Policy proposals in the area of ​​nutrition for the 2024 legislative elections

Understanding the measures and proposals of the different political parties before voting is essential for making an informed decision.

In the field of nutrition, we have been analyzing the proposals of different political forces in national elections, and we are doing so again in these legislative elections of March 2024. This discussion is important for the full participation of citizens in democratic life and is part of an effort to involve and train future nutrition science students as "agents of change" in their area of ​​influence.

This effort to bring young university students into the discussion of public issues as active citizens, involved in democracy and society, is at the genesis of the work developed at FCNAUP and in the Nutrition Policy discipline since 1997 and is part of European policies in this area, namely the “ EU Youth Strategy ”.

Nutritional policies and proposals in the area of ​​nutrition and food

Nutritional  policies , as public policies, are based on a set of distinguishing characteristics, namely the fact that they integrate a set of measures that are coherent with each other, taken by someone with political legitimacy, and that they involve diverse actors. In other words, decisions can be influenced before being made by the intervention of various actors and, thus, aim for results considered socially relevant.

In this context, we define nutritional policies as public policies that aim to improve the nutritional status of populations. Structurally, these policies attempt to modify the availability of certain foods and their supply in public spaces, informing and empowering citizens to purchase, prepare, and store healthy foods, especially among the most disadvantaged groups in the population.

Furthermore, they aim to improve the qualifications and performance of various professionals who, through their work, can influence knowledge, attitudes, and behaviors in the food sector. These interventions are often achieved in a coordinated and integrated manner with other sectors, namely agriculture, sports, environment, education, social security, or local authorities.

Policies aimed at improving the nutritional status of populations can therefore be included in electoral programs in areas other than health. 

From the analysis carried out in previous elections, namely the legislative elections of 2019 and 2022 , we identified isolated measures in the different electoral programs at the national level that could potentially influence the nutritional status of the population, but we did not find them organized in a coherent way or integrated with this objective.

The fact that these measures may be distributed throughout the food system can also hinder their integration and coordination, especially if the political power does not recognize them as parts of the same whole, which is the case in almost all instances.

How to analyze election programs

The methods used to compare programs and policies have grown in sophistication in recent decades. They can compare political processes and their evolution over time, the structures used for their implementation (e.g., within or outside the government), the proposals and objectives, and even the actual implementation versus the initial , for example.

In general, comparative analysis of political programs uses qualitative methods, but lately there has been increasing recourse to quantitative methods. Recently, several studies, using artificial intelligence, have attempted to evaluate factors that influence the decision to read texts .

Election programs also been the subject of research. Issues such as semantic complexity or the emotions they convey are beginning to be analyzed and integrated with the help of Artificial Intelligence (AI), greatly increasing the ability to understand political programs and texts.

However, in this document, we only provide a rudimentary and classic assessment of electoral programs.

Initially, we look at electoral programs as a) a "product of equilibrium" in the electoral market, influenced by the party's ideological line, the main orientation of the political force, and what its usual electorate seeks, and b) as a social reflection of the surrounding context, of what society is like and how it is at the time of the election.

The aim of this rudimentary analysis is to examine how food or nutrition issues are addressed as a programmatic theme and how different political forces refer to the issue of nutrition in their electoral programs. To this end, we examined the electoral programs of parties that elected at least one member of parliament in the last elections or the coalitions in which parties with these characteristics are included.

The selection of the most relevant information from each political program and its aggregation into different areas of intervention or political culture reflects the authors' perception*.

Next, we describe the proposals from the different political forces. 

The context of the 2024 legislative elections

In the 2019 and 2022 elections, we did not find a marked and visible ideological division in the proposals in the area of ​​nutrition and food.

If we wanted to try to divide the political options between a more protective and guarantor state, in health, education and the economy, as opposed to a less present state that essentially fulfills a regulatory role and opens up much more space for the private sector in different economic policies, that division would not be very visible.

Furthermore, in the area of ​​health, what we identified was a discussion centered around the sustainability of the National Health Service (SNS) and its human resources, focusing heavily on the attraction, retention, and professional development of medical and nursing staff (particularly general and family medicine specialists) and less on multidisciplinary health teams.

In the 2024 elections, the national political context highlights the need to respond to the demands of healthcare professionals, due to pressure from strikes and failures in Emergency Services that occurred throughout 2023, and the significant difficulties in the functioning of the National Health Service (SNS), which is seen as a fundamental component in the quality of life of the increasingly aging and ill Portuguese population.

