Hunger, undernutrition, and other forms of malnutrition from the perspective of achieving human rights: A critical essayABSTRACT
Objective This article critically evaluates how hunger and malnutrition have been addressed in the international context and Brazilian public policies from the perspective of human rights and in the face of a post-COVID-19 pandemic reconstruction and political crisis.
Method It is a critical essay based on experiences and research in the author’s collection, complemented by a random search in other databases. The text is a historical-critical perspective referenced in Morin’s contributions regarding planetary complexity.
Result The theme is introduced based on the main historical markers in the evolution of consensus regarding the Human Right to Adequate Food and the struggles for its achievement, followed by four sessions: hunger and malnutrition as a violation of the Human Right to Adequate Food; global overview of hunger and malnutrition in the context of the food system; an international strategy to ensure the Human Right to Adequate Food; the enforceability of the Human Right to Adequate Food in Brazil.
Conclusion Given the social, cultural, economic, and political context that we find ourselves in, the prognoses indicate that we will not be able to fulfill the commitment made by 2030, hence the importance of a new social pact towards a socially, environmentally, and economically sustainable future for the full realization of rights and sustainability of life on the planet.
Keywords:
Food; Food system; Human rights; Nutrition
RESUMO
Objetivo O objetivo foi fazer uma avaliação crítica de como a fome e a má nutrição vêm sendo abordadas no contexto internacional e nas políticas públicas brasileiras, na perspectiva dos direitos humanos e diante de um cenário de reconstrução pós-pandemia de COVID-19 e de crise política.
Método Trata-se de um ensaio crítico, a partir de vivências e pesquisa em acervo pessoal, complementado por busca aleatória em bases de dados. O texto é apresentado numa perspectiva histórico-crítica referenciada nas contribuições de Morin sobre a complexidade planetária.
Resultados A temática é introduzida a partir dos principais marcos históricos da evolução dos consensos sobre o Direito Humano à Alimentação Adequada e das lutas pela sua conquista, seguida de quatro sessões: Fome e má nutrição como expressão de violação do Direito Humano à Alimentação Adequada; Panorama global da fome e da má nutrição no contexto do sistema alimentar; Estratégias internacionais para a garantia do Direito Humano à Alimentação Adequada e A exigibilidade do Direito Humano à Alimentação Adequada no Brasil.
Conclusão Considerou-se que frente ao contexto social, cultural, econômico e político que nos encontramos, os prognósticos apontam que não conseguiremos saldar o compromisso assumido até 2030, daí a importância de um novo pacto social rumo a um futuro social, ambiental e economicamente sustentável para a plena realização dos direitos e sustentabilidade da vida no planeta.
Palavras-chave:
Alimentos; Sistema alimentar; Direitos Humanos; Nutrição
INTRODUCTION
As a social phenomenon, food deprivation is certainly the most forceful expression of inequalities in contemporary society [1]. Hunger hurts human dignity and exposes the wickedness of a society ruled by the interests of a minority that dominates the means of production, as well as its hegemonic predatory and excluding food system [2].
Eating is a complex social phenomenon determined by the food system, which is interdependent with other systems [3]. The Human Right to Adequate Food (HRAF) is intrinsically connected with human dignity and indispensable for making other human rights effective [4].
Since the Universal Declaration of Human Rights until these days, international diplomacy led by the United Nations (UN) has sought consensus on the HRAF. As the years have gone by, such consensus has been redefined before growingly complex challenges [5]. The notion of right itself was broadened and clarified, although there has been very little progress in effecting it [6].
The 1948 Universal Declaration of Human Rights recognized that human beings had rights connected to the freedom and dignity of the person, including social, economic, civil, and political issues [7]. In that sense, in 1966, the right to food was recognized in the International Covenant on Economic, Social, and Cultural Rights (ICESCR) [8]. In Article 11, the ICESCR explicitly includes this right.
The ICESCR states that UN member nations commit to progressively ensure the full exercise of rights, employing all possible resources to this end [8]. They must take measures to ensure physical access to food, production, conservation, and distribution of food genres to the entire population, land reform, and food and nutritional education [8]. By involving the state’s provisions, the HRAF represents a second generation of rights emerging from a struggle for better life and work conditions around the ideals of equality and social justice [9].
In 1996, the HRAF was ratified during the World Food Summit, with 146 UN member states taking up the commitment to ensure a political, social, and economic environment prone to liberate humanity from hunger [10]. For that, the path for the HRAF’s realization, as established in the ICESCR, needed to be made more explicit. In 1999, in General Comment No.12, the UN’s Committee on Economic, Social and Cultural Rights interpreted what was on the ICESCR, clarifying the dimensions of the HRAF and reaffirming its indivisible but progressive characteristics [5]. In Brazil, this period marks the first years after the democratic transition. In 1993, the Ação da Cidadania Contra a Fome e a Miséria (Action of Citizenship Against Hunger, Misery, and for Life, similar to a social movement focused on actions against hunger and poverty) was created; in the same year, the Conselho de Segurança Alimentar e Nutricional (CONSEA, National Council for Food and Nutrition Security) was instituted [11].
In 1996, a large national articulation in preparation for the World Food Summit originated the Fórum Brasileiro de Segurança Alimentar e Nutricional (Brazilian Forum on Food and Nutrition Sovereignty and Security). In the documents, one can find implicitly the ideas that characterized the 1996 Summit [12]. In Brazil, this debate has been taken up since Josué de Castro [1]. However, the country only signed the ICESCR in 1992, after Decree 591, also signed by President Itamar Franco that year [13].
General Comment 12 [5] defines that: “The right to adequate food is realized when every man, woman, and child, alone or in community with others, have physical and economic access at all times to adequate food or means for its procurement. The right to adequate food shall therefore not be interpreted in a narrow or restrictive sense which equates it with a minimum package of calories, proteins, and other specific nutrients.” It clarifies that any person who has their HRAF violated should have the right to international or national instruments of liability, juridical or of other nature [5].
The progressive realization of the HRAF implies that not only everyone is freed from hunger but that adequate foods are accessed, preserving the dignity of the person [9]. Its progressive character cannot be used to perpetuate injustice and discrimination in the destination of public resources [9]. Adequation is not only physiological, but people also have the right to decide on the food items to be produced or consumed, which involves participating in public policy processes [14]. The HRAF requires intersectoral policies and the involvement of multiple stakeholders, which has been a great challenge for policies of Segurança Alimentar e Nutricional (SAN, Food And Nutritional Security) [15].
Broadening horizons, the 2nd International Conference on Nutrition, which took place in 2014 in Rome, was aligned with the Sustainable Development Goals (SDG) that compose the UN’s 2030 Agenda, launched in 2015 [16,17]. This conference was decisive for a larger approximation between nutrition and agriculture as for the construction of a systemic view of the determinants of undernutrition and all forms of malnutrition.
