The teaching of "Nutrition Policy" began at the University of Porto in the 1996/1997 academic year, at the former Higher Institute of Nutrition and Food Sciences of the University of Porto (ISCNAUP), currently FCNAUP. A scientific, pedagogical and intellectual adventure that now celebrates 25 years. We take this opportunity to revisit the emergence of this disciplinary area and its evolution in the context of nutritionist training in Portugal.
From the need for nutritional policies to the need to teach nutritional policy
In the late 1990s, here at FCNAUP, we became aware of the need to deepen the discussion on public policies in the area of food, based on nutritional principles and objectives. After the joint FAO/WHO conference in Rome in 1974 position papers throughout the 1980s and 90s on , it was impossible to avoid this discussion in the academic training of nutritionists. In other words, over that time it was progressively assumed that achieving nutritional goals for the entire population should be an objective pursued by different national policies as a whole, as an alternative to the traditional practice of leaving the issue of the nutritional status of populations as a secondary concern and including it exclusively in agricultural policies (with evident conflicts of interest), social policies, economic policies, or even foreign affairs. In other words, we began to look at food policies from a nutritional perspective, through the eyes of a nutritionist, a health professional with a systemic vision, hence our use of the term "Nutritional Policy" or Public Policies with nutritional objectives throughout much of this essay.
This way of looking at intervention in society was also shaped by conversations with masters such as Francisco Gonçalves Ferreira, Cayolla da Mota, José Luís Castanheira, and Emílio Peres. Central to this political thought was the work of Professor Gonçalves Ferreira (1912-1994), who, practically from the opening of the Center for Nutrition Studies (CEN) in 1976 until the early 1990s, attempted to link the composition of Portuguese foods, the analysis of food availability, and the definition of a food and nutrition policy for our country. In 1978, Francisco Gonçalves Ferreira published "Food and Nutrition Policy in Portugal," where he presented a proposed food and nutrition strategy for Portugal, taking into account the information available at the time. Unfortunately, and due to various circumstances beyond his control, this objective was never achieved.
Although the dimension of public policy is quite present in Gonçalves Ferreira's writing and in numerous articles published in the 70s and 80s, it was not specifically applied to any disciplinary area when the Nutrition Course was created at the University of Porto, where he actively participated. An innovative course, in his words "intended to provide the country with senior technicians in food and nutrition, capable of working in the various sectors of Health, Medical Assistance, National Processing Industry and other activities related to the rational consumption of food, based on food education programs, nutrition teaching, technological applications and study, aimed at promoting the health of our population." ( FA Gonçalves Ferreira. The perspectives of the nutrition course. CEN Magazine, 12 (3) 1988 ).
During this period of consolidation of the profession and initial training of nutritionists, the objective was to train highly skilled and multidisciplinary technicians capable of intervening effectively in disease prevention, particularly through nutritional education, and in the treatment of major food-related diseases. Although the definition of public policies was a subject of debate in Portuguese society after 1974, within the conservative biomedical training context in which the young Nutrition Course was situated, this conceptual discussion never gained critical mass or visibility, despite a strong social awareness and various interventions in the field, notably through popular education campaigns and the fight against food and nutritional ignorance that characterize the Porto School of Nutrition. This situation was different in some countries (a few), for example in Brazil, where nutritional sciences were initially associated with the thinking of figures such as the Argentinian Pedro Escudero or Josué de Castro , with a greater doctrinal presence and also a greater perception of the need and urgency of public policies to solve nutritional problems .
Just as the training of nutritionists and dentists at the University of Porto arose by chance and opportunity related to the excessive number of students attending medical courses after April 25th, the emergence of a disciplinary area specifically dedicated to "Nutritional Policy" and taught by nutritionists also appeared by chance due to the departure of the person in charge, an economist who then taught "Food Policy and Economics," and whose replacement allowed the reformulation of the discipline to be called "Nutritional Policy." The support of the then director of the course, Professor Norberto Teixeira Santos, and later his successor, Professor Maria Daniel Vaz de Almeida, was central to this process.