This focus on professionals and improving their working conditions, as a way to rebalance the National Health Service and respond to their demands, is central to the political concerns of the different political parties and will certainly influence the drafting of the various electoral programs.

In this context, the struggles of professionals with the greatest capacity to influence the functioning of the National Health Service (SNS), namely doctors and nurses, are gaining prominence on the political agenda to the detriment of other professionals, particularly nutritionists.

These professional struggles are also gaining ground at the expense of health promotion and disease prevention policies which, in our opinion, should be central to the survival of the National Health Service.

Another important aspect of these 2024 elections is the importance given to mental health issues. Mental health has gained prominence in public opinion due to COVID, lockdowns, and the work of psychologists and their professional body in recent years.

Today, there is a heightened focus on mental health as an important determinant of our quality of life. This is not only due to the impact of lockdown, but also to new ways of working, the isolation it can promote, and the growth of social networks and technology in our personal and professional lives.

Another area that gained prominence, we believe through contagion between political parties, was oral health, particularly with the interest in strengthening the National Health Service and the role of dentists.

However, despite inadequate nutrition continuing to be one of the main determinants – if not the main determinant – of the loss of healthy years of life for the Portuguese population, a strategy for healthy eating and for improving nutritional status, as well as the presence of healthcare professionals, remains poorly visible or even invisible in many of the electoral programs proposed for 2024.

Meanwhile, food prices gained significant visibility in the economy and in citizens' perception of purchasing power due to rising inflation throughout 2022 and 2023, leading to various proposals to mitigate this impact, such as reducing VAT rates. Food as a factor in promoting health clearly loses importance in favor of food and its price as a factor in stabilizing the family economy. In other words, the economy, not health, is the focus of discussion in the food sector. 

Recently, the loss of purchasing power among farmers is putting pressure on governments to promote changes in agricultural policies, reducing some of the current environmental protection measures.

Achieving an ecological transition in agriculture without losing production seems to be difficult in the medium term, particularly with the growth of populism that easily exploits these banners of protecting national production on the eve of national and European elections. And it is precisely the producers of organic and integrated production who seem to be most affected, while those most resistant to ecological rules appear to be the more industrialized agriculture of large producers.

Paradoxically, and simultaneously, pressure on agricultural systems is increasing due to climate change, with reduced rainfall and rising temperatures. 

It is within this context of enormous uncertainty about the food system and also about the health system that these elections are taking place.

This uncertainty is compounded by significant citizen discontent and unease with the current political system, which could lead to more populist electoral campaigns that are further removed from realistic medium- and long-term goals.

Party platforms and nutrition issues

Left Bloc

The Left Bloc (BE) electoral program is titled "Doing what has never been done" and identifies wages, housing, care, health, education, and climate as central themes. In the area of ​​nutrition and food, we identify the following proposals:

– To enshrine in law a meal allowance for all private sector workers, with a minimum value equal to that of the public sector (without prejudice to collective agreements that establish a higher value)

– Promoting the production and consumption of locally sourced food products and sustainable agriculture;

– Establishment of a Framework Law for the human right to adequate food and nutrition;

– Application of a zero VAT rate to essential food items;

– Public management of school canteens with local production and short supply chains;

– 100% reimbursement for prescribed enteral nutrition, free distribution of new semi-automatic insulin devices to all children and young people with type 1 diabetes, as well as to adults with clinical criteria, and reimbursement for obesity medications.

– To hire a sufficient number of nutritionists to guarantee, in health centers, the minimum ratio of one nutritionist per 12,000 inhabitants, thus enabling access to nutrition consultations for users with diabetes, hypertension, and other clinical conditions that benefit from specific nutritional plans.

Liberal Initiative

The Liberal Initiative (IL) electoral program is titled “For a Portugal with a future” and identifies economic growth with lower taxes and greater purchasing power, health, education, housing, and justice as central themes. The discourse and proposals revolve around a central idea: “Lower taxes. Unlock the economy. Reduce the role of the State to that of a regulator.”

In the area of ​​nutrition or regarding nutritionists, IL says nothing. However, indirectly, certain measures affect or may affect food consumption and nutritional status. For example:

The Liberal Initiative is committed to studying the main reasons that have led to the high level of food waste in Portugal, so that it can design effective measures, even if only awareness-raising, to prevent it and help the Portuguese to better economize on their consumption, thus protecting the environment. Campaigns will be needed to raise awareness about food waste, with recommendations on food preservation, literacy regarding expiration dates, and food preference.