The human right is much more than a political option, given its indivisibility and inter-relatedness [9]. The HRAF is related to the right to health. The SDG Committee reinforces a view of rights-based health within the 2030 Agenda [18]. This perspective corroborates the importance of SAN in health actions for ensuring rights.
In 2016, the General Assembly established the UN’s Decade of Action on Nutrition [19]. Thus, improving nutrition to prevent all forms of malnutrition becomes part of the public agenda in a more assertive way. Food systems sensitive to nutrition were targeted in SAN actions [20]. Brazil has committed before the Decade of Action on Nutrition [21]. However, such a discussion suffered in the Bolsonaro Administration, and there has been little progress in the previously established goals. As in other areas, there has been a significant dismantling of the policies with budget restrictions, flexibility of conditions, and openly electoral uses of public resources [22-24].
The Sistema Nacional de Segurança Alimentar e Nutricional (SISAN, National Food and Nutritional Security System) was created in 2006 as an intersectoral system for the social participation in the integrated execution and monitoring of all policies that converge into SAN [25]. Ten years after its creation, coinciding with the coup against Dilma Rousseff’s administration, every Brazilian state had adhered to the system. Some had progressed more than others in elaborating and executing their plans, and municipalities began to adhere [26]. The lack of central guidelines paralyzed the process in several states and municipalities, as in the state of São Paulo, with CONSEA’s vacancy between October 2018 and January 2021 [27]. In more strengthened cities and states, the process continued as a form of resistance. In states like Paraná, for instance, state and municipal conferences were held in 2019 [28]. An effort could be felt from the organized civil society to carry out free conferences and keep the debates on SAN [29].
Considering the opportunity for a democratic resumption in Brazil and understanding that every resumption must look at the future without negating history, this article aimed to make a critical evaluation of how hunger and malnutrition are being assessed in the international context and the Brazilian public policies in the perspective of human rights before a scenery of reconstruction. It is a critical essay based on experience and research on the author’s basis, complemented by a random search in SciELO (Scientific Electronic Library Online) and Scopus databases, as well as on the website of UN’s Food and Agriculture Organization (FAO), using the terms “human right” and “nutrition” in the last five years. The text is presented from a historical-critical perspective referenced in Morin’s contributions on planetary complexity [2].
Hunger and malnutrition as a violation of the HRAF
Hunger is the physiological, social, and psychological experience resulting from the lack of food. It must be understood as a social, political, economic, and historical phenomenon [1]. Not being physically or financially able to access food generates food insecurity in different degrees. Severe food insecurity is the experience of hunger for not having food available periodically; moderate insecurity refers to precarious and insufficient food; and light insecurity is the concern that food will run out and one will not be able to replace it [30]. The psychometric scale of food insecurity is used by FAO all over the world as an objective measure of experiencing hunger [30]. In Brazil, the Brazilian Food Insecurity Scale has been used in populational studies since 2004 [31].
Traditionally, FAO infers chronic hunger or malnutrition considering the number of people not regularly consuming sufficient energy for an active and healthy life. This estimate considers the availability of food in the country, not the access to or consumption of nutrients. Although it has been continually improved since it was first proposed in 1963, it remains a generic and insensitive measure [32].
The indicators of children’s nutritional state are fundamental, given that children are among the main victims of hunger and starvation. Recent acute hunger manifests in lean bodies, while chronic hunger - the persistent deficiency of energy and nutrients for developing daily activities - manifests by compromising child development, which is shown by reduced stature [33,34].
The consequences of maternal-infant malnutrition are short and long-term ones. In the short-term, it accounts for increased morbimortality and disabilities; in the long-term, it affects cognitive abilities, reproductive performance, incidence of excessive weight, and metabolic diseases [35]. Among the immediate causes are the inadequate ingestion of food and diseases; the underlying causes include food insecurity, inadequate care, environment, and attention to health. Finally, as basic causes are low access to education, services, land, employment, income, and technology, all of which result from inadequate financial, human, and social capital facing a political, cultural, and social context [36].
As an analytical category, malnutrition involves the lack, excess, or inadequacy of energy and nutrients, reflecting an abnormal physiological condition. Micronutrient deficiency is a form of malnutrition related to inadequate consumption, regardless of the quantity. Vitamin A, iron, and iodine deficiencies are its most common forms [36].
Overweight and all of obesity’s comorbidities (diabetes, hypertension, joint problems) are among the most prevalent consequences of malnutrition in the world. They derive from an unfavorable food environment, lack of financial access to healthy foods, or inadequate food choices [37]. Cultural inheritance, food quality, culinary abilities, food and nutritional education all determine the dietary pattern [38,39]. A large part of individual choices constitutes automatic responses to the stimulus in the surroundings; thus, the greater the offer of inadequate foods, the larger their consumption [40].
There is a close relationship between growth deficits and developing excessive weight, and evidence that bad nutrition during pregnancy interferes with fetal programming [41]. Thus, the emphasis on protecting the child’s first 1000 days [42]. Overweight and prognoses of metabolic dysfunctions are more prevalent among stunted children, and that has been shown for adult life [42,43]. The triple burden of malnutrition, characterized by the coexistence of overweight, undernutrition, and micronutrient deficiency, is rising in low and middle-income countries [44-46]. In this framework, low weight was shown to be transitory, but overweight is persistent [47]. Although the mechanisms are still not clear, the episodic nature of food insecurity promotes metabolic damage and may be related to other obesity-causing triggers [48].
Global picture of hunger and malnutrition in the context of food systems
In 2018, the World Health Organization (WHO) affirmed that one in every three people in the world suffered from at least one form of malnutrition and that a large portion of the world’s population experienced diet-related diseases like cardiovascular diseases, diabetes, and cancer [49]. In 2003, a technical note from WHO pointed to the double burden of morbidity in the world, calling attention to the connection between diseases and eating. In the agenda, one would find the effects of nutrition in the life cycle, the late effects of intrauterine and childhood undernutrition, and the inter-generational effects of the gene-nutrient interactions [50].
The sanitary crisis caused by the pandemics of COVID-19 has shed light on the fragilities of our food systems and the inequities of contemporary society [51-54]. Besides the lost lives, the impact on livelihood was devastating, ending three decades of progress in reducing poverty in the world [6]. The data from 2022 shows that recovery has been slow and unequal and that less favored segments of the population struggle the most to regain their life standards before 2019 [6].