Although the disciplinary area of "Nutrition Policy," created in the 1996/1997 academic year, marks the beginning of the teaching of "modern food policies," it is important to highlight that since the beginning of the Nutrition Course, public policies related to food have been considered in relatively independent disciplinary areas, namely through the subjects of "Statistics and Food Economics" and "Food Policy and Economics." The Nutrition Course innovated by attributing, from the outset, a certain importance to issues of Food Economics. The first subject in this area of the disciplinary plan will be called "Statistics and Food Economics." The objective will be to teach basic economic principles that help to understand food supply and demand, price regulation, as well as basic management principles that could be useful in food purchasing and stock management in larger purchases. These principles stemmed from the perception of providing a multidisciplinary education capable of equipping future nutritionists with a basic knowledge of macroeconomics, market forces, and citizens as consumers, but also (probably) from a long tradition from the times of dietetics training where the disciplinary area of "Home Economics" had a strong presence in the Anglo-Saxon world.
The so-called "experimental program" in "Statistics and Food Economics" for the 1977/78 academic year had, in the words of its first instructor, two basic objectives: – to demonstrate that food problems are also, to a large extent, economic problems; and – to familiarize students with solving certain concrete problems in food economics. To achieve these objectives, a program was designed with "Fundamental notions of economics"; "Food economics"; and "Practical exercises in food economics". From the beginning, policy issues appeared associated with the assessment of the food situation and the proposals for food improvement included in the Ministry of Planning and Economic Coordination through the Medium-Term Plan 77/80 . The novelty and experimentation in the area were high because it was not common to teach economics to future nutritionists, a profession still under construction. In this sense, it is interesting to transcribe the notes of the instructor of this new discipline in his first report to the Course Directorate, where at a certain point one can read: Study Material – For the reasons already mentioned (new experience) there is no textbook containing the given program, nor is it possible to prepare adequate notes for the current academic year. Later, in the late 80s and mid-90s, the discipline changed its name to "Food Policy and Economics," emphasizing microeconomic issues and even taxation. The notions of food policy centered around trade balances, the Common Agricultural Policy (CAP), and the European Agricultural Guidance and Guarantee Fund (EAGGF), with the aim of guiding and improving the conditions of production and marketing of agricultural products. Nutritional issues and their framing within economic and political issues were at the time residual, with food and agricultural policy issues being predominant.
The first years of conceptual construction and consolidation (1996-2004)
At the time, almost intuitively, our intention was to alter this content by situating the new discipline within the context of the need for intervention in society to achieve broader and more significant improvements in the nutritional status of populations, where nutritionists could lead these processes.
Acquiring these skills required a conceptual framework that went beyond simply detecting health problems and planning and implementing interventions, as was traditional in public health. It involved a broad understanding of the food system and the tools capable of generating nutritional change—in other words, a shift in the intervention paradigm that began to take shape then, but which remains largely unfinished to this day. At the time, the perception of the need for action in this area, beyond education, was very limited or even nonexistent. It was thought that the intervention of nutritionists should be concentrated on teaching and educating citizens about rational eating. The word "politics" was (and still is, in part) taboo for students and health professionals, in the now-common confusion between politicians, politics, and public policies. It was in this completely experimental, intuitive environment that the construction of this area of knowledge began at FCNAUP.
From the very beginning of the development of this new disciplinary area, it was clear to us that nutritionists, despite being included within the sphere of health professionals, had to possess specific skills to organize their intervention within a food system where humans and nature are in constant dialogue. In other words, when choosing what foods to eat, humans make a choice that will influence their health in the medium term, but they also choose a producer and a method of production, a way of organizing food distribution, of consumption, and even a way of recycling, establishing a relationship with society and the food system (more or less consciously). The consumer pays a price for food and receives a benefit (nutritional, among others), but in parallel, the same consumer automatically establishes a pact with nature. Similarly, when advising on and influencing food consumption, the nutritionist is doing much more than shaping nutrient intake. They are influencing the entire food system, the same system that had previously influenced consumers' food choices.