Furthermore, in both health and education, issues such as nutrition or the inclusion of nutritionists are not addressed, with the focus shifting to the role of doctors and nurses, particularly in strengthening the skills of specialist nurses and promoting mental health.

Portuguese Communist Party

The electoral program of the Portuguese Communist Party (PCP) is entitled “Patriotic and Left-Wing Politics – Solutions for a Portugal with a Future” and identifies as main areas, among others, “A free and sovereign Portugal, a country that commands its own destiny, a people that builds its own future”; “A State at the service of the people, which enforces social rights, ensures the rights to health, housing and education and promotes culture”; A cohesive and balanced country, the defense of the interior and the rural world, based on regionalization and territorial planning and an environmental policy that safeguards nature;

In the area of ​​nutrition and food, we identified the following proposals:

– To ensure the provision of visual health care, physical medicine and rehabilitation, and nutrition in primary health care;

– VAT: creation of a broader basket of essential goods, taxed at 6%, including all electricity, natural gas, bottled gas, telecommunications and all products for human consumption, along with a reduction in the standard VAT rate;

– Revitalizing local and regional economies, with support for agricultural associations (storage, processing, local markets); focusing on short supply chains with priority given to supplying public canteens, promoting agritourism and rural tourism, and showcasing the quality of local flavors, culture, and traditions; 

– Combating the causes of mass migration, namely neocolonial policies, processes of external interference and wars of aggression, and the plundering of natural resources. Defending the right of peoples to development, life, food, housing, health, education, employment, security, and peace.

Free

The Livre party's electoral program for the 2024 legislative elections is titled "A Contract with the Future" and identifies labor and social harmony, strengthening areas such as health and education, expanding the welfare state, and ecological transition as priority areas. This is one of the programs that gives the most importance to food and nutrition issues. How? Through the following measures:

– To create the Chronic Patient Statute, a comprehensive initiative involving patient associations, that establishes broad criteria for the prevention, diagnosis, treatment, and rehabilitation of people with chronic and/or disabling diseases, aiming to mitigate early disability and reduced life expectancy associated with chronic diseases.

– Include clinical psychologists and nutritionists in primary healthcare teams, ensuring that each health center has at least one clinical psychologist working in conjunction with other professionals.

– Update the tables of chronic and disabling diseases and create specific measures that allow for the improvement of the quality of life and well-being of people with these diseases, including the co-payment of specific products available in community pharmacies (such as laxatives, straws, parenteral and enteral nutrition products, nasogastric tube feeding, among others).

– Strengthen the National Program for the Promotion of Healthy Eating;

– Strengthen primary obesity prevention strategies by increasing health literacy and effectively implementing programs that promote healthy lifestyles;

– Increase regulation of the sale and advertising of foods that are harmful to health;

– To develop a structured curriculum on health literacy through multidisciplinary teams (with professionals from the fields of psychology, nursing, general medicine and nutrition) to be applied in all schools, within the scope of the citizenship education subject, adapted to the various age groups, on topics such as mental health, sexual and reproductive health, violence prevention, healthy and balanced eating, nutrition, physical activity, among others;

– To revitalize public canteens so that the main objective is the well-being and nutrition of children and young people, and not profit, through a service provided by the educational establishments themselves or by local authorities, and not by private companies, improving the meals provided both in terms of quality and quantity, thus providing healthy meals suitable for the various age groups of students, with due quality control, ensuring the essential nutrients to promote healthy eating and lifestyles, enabling the use of regional products, promoting the practice of the circular economy.

– Increase funding for Higher Education Institutions that financially support Medical Centers and Canteens, allowing for consistent and sustained investment by these institutions in the health and well-being of their community, rewarding those who invest heavily in these areas of social action.

– To promote a diet that is both healthy and sustainable, ensuring that non-local products include the cost and externalities of their transport and production in their final price; supporting the purchase of seasonal and locally produced foods for canteens and public institutions; promoting the use of organic or integrated production products; and continuing the National Strategy to Combat Food Waste.

– To promote small-scale and family farming through the implementation of agroecological and regenerative practices, maintaining the dynamism of rural areas, combating climate change and biodiversity loss, with the support of traditions, knowledge, culture and the use, by these farmers, of their own seeds and native species.