The signs of increasing hunger began to show in 2017 and were exacerbated by the pandemic [51]. The global moderate and severe food insecurity rates were unaltered from 2021 to 2022. Despite that, 25.3% of the world’s families suffered from hunger in 2019 and this number grew to 29.6% in 2022. In rural areas, it came up to 33.3%; in the African continent, 69.9% of the families. In 2019, severe food insecurity reached 720 million people, growing to around 900 million people in 2022 - that is, 11.3% of the world population [6]. From 2021 to 2022, chronic hunger or malnutrition remained well above 2019 values - from 7.9 percent to 9.2 percent in 2022 [6]. In absolute numbers, it is estimated that 735.1 million people suffered from malnutrition in 2022 [6].
Among children below 5, the historical series showed improvement since 2000, when 33% suffered from a growth deficit. In 2012, it amounted to 26.3%; in 2022, 22.3% [6,51]. In the same temporal order, underweight went from 8.7% to 7.5% and 6.8%, and obesity ranged from 5.3% to 5.5%, and 5.6%, respectively. In 2020, 14.7% of those born alive had low birth weight; in 2012, it was 15%, and in 2000, 17.5% [6,51]. Globally, the prevalence of exclusive mother breastfeeding in the first six months increased from 37.1% in 2012 to 47,7% in 2022, but it is still distant from the goal of 70% by 2030 [6]. The UN goals for 2030 regarding children’s indicators are far from being reached [6].
Among adults, obesity has risen from 8.7% in 2000 to 13.1% in 2016 [51]. By 2050, it is estimated that 45% (39-52%) of the world’s population will be overweight and 16% (13-20%) will be obese [55].
Economic globalization exacerbated malnutrition’s triple burden, proving more detrimental in poorer countries [46]. A study in 22 countries considering the mother-child binomial showed that these findings hold up for one in every 10 evaluated houses [44].
Besides the economic crisis already in place before the pandemic, the war in Ukraine and several climatic events have affected the world’s production and supply of food items, with daunting prognoses regarding hunger [56]. In Brazil, added to the influences of the external political and economic scenery, the democratic crisis in recent years and the progress of neoliberalism resulted in drastic reductions in investments in public policies and contributed to the chaos in the transition to a new government in 2022-2023 [22]. However, for a portion of the population, the pandemic and the omission of the central power represented the valuing of local products and family farming [53], as well as a rescue of civil society’s solidarity [57].
The effects of inflation on the prices of food, one of the economic impacts of the pandemic and the measures to contain it, increased the global costs of a healthy diet. The number of people who could not sustain such diets increased to 3.1 billion in 2020, 112 million people more than the year before [51]. In Brazil, in 2022, 30.7% of the population could no longer afford a healthy diet [56]. This reflects the shrinking incomes and employment opportunities but also the rising costs of food.
The volatility in international food prices is an important factor for developing countries, most of which export raw materials for food [58]. It is the case of Brazil and other Latin American countries, where food items turned into commodities and produced in large quantities became prohibitive for internal consumption as the external, more lucrative markets were prioritized [59].
The crisis of food systems is among capitalism’s crises. It transcends cyclical causes, centering on the conflicts and contradictions of the modes of production, distribution, and consumption, all heavily influenced by the international market [60]. The commercial policy was profoundly altered in the last decades, increasing the hegemony of the neoliberal paradigm, closely linked to the interests of transnational corporations and big enterprises. In this model, hunger and malnutrition would find their solutions in the complete liberalization of international commerce and a strategy of assistance and donations, reducing the HRAF to a minimum package of calories [61].
Understanding food items as commodities contributes to nutritional settings where profitable, unsustainable, cheaper, unhealthy, and more readily available foods prevail [62]. Big supermarkets and other transnational corporative giants are at this market’s top tiers [62]. Thus, commercial agreements have refrained the autonomy of governments to implement national interventions on prices, availability, and labeling [63]. This is a neuralgic point in Brazil. For instance, in the item “Trade and investment for improved nutrition” of the report of the UN Decade of Action for Nutrition, there are no established goals - certainly reflecting the lack of consensus in the sector [21].
Another effect of capitalism, consumerism affects the food systems, leading to food waste and environmental pressure [55]. In global Syndemics, hunger and other forms of malnutrition and the damage to natural systems have synergistic cause-and-effect relations that potentialize one another [4].
The climatic stability that allowed the development of agriculture and several civilizations on Earth to flourish is currently under threat. Recent analyses show that the planetary limits to protect this stability have been transgressed repeatedly: deforestation, loss of biodiversity, and phosphorus in fertilizers [64]. Food production is responsible for most of the greenhouse gases emitted [64].
Urbanization has been shaping the food systems, and a continual rural-urban lens that includes production, processing, distribution, and markets will be needed to understand the dynamics of the food system in its complexity and interaction with natural and human systems [2,6].
International strategies to ensure the HRAF
The reduction of hunger and malnutrition does not depend only on emergency measures to distribute food but also on the offer of goods and services to develop the productive sectors, empower women and other marginalized social sectors, and on the implementation of systems of social protection, all relying on public policy [38,65].
Malnutrition presents multiple challenges to sustainable development and health. The causes of malnutrition are complex and multidimensional, including poverty, lack of access to adequate food, inadequate care practices, and bad sanitation. On the other hand, given the lack of resources and environmental problems derived from an unsustainable model of production and consumption, challenges for food systems to ensure sufficient, safe, and nutritious foods have been on the rise.
Regarding obesity, violations of the HRAF influence not only the physical and financial means for obtaining food but also the criteria of the food environments’ adequation. To contain the rise of obesity and chronic conditions associated with diabetes and hypertension, drastic measures to make food environments healthier are needed [49]. Strengthening the systems of accountability that include all the actors involved in the food system, involving fees and taxation, strengthening governments and restricting the influence of the private sector, engaging civil society, and including adequate communication policies may become effective strategies for healthier and more sustainable diets [60,66].
The FAO has established the four dimensions of a healthy diet: health and nutrition; economic; social and cultural; and environmental. Sustainable diets are “those diets with low environmental impacts which contribute to food and nutrition security and a healthy life for present and future generations” [67]. The production and consumption of foods cause nearly a third of the total gas emissions on the planet [68]. A challenge to current paradigms is recognizing the connections among biodiversity, sustainability, and human health [38]. Because of that, it is also a big challenge and an important agenda for SAN public policies, given its intersectoral characteristics. Thus, ending hunger, enabling healthy and adequate diets, and consumption following environmental limits requires a coordinated redirecting of eating practices [55].
All through evolution, men have faced several problems and, little by little, developed strategies to deal with them. The transformation of food systems to become sustainable and sensitive to nutrition is one of those complex challenges. An approach to food systems that meets the HRAF’s perspective converges with the concept of “One Health” adopted by WHO and FAO when approaching human, animal, and environmental health indissociably, worrying about the population’s health while preserving the environment and natural resources for future generations [69]. This approach implies interdisciplinary work, which requires networking to improve health and nutrition, the processes of producing and supplying food, and sustainability for agriculture in a new perspective of interaction among vegetables, animals, and humans [70]. The complexity of food systems demands a systemic perspective of research and transdisciplinary methods of approaching; despite that, the initiatives for global development remain scarcely connected [71].