This link between production systems and food choices had already been the subject of reflection throughout the 20th century. For example, since the 1970s, the American essayist and philosopher Wendell Berry had simplified part of this equation as follows: “The industrial eater is, in fact, one who does not know that eating is an agricultural act, who no longer knows or imagines the connections between eating and the land, and who is therefore necessarily passive and uncritical—in short, a victim. When food, in the minds of eaters, is no longer associated with farming and with the land, then the eaters are suffering a kind of cultural amnesia that is misleading and dangerous.” Wendell Berry gives voice to a current of academics and activists who were precursors of a simpler consumption model closer to production, linked to the protection of nature, as was the case of Joan Dye Gussow, one of the forerunners of food and nutrition policy in the USA ( The Pleasures of Eating” from WHAT ARE PEOPLE FOR? by Wendell Berry. Copyright © 1990 by Wendell Berry ). On another level, the act of eating, and in particular the purchase or boycott as a form of political participation and criticism of certain regimes or political actions, has also been discussed extensively in the literature ( International Political Science Review (2005), Vol 26, No. 3, 245–269 ) and, more recently, the study of political consumerism has been extended to include not only individual but also collective .
The act of eating is a profoundly influential act for the whole of society, for the entire polis, and is therefore deeply political. Only with this awareness can the nutritionist be an actor capable of making a difference in the food system, using the appropriate tools. While the citizen – the consumer – can influence the food system through their food choices, the nutritionist needs to go further , understanding and being able to act on the different forces that condition the market, that is, advocating for causes, putting pressure on regulation and legislation producers, identifying points of connection between voters and decision-makers, creating and supporting scientific evidence useful for decision-making, or influencing public opinion, to name just a few examples. Unfortunately, the training that existed until now, both in biomedical-based courses and in the training of dietitians/nutritionists in Europe, did not contain these premises, essentially working on community intervention through education/information and empowering citizens to make healthy food choices, and less on environmental modifications. This is the innovation that the Nutrition Policy discipline aimed to bring to the training of nutritionists, and it will begin, albeit in its early stages, in the first years of study.
The theoretical program of the Nutrition Policy course in the first years is very focused on demonstrating the need for policies in the area of food and nutrition and on concrete examples of their implementation. The case of Norway, which implemented a nutrition policy in 1974 , the economic foundations of public policies (subject matter still inherited from the previous course), the nutritional and food objectives to be achieved in nutritional policies, issues of equity, ethical issues, the defense of regional identities, activities that influence food availability, from production to distribution, and finally, information and monitoring systems, are all intertwined in a very diverse program that is still seeking stabilization and conceptual framing. It should be noted that at the time, few European countries had implemented food and nutrition strategies and policies, with most of the course's study proposals based on an approach to a reality constructed experimentally. Still in the late 90s, after 98/99, environmental issues were introduced – “The preservation of ecosystems and food policy” or issues of territorial protection, launching these debates in our academic community, albeit in an incipient way, but well ahead of their time.
In parallel, and in these initial years, we begin working early in practical classes on case study models with unsolved problems, a methodology that we will not abandon and that seems appropriate for this training area. For example, in the 97/98 academic year, we worked on 4 major areas with unsolved problems in each: – “Nutrition Policy and Major Political Issues”; “Social Change and Nutrition Policy”; “Demographic Change and Nutrition Policy”; and “Economics and Nutrition Policy”. Great emphasis will also be placed on the pedagogical assessment of our students, which will be crucial for making adjustments almost every semester and which remains a central component of this teaching method. Making this topic relevant to our students and retaining their interest in this area requires continuous feedback from our audience, which we have maintained since day one.