– To protect the position of farmers in the agri-food distribution chain, by prohibiting sales below production costs (dumping) or by establishing price and profit margin control systems.

– To create a Food Observatory and an intersectoral food planning system that includes policy instruments at all scales (national, regional, and local) and is fully aligned with the CAP Strategic Plan (2023-2027) and with the land-use planning system and legal instruments for land management. National food policy should follow a socio-ecological and territorial approach to food security, integrating perspectives from public health, environmental preservation, and biodiversity. This policy should promote the territorialization of the food system, prioritizing increased food self-sufficiency at the national level, according to the specificities and potential of each agricultural region. In this sense, the aim is to prioritize the production of certain traditional crops and varieties, encouraging the production systems necessary to reduce supply shortages in the domestic market, reducing external dependence, and promoting local production and consumption patterns aligned with the objectives of a true circular economy

– Review the National Strategy for Organic Agriculture, updating it in line with the objective of ensuring 25% of usable agricultural land is dedicated to organic production methods, as formalized in the European "Farm to Fork" Strategy, promoting short supply chains and local markets, and supporting the creation of Associations for the Maintenance of Local Agriculture.

– To encourage farmers to implement Organic Production Methods, as well as other production methods based on best environmental practices, subject to measures that promote the safeguarding of biodiversity, soils and natural resources, through the creation of a reserve fund that ensures the availability of funds, at the right time, for the payment of agri-environmental measures, and through reduced VAT for products that are entirely “organic” in origin and produced in Portugal.

– Reopen the process of amending the statutes of professional bodies in the next legislature, with a view to clarifying the issues raised by the various organizations and correcting the gaps identified in the approved statutes, ensuring consultation with the professional bodies and an open and participatory discussion.

– To improve healthcare and nutrition in educational centers and prisons.

He arrives

The Chega party's electoral program for the 2024 legislative elections is titled – Clean Up Portugal – and identifies as priority areas “Ending the abuse of power and impunity for the corrupt; achieving a more honest political class, but also promoting greater integrity in the private sector; ensuring transparency in public processes or those involving public money; and strengthening judicial integrity and capacity, among others.” The program pays little attention to nutritional and food-related problems. How does it address this? Through the following measures:

– To strengthen the implementation of the strategy to combat obesity by encouraging obesity prevention consultations and monitoring of patients with pre-obesity and obesity, with a view to their treatment in the early stages of disease development, and the implementation of obesity and metabolic disorder screening programs by personalized healthcare units and family health units.

– Prioritize the marketing of national agricultural production, promoting preferential use of local produce, purchases by municipalities for canteens and cafeterias, supporting local or community-based agricultural initiatives, as well as national initiatives such as the “Portuguese Product” program.

Democratic Alliance

The electoral program of the AD – Democratic Alliance for the 2024 legislative elections is titled – “Safe Change” and identifies as its most relevant axis “social policies and the promotion of the well-being of the population, seeking a more just, more supportive and more humane society that respects the dignity of the human person, protects the most vulnerable, values ​​work and merit, and encourages responsibility and citizenship”. Among other aspects, it defends the following initiatives in the area of ​​food and nutrition:

– To create a Motivation Plan for Healthcare Professionals, in order to autonomously value all human resources involved in providing healthcare to people, especially in the National Health Service (SNS). This plan will cover the careers of doctors, nurses, pharmacists, administrators, psychologists, physiotherapists, nutritionists, and auxiliary healthcare technicians. This plan will cover work incentives, career development, flexible working hours, professional differentiation, and new skills profiles.

– It is absolutely essential to motivate, support and bring together the ethical and professional spirit of Doctors, Nurses, Pharmacists, Psychologists, Physiotherapists, Nutritionists, Diagnostic and Therapeutic Technicians, Emergency Technicians, Operational Assistants, Administrators, IT support teams, engineering, administrative and financial teams, and all those who work with dedication in the NHS and the Portuguese health system.

– Expand Clinical Psychology, Rehabilitation Therapy, and Nutrition consultations in Health Centers.

– Consider reducing the VAT rate to the minimum for baby food, supporting families in accessing nutritionally adequate food to meet the needs of babies.