Morin has debated humanity’s general crisis and points to civilization’s ambiguities. For the author, the origin of contemporary problems is globalization; meanwhile, we have never been so interconnected. The challenge is to “globalize and deglobalize” at the same time, accepting our mistakes along the way and trying to innovate with a symbiosis capable of recovering important values and aggregating them to all types of processes obtained [2]. Morin defends the idea of a politics of humanity, unifying the best of development with respect for the qualities and values of different cultures in a symbiotic process [2].
This systemic and totalizing approach requires a gaze that is both comprehensive and specific, along with integrated studies of global health determined by food systems and environmental changes [55]. Figure 1 shows a synthesis of subsystems that regulate the food system; each item develops into successive subsystems to explain the relations of cause and effect and the potentials of regulation.
A vision of the subsystem of food regulation in the perspective of the Human Right to Adequate Food.
The enforceability of the HRAF in Brazil
In Brazil, the juridical effectiveness of the HRAF occurred with the creation of the SISAN by the Organic Law on Food and Nutritional Security, Law nº11.346/2006, LOSAN [25], reaffirmed by amendment 64 of 2010 to the Federal Constitution, which includes “eating” as a social right [72]. In Chapter II, Article 6th, one reads: “Comprised among social rights are education, health, eating, work, housing, leisure, safety, social security, protection to maternity and childhood, and assistance to deprived persons in the form of this Constitution”. Thus, in 2010, the Constitution of the Federal Republic of Brazil became the main national juridical document to recognize and promote the HRAF [73].
As a human right, the HRAF requires that public power meets different obligations. The state must respect the HRAF, preventing any measure that provokes individual and collective deprivation to the acquisition of food for oneself; equally, the state must protect against the violation of this right by third parties; it must promote the HRAF by creating conditions for its effective realization; and, finally, it must ensure adequate eating to individuals or collectives in need of social protection [15]. Given that it is a social right, the HRAF presents a positive dimension - that is, for its effectiveness, besides its non-violation by the state (negative dimension), it requires a positive dimension from the public power, whose obligation to make it effective incorporates both facilitating and providing it [9].
The enforceability of the HRAF is the opportunity for a beneficiary to require this right from the state. It is made concrete by obligations and mechanisms (protocols and instruments) taken up by one or more entities of the state or those who represent them to ensure the beneficiary the good or service that allows the fruition of this right [74]. The absence of SISAN’s components (Câmara Interministerial de Segurança Alimentar e Nutricional [CAISAN, Inter-ministerial Chamber of Food and Nutritional Security], CONSEA, SAN conferences, and the elaboration of a SAN plan) is an important indicator of the deficient promotion of the HRAF, as it demonstrates the needs of the local population to access important mechanisms of the HRAF’s enforceability. Facing the obligation to realize the HRAF, municipalities must strengthen their councils and cameras, elaborate laws, mobilize the civil society, carry out conferences, build their SAN plans which include mechanisms for monitoring, evaluating, and requiring the HRAF. In the Brazilian experience, especially the Ação Brasileira pela Nutrição e Direitos Humanos (ABRANDH, Brazilian Action for Nutrition and Human Rights), mechanisms or instruments for requiring the HRAF were classified into four types [74]: administrative (public organs); political (with the organs of shared management, such as councils); quasi-judicial (public prosecutions); judicial (the judiciary).
According to LOSAN [25], “adequate eating is a fundamental right of human beings, inherent to the dignity of the human person and indispensable for the realization of the rights enshrined in the Federal Constitution, and the state must adopt the policies and actions needed to promote and ensure the population’s food and nutritional safety”. It establishes: “the state must respect, protect, promote, provide, inform, monitor, inspect, and evaluate the realization of the human right to adequate food, as well as ensure the mechanisms for its enforcement” (§2nd, art. 1st). The violations of one of the human rights occur when it is not respected, protected, promoted, or put into practice [74]. Violations of the HRAF may be identified when the situations of hunger, food and nutritional insecurity, undernourishment, malnutrition, loss of eating culture, consumption of foods of bad quality, land expulsion, and unemployment are observed [73].
However, although Brazil had the juridical basis for enforcing the HRAF, CAISAN affirms that “public agents’ accountability for not offering food or unqualified policies is still inexistent [73]. There are no effective mechanisms to make the public government accountable when the results are proven inferior or suboptimal in terms of the expected quality. There are not even mechanisms to demand rights or reparations in the context of public policies in the responsible organs” [73]
According to CAISAN [73], “if all public policies integrating SISAN go through a process of analysis and adequation for incorporating mechanisms of administrative enforceability, a new paradigm will be inaugurated in this field, with a less fragmented view of human rights and the progressive growth of social participation. On top of that, the HRAF will be leaving the exclusive domain of theoretical treatises and moving to concrete and practical applications”. This would have been a great leap for making the HRAF effective in Brazil if not for the paralysis of CAISAN and CONSEA’s work between 2019 and 2022 [22]. The expectation is their resumption and progress, even after a scenery of great structural and cyclical social, political, and economic challenges. Hunger is a structural fact in Brazil, resulting from inequalities, racism, and patriarchy. It cries out for socio-environmental, economic, political, and cultural justice. It calls the ongoing method of production and consumption into question in the face of food systems’ sustainability. Thus, ensuring the HRAF must be taken equally, as hunger and other forms of malnutrition connect with race, gender, level of schooling, class, and geographic determination in Brazil [56].
CONCLUSION
Hunger and malnutrition place us before a great challenge, that is, entirely transforming our food systems from daily practices to the systems of production and supply intrinsically connected with natural systems. Facing our current social, cultural, economic, and political context, the prognoses are that we will not be able to meet the commitment established by 2030. Thus, the importance of a new social pact towards a socially, environmentally, and economically sustainable future for the full realization of the rights and sustainability of life on the planet.
Accessing adequate food and its forms of consumption depends on financial possibilities, inequities, discrimination, education, and social status. The HRAF is centered on the principles of nondiscrimination and participation. It must be ensured without discrimination of culture, economics, ethnicity, gender, language, religion, political option, or anything else, and does not exclude the need for affirmative actions that prioritize vulnerable groups. Participation implies people’s agency and power regarding the actions needed for their well-being, as well as their active and informed participation in planning, conceiving, monitoring, and evaluating public policies. What is not given must be conquered, given that progress in social rights is the result of social struggles and engagement.