From 1998 onwards, with the revision of the Maastricht Treaty in Amsterdam, Article 152 states that "the protection of health must be ensured in the development and implementation of all Community policies and activities". The possibility of a Common Food Policy, with the active participation of nutritionists, gained some weight in the following years, and in April 2001 we discussed this subject in the article "Nutritionists and National Food Policy" . In this text, now 20 years old, we concluded as follows: "For all these reasons, the integration of nutritionists into the future structures responsible for the implementation of Food Policies will be a necessary step and will happen in most European countries. It is hoped that in Portugal, due to the exceptional situation of human resources we are experiencing, the rule will not be broken, and may even be surpassed. The moment we are currently living through is therefore one of great hope for all those who have fought for a healthier society, more attentive to nutritional problems." The text was said to be premonitory, but this situation would only happen 11 years later, in 2012, as we will see.
Scientific and pedagogical consolidation (2004-2012)
In the mid-decade, and progressively, health and safety issues, which had been at the center of the food debate in Europe since the BSE crisis in 1996 (leading to the publication of the White Paper on Food Safety in 2000 by the European Commission and the creation of EFSA), gave way to concerns about the impacts and extent of chronic diseases, with obesity being central to this discussion. In 2006, the European Charter for Combating Obesity , which Portugal signed in Istanbul and which later led to the creation of the Platform against Obesity within the Directorate-General of Health in Portugal. Among other objectives in the Charter, Portugal committed to mobilizing different sectors of society to create less obesogenic environments – “High-level political will and leadership and whole-government commitment are required to achieve mobilization and synergies across different sectors.” This mobilization of society around the fight against obesity in Portugal allowed for the testing of various good practices and stimulated the study of public strategies to improve the nutritional status of populations. The Adelaide Declaration on Health in All Policies (2010), a landmark WHO document highlighting the “need to develop coordinated governmental actions that consider health as one of its central components,” will also contribute significantly to this. It will also serve as an inspiration for teaching Nutrition Policy at FCNAUP. This increased receptiveness to public policies addressing chronic disease will translate into the scientific consolidation of this area and will be fundamental for the construction of a public policy in the area of food and nutrition, which will be launched on January 13, 2012, with the creation, by Decree No. 404/2012, of the National Program for the Promotion of Healthy Eating (PNPAS), a priority health program managed by the Directorate-General of Health and integrated into the National Health Plan.
Unfortunately, in a process of reflection of this type, it is not possible to identify the key areas that we helped to build or consolidate, beyond the obvious technical, scientific and human training of our students. However, we would like to emphasize that during this period a strong discussion began on the “Definition of the competencies of the Nutritionist and harmonization of programmatic content of Bachelor's Degrees in Nutrition Sciences (2006)”; on the need for “Guiding principles for professional ethics in the area of Nutrition Sciences” in partnership with the Portuguese Association of Nutritionists (2008) and the “Need for a Food Strategy and Policy for Portugal (2004-2009)”. These discussions and trial models, carried out within FCNAUP and also in other forums in which we participated, would later evolve and give rise to several regulatory codes and national policies in the area.
However, from a pedagogical standpoint, this was a period of much experimentation. In 2005/2006, a webpage for the Nutrition Policy course was created. In addition to the syllabus content, two new concepts were introduced on this page: “Information” and the “PNmultimedia Café”. The “Information” section is an initial news bulletin board on the site. It functions like a wall bulletin board and allows for the posting of information deemed useful. The “PNmultimedia Café” is a space for extracurricular information where questions and news related to international politics, culture, or leisure are posted. Subsequently, throughout 2005-2006, the tools were improved, and students gained access to a personalized email account, a chat, and a forum for discussing assignments and accessing solved quizzes.
From 2005/2006 onwards, the connection to other curricular units of the course increased, namely to the basic curricular units offered in the first years, such as Biostatistics. Within the scope of this collaboration, a database and a web platform called "Alvoroço" were developed, which presented a virtual country with social, demographic and nutritional indicators, as well as other useful information and bibliographic materials, on which students built a food and nutrition policy proposal, which was presented publicly at the end of the academic year. The construction of this utopian community that we called "Alvoroço" and later "Nutopia" was nothing more than an experimental and visionary community with consumption data from our FAO scales to simulate a Portugal closer to reality when the food surveys of the 1980s were of little use to discuss the national food reality of the 21st century and make proposals for change. It was in this utopian environment that we taught generations of nutritionists.
