Brasil. Portaria nº 1.862, de 10 de Agosto de 2021. Institui a Estratégia Nacional para Prevenção e Atenção à Obesidade Infantil - Proteja. Diário Oficial da União. 10 Ago 2021.
  • 27 Brasil. Decreto nº 10.490, de 17 de Setembro de 2020. Institui a Rede Brasileira de Bancos de Alimentos e o Comitê Gestor da Rede Brasileira de Bancos de Alimentos. Diário Oficial da União. 18 Set 2020.
  • 28 Brasil. Resolução da Diretoria Colegiada - RDC nº 429, de 8 de Outubro de 2020. Dispõe sobre a rotulagem nutricional dos alimentos embalados. Diário Oficial da União. 9 Out 2020.
  • 29 Brasil. Decreto nº 37.106, de 31 de Março de 1955. Institui a companhia da Merenda Escolar. Diário Oficial da União. 2 Abr 1955.
  • 30 Brasil. Decreto nº 10.854, de 10 de Novembro de 2021. Regulamenta disposições relativas à legislação trabalhista e institui o Programa Permanente de Consolidação, Simplificação e Desburocratização de Normas Trabalhistas Infralegais e o Prêmio Nacional Trabalhista, e altera o Decreto nº 9.580, de 22 de Novembro de 2018. Diário Oficial da União. 11 Nov 2021.
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    » https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf
  • 32 Brasil. Decreto nº 10.930, de 7 de Janeiro de 2022. Declara a revogação de decretos normativos. Diário Oficial da União. 7 Jan 2022.
  • 33 Brasil. Banco Nacional de Desenvolvimento Econômico e Social. AVISO SUP/ADIG nº 12/2022. Suspensão Protocolo e Contratação PAGFs [Internet]. Rio de Janeiro: BNDES; 2022 [citado 22 Out 2022]. Disponível em: https://www.bndes.gov.br/wps/wcm/connect/site/e72958d2-e0ab-47e5-9e43-3f554a3e6492/22avadig12+Suspens%C3%A3o+Protocolo+e+Contrata%C3%A7%C3%A3o+PAGFs.pdf?MOD=AJPERES&CVID=o25bvLj
    » https://www.bndes.gov.br/wps/wcm/connect/site/e72958d2-e0ab-47e5-9e43-3f554a3e6492/22avadig12+Suspens%C3%A3o+Protocolo+e+Contrata%C3%A7%C3%A3o+PAGFs.pdf?MOD=AJPERES&CVID=o25bvLj
  • 34 Grupo de Trabalho da Sociedade Civil para a Agenda 2030. VI Relatório Luz da Sociedade Civil da Agenda 2030 de Desenvolvimento Sustentável [Internet]. Recife: GTSC; 2022 [citado 22 Nov 2022]. Disponível em: https://brasilnaagenda2030.files.wordpress.com/2022/06/rl_2022-completoweb-30_06_01.pdf
    » https://brasilnaagenda2030.files.wordpress.com/2022/06/rl_2022-completoweb-30_06_01.pdf
  • 35 Instituto Brasileiro de Geografia e Estatística. Produção Agrícola Municipal - PAM [Internet]. Rio de Janeiro: IBGE; 2024 [citado 25 Jun 2024]. Disponível em: https://www.ibge.gov.br/estatisticas/economicas/agricultura-e-pecuaria/9117-producao-agricola-municipal-culturas-temporarias-e-permanentes.html
    » https://www.ibge.gov.br/estatisticas/economicas/agricultura-e-pecuaria/9117-producao-agricola-municipal-culturas-temporarias-e-permanentes.html
  • 36 Berwald D, Batista RRG, Alvez AAA. Panorama brasileiro atual dos indicadores para os Objetivos de Desenvolvimento Sustentável - ODS. Contrib Cienc Soc. 2024; 17(1):1226-49. doi: 10.55905/revconv.17n.1-067.
    » https://doi.org/10.55905/revconv.17n.1-067
  • 37 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis. Brasília: VIGITEL BRASIL - 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2019 [Internet]. Brasília: Ministério da Saúde; 2020 [citado 8 Nov 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2019_vigilancia_fatores_risco.pdf
    » https://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2019_vigilancia_fatores_risco.pdf
  • Oliveira FL, Gonçalves MR, Machado AD, Carvalho AM. Food and Nutrition: Interface of Brazilian National Health System (SUS) and Food and Nutritional Security Public Policies for the 2030 Agenda.Interface (Botucatu). 2025; 29: e240565 https://doi.org/10.1590/interface.240565
  • Funding
    This research was funded by the Department of Science and Technology of the Secretariat of Science, Technology, Innovation, and Health Complex of the Brazilian Ministry of Health (MS) and by the National Council for Scientific and Technological Development (CNPq) (grant number 444588/2023-0), as well as by the São Paulo Research foundation (FAPESP) (grant number 2022/03091-6).

Edited by

  • Editor
    Denise Martin Coviello
  • Associated editor
    Micheli Dantas Soares

Publication Dates

  • Publication in this collection
    21 Feb 2025
  • Date of issue
    2025

History

  • Received
    29 Feb 2024
  • Accepted
    11 Oct 2024
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