REFERENCES
- 1. Castro J. Geografia da Fome - o dilema brasileiro: Pão ou aço. 10th ed. Rio de Janeiro: Edições antares; 1984.
- 2. Morin E. A via para o futuro da humanidade. São Paulo: Bertrand Brasil; 2013.
-
3. Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Jessica R, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet. 2019;393(10173):791-846. https://doi.org/10.1016/S0140-6736(18)32822-8
» https://doi.org/10.1016/S0140-6736(18)32822-8 -
4. Organização das Nações Unidas. Comentário Geral número 12. O direito humano à alimentação (art.11). 1999 [cited 2023 Nov 10]. Available from: https://fianbrasil.org.br/wp-content/uploads/2016/12/Comentario-Geral-No-12.pdf
» https://fianbrasil.org.br/wp-content/uploads/2016/12/Comentario-Geral-No-12.pdf -
5. High Level Panel of Experts. Food security and nutrition: Building a global narrative towards 2030. Rome: Committee on World Food Security; 2020 [cited 2023 Nov 10]. Available from: https://www.fao.org/3/ca9731en/ca9731en.pdf
» https://www.fao.org/3/ca9731en/ca9731en.pdf -
6. Food and Agriculture Organization of the United Nations; International Fund for Agricultural Development; United Nations Children's Fund; World Food Programme; World Health Organization. The State of Food Security and Nutrition in the World 2023. Urbanization, agrifood systems transformation and healthy diets across the rural-urban continuum. Rome: FAO; 2023. https://doi.org/10.4060/cc3017en
» https://doi.org/10.4060/cc3017en -
7. United Nations. Universal human rights. Paris: United Nations; 1948 [cited 2023 Nov 10]. Available from: https://www.un.org/en/about-us/universal-declaration-of-human-rights
» https://www.un.org/en/about-us/universal-declaration-of-human-rights -
8. Assembleia Geral da ONU. Pacto internacional dos direitos econômicos, sociais e culturais. ONU; 1966 [cited 2023 Nov 10]. Available from: https://www.oas.org/dil/port/1948%20Declara%C3%A7%C3%A3o%20Universal%20dos%20Direitos%20Humanos.pdf
» https://www.oas.org/dil/port/1948%20Declara%C3%A7%C3%A3o%20Universal%20dos%20Direitos%20Humanos.pdf -
9. Soares S. Análise do direito humano à alimentação adequada: um direito social e político. R Dir Sanit. 2018;19(2):36-54. https://doi.org/10.11606/issn.2316-9044.v19i2p36-54
» https://doi.org/10.11606/issn.2316-9044.v19i2p36-54 - 10. Clay E. Food security: Concepts and measurement, paper for FAO Expert Consultation on Trade and Food Security: Conceptualising the Linkages Rome, 11-12 July 2002. Published as Chapter 2 of Trade Reforms and Food Security: conceptualising the linkages. Rome: FAO ; 2003.
- 11. Ação da Cidadania contra a fome, a miséria e pela vida. Conselho nacional de Segurança Alimentar. Secretaria Executiva da Ação da Cidadania. I Conferência Nacional de Segurança Alimentar. Brasília; 1995.
-
12. Maluf RS, Menezes F. Caderno ‘Segurança Alimentar’ - Fórum Social Mundial. Yumpu; 2013 [cited 2023 Nov 10]. Available from: https://www.yumpu.com/pt/document/view/12628947/caderno-seguranca-alimentar-forum-social-mundial
» https://www.yumpu.com/pt/document/view/12628947/caderno-seguranca-alimentar-forum-social-mundial -
13. Presidência da República (Brasil). Decreto n. 591, de 6 de julho de 1992. Atos Internacionais. Pacto Internacional sobre Direitos Econômicos, Sociais e Culturais. Promulgação. Diário Oficial da União - Seção 1 - 7/7/1992, Página 8713. 1992 [cited 2023 Nov 10]. Available from: https://www2.camara.leg.br/legin/fed/decret/1992/decreto-591-6-julho-1992-449000-publicacaooriginal-1-pe.html
» https://www2.camara.leg.br/legin/fed/decret/1992/decreto-591-6-julho-1992-449000-publicacaooriginal-1-pe.html -
14. OXFAM. Terrenos da Desigualdade: Terra, agricultura e desigualdades no Brasil rural, 2016. OXFAM Brasil; 2016 [cited 2023 Nov 10]. Available from: https://www.oxfam.org.br/publicacao/terrenos-da-desigualdade-terra-agricultura-e-desigualdade-no-brasil-rural/
» https://www.oxfam.org.br/publicacao/terrenos-da-desigualdade-terra-agricultura-e-desigualdade-no-brasil-rural/ -
15. Burity V, Franceschini T, Valente F, Recine E. Direito humano à alimentação adequada no contexto da segurança alimentar e nutricional. Brasília: ABRANDH; 2010 [cited 2023 Nov 10]. Available from: https://www.redsan-cplp.org/uploads/5/6/8/7/5687387/dhaa_no_contexto_da_san.pdf
» https://www.redsan-cplp.org/uploads/5/6/8/7/5687387/dhaa_no_contexto_da_san.pdf -
16. Organización de las Naciones Unidas para la Alimentación y la Agricultura. Segunda Conferência Internacional sobre Nutrición: compromiso por un futuro sin malnutrición. Organización de las Naciones Unidas para la Alimentación y la Agricultura; 2014 [cited 2023 Nov 10]. Available from: https://www.fao.org/3/i4465s/i4465s.pdf
» https://www.fao.org/3/i4465s/i4465s.pdf -
17. United Nations Development Programme. Transforming our world: The 2030 agenda for sustainable development. United Nations Development Programme; 2015 [cited 2023 Nov 10]. Available from: https://www.undp.org/publications/sustainable-development-goals-booklet
» https://www.undp.org/publications/sustainable-development-goals-booklet -
18. World Health Organization - Global Coordination Mechanism on NCDs. Noncommunicable Diseases and Human Rights - Seminar held ahead of the eighth meeting of the UN Inter-Agency Task Force on NCDs. United Nations Humam Rights; 2017 [cited 2023 Nov 10]. Available from: https://cdn.who.int/media/docs/default-source/unitaf/seminar-on-ncds-and-human-rights-summary.pdf?sfvrsn=98c40488_3
» https://cdn.who.int/media/docs/default-source/unitaf/seminar-on-ncds-and-human-rights-summary.pdf?sfvrsn=98c40488_3 -