In 2005/2006 and until 2008/09, the recording of the final presentations of the practical classes in Nutrition Policy in digital video format began. This material was compiled into a CD containing these contents, increasing the historical archive of the course and providing students in subsequent years with an example of good practices. The material was made available to students.
Based on the core material taught in the Nutrition Policy course, an adaptation was made to improve the Food and Nutrition Policy module given within the European Master's Degree in Nutrition and Public Health, led by the Karolinska Institute, in which FCNAUP participated.
Throughout this period, this topic has transformed into a disciplinary area included in virtually all undergraduate curricula in Nutrition Sciences in Portugal, and will later be considered a benchmark area in the academic training of nutritionists .
But more importantly for us, as the School of Nutrition in Porto, is that we have fostered in our academic community an interest in public policies that promote healthy eating and in involved, committed citizenship in the common good. It is our understanding that this disciplinary body encourages reflection on the major issues concerning the kind of society we want to become and how we should achieve that society. In recent decades, there has been a noticeable abandonment of democratic participation by citizens. In particular, this has been observed among younger people, whose levels of electoral and party involvement tend to be lower than that of the general population ( Henn M and Foard N (2012b) Young people, political participation and trust in Britain. Parliamentary Affairs 65: 47–67 ), and even among previous generations of young people. However, studies have also revealed that, despite their apparent lack of interest in formal political activities, young people are attracted to and engage in informal modes and styles of participation in political life ( O'Toole T (2015) Beyond crisis narratives: changing modes and repertoires of political participation among young people. In: Kallio K, Mills S and Skelton T (eds) Politics, Citizenship and Rights. Singapore: Springer, 1–15 ). This civic participation, through activities such as “giving money or raising funds for a social, civic or political activity, buying or boycotting certain products for political reasons or to favor the environment, or signing petitions” — seems to be more commonly used by young Portuguese people, as well as “online participation” — in forums or discussion groups on the internet and on social networks. Different studies in Portugal suggest that younger people have higher levels of "political self-efficacy" and "external political efficacy," meaning they have a greater perception of their ability to influence and listen to political processes. In the food sector, there is a growing interest among our university students in food-related issues, such as environmental concerns, animal rights, or humanitarian aid. These personal interests encourage our students from life sciences (usually through a very demanding, but also very individualistic and self-centered academic path) to consider themselves members of the same community, embedded in a vast food system, valuing and sharing common democratic values through civic education initiatives.
Experience-based teaching (2012-2022)
However, after many years of waiting, in January 2012, Nutrition Policy in Portugal became a reality through the creation of the National Program for the Promotion of Healthy Eating (PNPAS), a priority health program managed by the Directorate-General of Health and established by decree of the Ministry of Health. The existence of a national strategy for the promotion of healthy eating, conducted by the DGS at the national level, allowed the use of examples from a local reality and the elimination of artificially produced examples from simulators or other countries. It was in this context that education evolved towards a model based on social, legislative, and interventionist experimentation in Portuguese society produced by the PNPAS over the last 10 years.
This experimentation in the field of public policy in Portugal, despite being entirely innovative in many areas, particularly in the legislative domain, allowed us to accumulate diverse lessons that served as sources of sharing and inspiration for pedagogy in academia and also helped to build a network of national and international stakeholders in public policy in this area. The experience-based teaching and leadership we gained here also had the ethical obligation of sharing. It was precisely with the aim of extending our experience in Nutrition Policy to other national higher education institutions that trained nutritionists that we published, in 2013, in partnership with other colleagues and professors with affinities to this area, the article "Consensus on Technical, Pedagogical and Ethical Aspects of Training in the Area of Nutrition Policy for Nutrition Sciences in Portugal" . The broad dialogue on technical, pedagogical and ethical aspects of the disciplinary area of Nutrition Policy began on May 17, 2013, under the auspices of the Portuguese Association of Nutritionists (APN). At the time, all those responsible for this disciplinary area in the different public and private educational institutions were invited. As we stated at the time… “Credibility in such a recent and rapidly growing disciplinary area requires permanent and broad consensus among the professionals who work in it.” In this text, we identified a set of key premises or aspects for consolidating training in this disciplinary area that remain valid even today.