19. United Nations System Standing Committee on Nutrition. A Spotlight on the nutrition decade news 42. Rome; 2017 [cited 2023 Nov 10]. Available from: https://www.unscn.org/uploads/web/news/UNSCN-News42-2017.pdf
» https://www.unscn.org/uploads/web/news/UNSCN-News42-2017.pdf -
20. Work Programme of the UN Decade of Action on Nutrition 2016-2025. 2016 [cited 2023 Nov 10]. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_R8-en.pdf
» http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_R8-en.pdf -
21. Ministério do Desenvolvimento Social. Câmara Intersetorial de Segurança Alimentar e Nutricional. Compromissos do Brasil para a Década de Ação das Nações Unidas para a Nutrição (2016-2025). Brasília: ONU, FAO; 2015 [cited 2023 Nov 10]. Available from: https://www.fao.org/3/ca2787pt/CA2787PT.pdf
» https://www.fao.org/3/ca2787pt/CA2787PT.pdf -
22. Recine E, Fagundes A, Silva BL, Garcia GS, Ribeiro CL, Gabriel G. Reflections on the extinction of the National Council for Food and Nutrition Security and the confrontation of Covid-19 in Brazil. Rev Nutr. 2020;33:e200176. https://doi.org/10.1590/1678-9865202033e200176
» https://doi.org/10.1590/1678-9865202033e200176 -
23. Instituto de Pesquisa Econômica Aplicada. Desmonte e reconfiguração de políticas públicas (2016-2022). Brasília: IPEA, INCT/PPED; 2023 [cited 2023 Nov 10]. Available from: https://repositorio.ipea.gov.br/handle/11058/11939
» https://repositorio.ipea.gov.br/handle/11058/11939 -
24. Neves JÁ, 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. https://doi.org/10.1590/1678-9865202134e200170
» https://doi.org/10.1590/1678-9865202134e200170 -
25. Presidência da República (Brasil). Lei n. 11.346, de 15 de setembro de 2006. Cria o Sistema Nacional de Segurança Alimentar e Nutricional - SISAN com vistas em assegurar o direito humano à alimentação adequada e dá outras providências. Diário Oficial da União; 2006 [cited 2023 Nov 10]. Available from: https://www.planalto.gov.br/ccivil_03/_Ato2004-2006/2006/Lei/L11346.htm
» https://www.planalto.gov.br/ccivil_03/_Ato2004-2006/2006/Lei/L11346.htm -
26. Vasconcellos ABPA, Moura LBA. Segurança alimentar e nutricional: Uma análise da situação da descentralização de sua política pública nacional. Cad Saúde Pública. 2018;34(2):e00206816. https://doi.org/10.1590/0102-311X00206816
» https://doi.org/10.1590/0102-311X00206816 -
27. Conselho Estadual de Segurança Alimentar Nutricional Sustentável do Estado de São Paulo. Reuniões Consea-SP. [cited 2023 Nov 10]. Available from: https://consea.agricultura.sp.gov.br/calendario-reunioes
» https://consea.agricultura.sp.gov.br/calendario-reunioes -
28. Ministério Público do Paraná. Painel SISAN. Ministério Público do Paraná. [cited 2023 Nov 10]. Available from: https://site.mppr.mp.br/direito/Pagina/Painel-SISAN
» https://site.mppr.mp.br/direito/Pagina/Painel-SISAN -
29. Fórum Brasileiro de Soberania e Segurança Alimentar e Nutricional. Carta convocatória: Conferência Nacional, Popular, Autônoma, 24 de julho de 2019. FBSSAN; 2019 [cited 2023 Nov 10]. Available from: https://fbssan.org.br/2019/07/carta-convocatoria/
» https://fbssan.org.br/2019/07/carta-convocatoria/ -
30. Food and Agriculture Organization of the United Nations. Food Insecurity Experience Scale (FIES), 2018. 2018 [cited 2023 Nov 10]. Available from: http://www.fao.org/in-action/voices-of-the-hungry/fies/en/
» http://www.fao.org/in-action/voices-of-the-hungry/fies/en/ -
31. Segall-Corrêa AM, Marin-Leon L. A segurança alimentar no Brasil: Proposição e usos da escala brasileira de medida da insegurança alimentar (EBIA) de 2003 a 2009. Segur Aliment Nutr. 2009;16(2):1-19. https://doi.org/10.20396/san.v16i2.8634782
» https://doi.org/10.20396/san.v16i2.8634782 -
32. Ministério do Desenvolvimento Social e Combate à Fome; Secretaria de Gestão da Informação (Brasil). Análise técnica do indicador PoU/FAO - População em situação de sub-alimentação, no Relatório sobre Estado da Insegurança Alimentar no Mundo 2013. 2013 [cited 2023 Nov 10]. Available from: https://aplicacoes.mds.gov.br/sagi/pesquisas/documentos/estudo/70.pdf
» https://aplicacoes.mds.gov.br/sagi/pesquisas/documentos/estudo/70.pdf -
33. Olofin I, McDonald CM, Ezzati M, Flaxman S, Black RE, Fawzi WW, et al. Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: A pooled analysis of ten prospective studies. PLoS One. 2013;8(5):e64636. https://doi.org/10.1371/journal.pone.0064636
» https://doi.org/10.1371/journal.pone.0064636 -
34. Martins VJB, Florêncio TMMT, Grilo LP, Franco MCP, Martins PA, Clemente APG, et al. Long-lasting effects of undernutrition. Int J Environ Res Public Health. 2011;8(6):1817-26. https://doi.org/10.3390/ijerph8061817
» https://doi.org/10.3390/ijerph8061817 -
35. Food and Agriculture Organization of the United Nations. Nutrition and Social Protection. Food and Agriculture Organization of the United Nations; 2015 [cited 2023 Nov 10]. Available from: https://file:///C:/Users/User/Downloads/a-i4819e.pdf
» https://file:///C:/Users/User/Downloads/a-i4819e.pdf -
36. Food and Agriculture Organization of the United Nations. Nutrition and resilience. Food and Agriculture Organization of the United Nations; 2014 [cited 2023 Nov 10]. Available from: http://www.fao.org/3/a-i3777e.pdf
» http://www.fao.org/3/a-i3777e.pdf -
37. Camargo DFM, Belon AP, Marín-León L, Souza BFNJ, Pérez-Escamilla R, Segall-Corrêa AM. Comparing food environment and food purchase in areas with low and high prevalence of obesity: Data from a mapping, in-store audit, and population-based survey. Cad Saúde Pública . 2019;35(9):e00247218. https://doi.org/10.1590/0102-311X00247218
» https://doi.org/10.1590/0102-311X00247218 -
38. Food and Agriculture Organization of the United Nations. World Health Organization. Sustainable healthy diets guiding principles, Food and Agriculture Organization of the United Nations; 2019 [cited 2023 Nov 10]. Available from: https://www.fao.org/3/ca6640en/ca6640en.pdf
» https://www.fao.org/3/ca6640en/ca6640en.pdf -
39. Cohen DA, Babey SH. Contextual influences on eating behaviors: Heuristic processing and dietary choices. Obes Rev. 2012;13(9):766-79. https://doi.org/10.1111/j.1467-789X.2012.01001.x
» https://doi.org/10.1111/j.1467-789X.2012.01001.x -
40. Leite FHM, de Carvalho Cremm E, de Abreu DSC, de Oliveira MA, Budd N, et al. Association of neighbourhood food availability with the consumption of processed and ultra-processed food products by children in a city of Brazil: A multilevel analysis. Public Health Nutr. 2018;21(1):189-200.https://doi.org/10.1017/S136898001600361X
» https://doi.org/10.1017/S136898001600361X -
41. Zhu Z, Cao F, Li X. Epigenetic programming and fetal metabolic programming. Front Endocrinol (Lausanne). 2019;10:764. https://doi.org/10.3389/fendo.2019.00764
» https://doi.org/10.3389/fendo.2019.00764 -
42. De Lucia Rolfe E, de França GVA, Vianna CA, Gigante DP, Miranda JJ, Yudkin JS, et al. Associations of stunting in early childhood with cardiometabolic risk factors in adulthood. PLoS One . 2018;13(4):e0192196. https://doi.org/10.1371/journal.pone.0192196
» https://doi.org/10.1371/journal.pone.0192196 -
43. Vale D, Andrade MEC, Dantas NM, Bezerra RA, Lyra CO, Oliveira AGRC. Social determinants of obesity and stunting among brazilian adolescents: A multilevel analysis. Nutrients. 2022;14(11):2334. https://doi.org/10.3390/nu14112334
» https://doi.org/10.3390/nu14112334 -
44. Chilot D, Belay DG, Merid MW, Kibret AA, Alem AZ, Asratie MH, et al. Triple burden of malnutrition among mother-child pairs in low-income and middle-income countries: A cross-sectional study. BMJ Open. 2023;13(5):e070978. https://doi.org/10.1136/bmjopen-2022-070978
» https://doi.org/10.1136/bmjopen-2022-070978 -
45. Rafael Perez-Escamilla R, Bermudez O, Buccini BS, Kumanyika S, Lutter CK, Monsivais P, et al. Nutrition disparities and the global burden of malnutrition. BMJ. 2018;36:k2252. https://doi.org/10.1136/bmj.k2252
» https://doi.org/10.1136/bmj.k2252 -
46. Seferidi P, Hone T, Duran AC, Bernabe-Ortiz A, Millett C. Global inequalities in the double burden of malnutrition and associations with globalisation: A multilevel analysis of Demographic and Health Surveys from 55 low-income and middle-income countries, 1992-2018. Lancet. 2022;10:e482. https://doi.org/10.1016/ S2214-109X(21)00594-5
» https://doi.org/10.1016/ S2214-109X(21)00594-5 -
47. Azomahou TT, Diene B, Gosselin-Pali A. Transition and persistence in the double burden of malnutrition and overweight or obesity: Evidence from South Africa. Food Policy. 2022;113:102303. https://doi.org/10.1016/j.foodpol.2022.102303
» https://doi.org/10.1016/j.foodpol.2022.102303 -
48. Brown AGM, Esposito LE, Fisher RA, Nicastro HL, Tabor DC, Walker JR. Food insecurity and obesity: Research gaps, opportunities, and challenges. Transl Behav Med. 2019;9(5):980-7. https://doi.org/10.1093/tbm/ibz117
» https://doi.org/10.1093/tbm/ibz117 -
49. World Health Organization. Noncommunicable diseases country profiles 2018. World Health Organization; 2018 [cited 2023 Nov 10]. Available from: https://file:///C:/Users/User/Downloads/9789241514620-eng.pdf
» https://file:///C:/Users/User/Downloads/9789241514620-eng.pdf -
50. Organización Mundial de la Salud. Série de Informes Técnicos 916. Dieta, nutrición y prevención de enfermedades crónicas. Genebra: Organización Mundial de la Salud; 2003 [cited 2023 Nov 10]. Available from: https://www.fao.org/3/ac911s/ac911s.pdf
» https://www.fao.org/3/ac911s/ac911s.pdf -
51. Food and Agriculture Organization; Fundo Internacional para o Desenvolvimento Agrícola; Fundo das Nações Unidas para a Infância; Programa Mundial de Alimentos; Organização Mundial da Saúde. El estado de la seguridad alimentaria y la nutrición en el mundo - 2022. FAO, IFAD, WHO, WFP, UNICEF; 2022 [cited 2023 Nov 10]. Available from: http://www.fao.org/documents/card/es/c/cc0640es
» http://www.fao.org/documents/card/es/c/cc0640es -
52. Abreu AM, Palazzo CC, Barboza BP, Wazlawik E, Diez-Garcia RW, Vasconcelos FAG. Conjunctural hunger and structural obesity in the global scenario: Reflections on what Covid-19 masks reveal. Rev Nutr . 2021;34:e200221. https://doi.org/10.1590/1678-9865202134e200221
» https://doi.org/10.1590/1678-9865202134e200221 -
53. Martinelli SS, Cavalli SB, Fabri RK, Veiros MB, Reis ABC, Amparo-Santos L. Strategies for the promotion of healthy, adequate and sustainable food in Brazil in times of Covid-19. Rev Nutr . 2020;33:e200181. https://doi.org/10.1590/1678-9865202032e200181
» https://doi.org/10.1590/1678-9865202032e200181 -
54. Matsuo LH, Tureck C, Lima LP, Hinnig PF, Trindade EBSM, Vasconcelos FAG. Impact of social isolation by Coronavirus disease 2019 in food: A narrative review. Rev Nutr . 2021;34:e200211. https://doi.org/10.1590/1678-9865202134e200211
» https://doi.org/10.1590/1678-9865202134e200211 -
55. Bodirsky BL, Dietrich JP, Martinelli E, Stenstad1 A, Pradhan P, Gabrysch S, et al. The ongoing nutrition transition thwarts long-term targets for food security, public health and environmental protection. Sci Rep. 2020;10(1):19778. https://doi.org/10.1038/s41598-020-75213-3
» https://doi.org/10.1038/s41598-020-75213-3 -
56. Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar e Nutricional. II Inquérito Nacional sobre Insegurança Alimentar no Contexto da Pandemia da COVID-19 no Brasil. II VIGISAN: Relatório final/Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar. São Paulo: Fundação Friedrich Ebert: Rede PENSSAN; 2022 [cited 2023 Nov 10]. Available from: https://olheparaafome.com.br/wp-content/uploads/2022/06/Relatorio-II-VIGISAN-2022.pdf