We believed at the time that it was important that this curricular area:
“- It should be taught independently from other curricular areas, but with the collaboration of related areas, namely the agricultural, environmental, social, economic, health and political science areas;
– Ideally, it should be taught in the final year of undergraduate training, integrating knowledge acquired in previous years and capable of enhancing the future Nutritionist's capacity for intervention in society;
– It should have a standardized course title, e.g., Nutritional Policy or Food and Nutrition Policy;
– It should present pedagogical proposals in line with national and international technical or political proposals for this sector, allowing the student to understand how to intervene and participate publicly;
– It should focus on raising student awareness of political ethics associated with the ethical and deontological duties of the profession and of politics as a civic duty;
– It should provide the student with a set of consolidated basic bibliographic resources, although not restricting the total freedom and autonomy of the teacher and institution in the final choice of materials and methods of pedagogical support for the student.”
The growth of critical mass in this area and its progressive differentiation is one of our objectives. Although public policies with nutritional objectives sometimes coincide with the disciplinary area of public health, over the last decade we have become aware of their differentiation and autonomy. The teaching of political science refers to a specific theoretical corpus, an analytical methodology, and the language of public policies that need to be taught in some depth before incorporating the nutritional sciences and the thinking behind public policies with nutritional objectives. Public policies are designed in institutional contexts with certain easily typified characteristics, where political actors behave in a certain, often similar, way, and the contents of public policies can be analytically reduced to certain general categories. In this context, the analysis of public policies requires knowledge of “(i) the public policy actor (whether governmental or non-governmental), their decisions and non-decisions; (ii) the objectives of public policies and the institutional means to achieve them; (iii) the problems that attract the attention of the decision-maker and become – and how they do so – the subject of public policies; (iv) the processes of policy implementation and evaluation for its improvement.” This process of analyzing the construction of agendas, the formulation of intervention proposals, the decision-making process, implementation, and evaluation requires its own methodology. In the analysis of public policies, central emphasis is placed on the processes through which actors, institutions, and the food system interact, reflecting a unique complexity and the need for disciplinary knowledge very distinct from public health. This observation has allowed the faculty of FCNAUP to invest in this area and to increasingly incorporate some principles of public policy that are essential to the development and autonomy of this new disciplinary body.
Beyond these conceptual and pedagogical issues, in the last decade we have initiated several processes to evaluate the success of the policies and strategies implemented in Portugal . Research in this area is fundamental for consolidating the disciplinary field of nutritional policy, but also for linking it to postgraduate education, where public policies have been assuming an important growth space in the training of nutritionists. Research in the area of public policies thus gains relevance, and in this sense, we recently created the Food Policy Lab within the Epidemiological Research Unit and the Laboratory for Integrative and Translational Research in Population Health (ITR) of the Institute of Public Health of the University of Porto (ISPUP), with the aim of linking research to a center of excellence.
Final notes
This year we celebrate 10 years of Nutrition Policy in Portugal and 25 years of its teaching. Conditions now exist for teaching Nutrition Policy with higher quality, and for Portuguese nutritionists with this training to progressively gain awareness of their transformative capacity. This is perhaps the greatest achievement of these years: the training of health professionals with greater collective awareness, a greater capacity to intervene in the food system, and an understanding of the collective action necessary to improve the nutritional status of populations. We believe that one of the objectives of the founding fathers of the Porto School of Nutrition . In any case, the mission is still far from complete, and public policies aimed at improving the nutritional status of populations are subject to strong pressures preventing their full consolidation. This is a huge challenge for future generations of nutritionists.
Pedro Graça has been the lecturer for the Nutrition Policy course at FCNAUP since the 1996/1997 academic year.
Maria João Gregório has been a lecturer in the Nutrition Policy course unit at FCNAUP since 2011.
Written by
Pedro Graça, Director of the Faculty of Nutrition and Food Sciences at the University of Porto