» https://olheparaafome.com.br/wp-content/uploads/2022/06/Relatorio-II-VIGISAN-2022.pdf -
57. Oliveira LTC, Camargo AM, Machado BOB, Oliveira AR, Fiates GMR, Vasconcelos FAG. “Hunger and rage (and the virus) are human things”: Reflections on solidarity in times of COVID-19. Rev Nutr . 2021;34:e200183. https://doi.org/10.1590/1678-9865202134e200183
» https://doi.org/10.1590/1678-9865202134e200183 -
58. Amrouk EM, Hecklei T, Grosche S-C. International interdependence between cash crop and staple food futures price indices: A dynamic assessment. J Agric Appl Econ. 2019;51(3):450-71. https://doi.org/10.1017/aae.2019.12
» https://doi.org/10.1017/aae.2019.12 -
59. Baccarin JG, Oliveira JÁ. Inflação de alimentos no Brasil em período da pandemia da Covid 19, continuidade e mudanças. Segur Aliment Nutr . 2021;28:e021002. https://doi.org/10.20396/san.v28i00.8661127
» https://doi.org/10.20396/san.v28i00.8661127 -
60. Machado PP, de Oliveira NRF, Mendes ÁN. O indigesto sistema do alimento mercadoria. Saúde Soc. 2016;25(2):505-15.https://doi.org/10.1590/S0104-12902016151741
» https://doi.org/10.1590/S0104-12902016151741 -
61. Valente FLS. Rumo à realização plena do direito humano à alimentação e à nutrição adequadas. Brasília: FIAN Brasil; 2014 [cited 2023 Nov 10]. Available from: https://fianbrasil.org.br/wp-content/uploads/2017/02/Rumo-%C3%A0-realiza%C3%A7%C3%A3o-plena-do-DHANA_Flavio-Valente.pdf
» https://fianbrasil.org.br/wp-content/uploads/2017/02/Rumo-%C3%A0-realiza%C3%A7%C3%A3o-plena-do-DHANA_Flavio-Valente.pdf -
62. Hamilton S, Humbert F, Jennings S, Mcallister P, Mistry R, Munoz E, et al. Ripe for change: Ending human suffering in supermarket supply chains. OXFAM; 2018 [cited 2023 Nov 10]. Available from: https://policy-practice.oxfam.org/resources/ripe-for-change-ending-human-suffering-in-supermarket-supply-chains-620418/
» https://policy-practice.oxfam.org/resources/ripe-for-change-ending-human-suffering-in-supermarket-supply-chains-620418/ -
63. Ferreira PM. A coerência das políticas para o desenvolvimento: Um instrumento em prol do desenvolvimento? Cad Estud Africanos. 2017;34:31-63. https://doi.org/10.4000/cea.2281
» https://doi.org/10.4000/cea.2281 -
64. Rockström J, Stordalen GA, Horton R. Acting in the anthropocene: The EAT-lancet commission. Lancet. 2016;387(10036):2364-5. https://doi.org/10.1016/S0140-6736(16)30681-X
» https://doi.org/10.1016/S0140-6736(16)30681-X -
65. Toro CM, Carriedo A, Tamayo EMP, Crosbie E. Barriers to overcoming child hunger and malnutrition: Applying a human rights approach to improve policy and action. Int J Public Health. 2023;68:1605969. https://doi.org/10.3389/ijph.2023.1605969
» https://doi.org/10.3389/ijph.2023.1605969 -
66. Swinburn B, Kraak V, Rutter H, Vandevijvere S, Lobstein T, Sacks G, et al. Strengthening of accountability systems to create healthy food environments and reduce global obesity. Lancet. 2015;385(9986):2534-45. https://doi.org/10.1016/S0140-6736(14)61747-5
» https://doi.org/10.1016/S0140-6736(14)61747-5 -
67. Pray L. Sustainable diets, food, and nutrition: Proceedings on a workshop. Washington, D.C.: National Academies Press; 2019 [cited 2023 Nov 10]. Available from: https://www.nap.edu/catalog/25192
» https://www.nap.edu/catalog/25192 -
68. Goucher L, Bruce R, Cameron DD, Lenny Koh SC, Horton P. The environmental impact of fertilizer embodied in a wheat-to-bread supply chain. Nat Plants. 2017;3:17012. https://doi.org/10.1038/nplants.2017.12
» https://doi.org/10.1038/nplants.2017.12 -
69. World Health Oorganization. One health WHO. Genebra: WHO; 2017 [cited 2023 Nov 10]. Available from: http://www.who.int/features/qa/one-health/en/
» http://www.who.int/features/qa/one-health/en/ -
70. Garcia SN, Osburn BI, Jay-Russell MT. One health for food safety, food security, and sustainable food production. Front Sustain Food Syst. 2020;4:1. https://doi.org/10.3389/fsufs.2020.00001
» https://doi.org/10.3389/fsufs.2020.00001 -
71. Hammond RA, Dubé L. A systems science perspective and transdisciplinary models for food and nutrition security. Proc Natl Acad Sci U S A. 2012;109(31):12356-63. https://doi.org/10.1073/pnas.0913003109
» https://doi.org/10.1073/pnas.0913003109 -
72. Brasil. Emenda Constitucional no 64, de 4 de fevereiro de 2010. Altera o art. 6o da Constituição Federal para introduzir a alimentação como direito social. Brasília: Diário Oficial da União; 2010 [cited 2023 Nov 10]. Available from: https://www.planalto.gov.br/ccivil_03/Constituicao/Emendas/Emc/emc64.htm
» https://www.planalto.gov.br/ccivil_03/Constituicao/Emendas/Emc/emc64.htm -
73. Câmara Interministerial de Segurança Alimentar e Nutricional. A exigibilidade do Direito Humano à alimentação adequada: ampliando a democracia no SISAN. Caderno SISAN/01. Brasília: MDSA, CAISAN; 2017 [cited 2023 Nov 10]. Available from: https://www.mds.gov.br/webarquivos/arquivo/seguranca_alimentar/caisan/Publicacao/Caisan_Nacional/exigibilidade_direito_humano_alimentacao_adequada.pdf
» https://www.mds.gov.br/webarquivos/arquivo/seguranca_alimentar/caisan/Publicacao/Caisan_Nacional/exigibilidade_direito_humano_alimentacao_adequada.pdf -
74. Leão M. O direito humano à alimentação adequada e o sistema nacional de segurança alimentar e nutricional. Brasília: ABRANDH ; 2013 [cited 2023 Nov 10]. Available from: https://www.mds.gov.br/webarquivos/publicacao/seguranca_alimentar/DHAA_SAN.pdf
» https://www.mds.gov.br/webarquivos/publicacao/seguranca_alimentar/DHAA_SAN.pdf