Socialist Party

The Socialist Party's electoral program for the 2024 legislative elections is titled – “Action Plan for the Whole of Portugal” and presents the following 5 pillars: “An Economy in Transformation, based on Balanced Accounts; A Strong, Modern and Inclusive Social State; An Entire Territory and a Just Climate Transition; A Quality Democracy for All; A Central Portugal in Europe and the World”. Among other aspects, it advocates the following initiatives in the area of ​​food and nutrition:

– To focus on improving the quality of responses, both in terms of teaching and the implementation of a healthy eating program aimed at young children.

– To strengthen and diversify the provision of local care, improving access to, among other things, oral and visual health services, pediatrics, speech therapy, clinical psychology, mental health, and nutrition.

– Invest in prevention and health promotion, focusing on public health and combating the determinants of health.

– To strengthen the training of professionals in social services for the elderly in preventive health and risk factors, in matters related to physical and psychological health, overdose and side effects, nutrition and healthy habits, among others.

– Reducing waste in landfills and treating it more efficiently is also correlated with the paradigm shift towards a more circular economy, as well as changes in consumption habits, particularly in food.

Evolving towards agriculture that is better adapted to climate, ecological, and energy transitions, and that promotes carbon sequestration, requires greater interaction with the scientific and technological system, enabling proper water management, fire prevention, and healthy and sustainable food production.

– To promote sustainable food systems, in line with the Farm to Fork strategy, with an emphasis on public procurement of school and hospital food, ensuring healthy food in canteens.

Conclusions

The current social, economic, and political climate seems to have significantly influenced the production of the electoral programs for these legislative elections.

The growth of problems and disputes in the areas of health and agriculture could have been an important opportunity for increased attention to issues of food, nutrition, and the health professionals who work directly in these areas, namely nutritionists.

However, it is felt that, more than a strategic and organized response to these problems, the different electoral programs attempt to respond to the demands of professional classes with greater capacity for making claims, to the immediate concerns of voters, and to try to contain the political use of these issues by more populist forces that are growing in the polls in terms of voting intentions.

There is still much work to be done by nutritionists so that inadequate nutrition is truly understood as one of the main determinants of poor health among the Portuguese population, and where it is worthwhile to invest.

A recent poll on voters' concerns revealed that 72% of respondents cited health as the issue they would like candidates to discuss during the election campaign. Education followed with 48%, and only 7% mentioned security or 4% mentioned wages.

However, we believe that the issue of inadequate nutrition as a major determinant of the loss of healthy years of life for the Portuguese population and of health inequalities is not considered central to the political discussion of health problems in Portugal, despite scientific evidence to the contrary.

Most of the electoral programs analyzed do not show a perception of the centrality of healthy eating and the enormous impact of diet-related diseases such as overweight (affecting more than 6 million Portuguese), diabetes (1 million Portuguese), hypertension (more than 3 million Portuguese), cerebrovascular disease or certain cancers on the functioning of the National Health Service or on the growth of social inequalities in Portugal.

Prevention and approaches to these diseases are crucial for the survival of the National Health Service (SNS) as they represent the vast majority of its costs; however, these aspects are given almost no importance in most of the documents analyzed in these 2024 legislative elections. 

Similarly, most election programs divide problems sector by sector (health, education, agriculture, etc.), having difficulty relating sectors or integrating problems.

Examples of this difficulty include the lack of references to the promotion and safeguarding of the Mediterranean food pattern, also known as the Mediterranean Diet, as a model of food consumption that allows for the integration of the promotion of healthy eating, the defense of health, traditional products, and the rural world with environmental issues.

Another example could be the absence of references, in electoral programs and specifically in the health sector, to the problem of alcohol and its excessive consumption, one of the major public health problems in Portugal, but one that has implications for strategies for rural areas and tourism.

The need for strategic intervention in food support and the promotion of healthy eating among a population of 2 million Portuguese living below the poverty line remains largely invisible in most electoral programs. This is an economically vulnerable population where inadequate nutrition and the subsequent associated food-related illnesses are more prevalent, creating a toxic circular effect between poverty and disease. Poverty issues in Portugal often stem from a lack of access to essential goods such as healthy food, an issue that is largely ignored in the programs of various political parties.

We also detected a significant inability to connect issues of food production and consumption with environmental issues. This inability is also revealed in the haphazard way in which agricultural and food issues are presented in the space that the main political parties dedicate to the rural world or the environment, with few exceptions, such as some more fringe parties.  

Today, we know the enormous impact that different food choices have on greenhouse gas production, with food production and consumption considered a central determinant in the current climate crisis. This aspect should highlight the importance of discussing food consumption models, namely the promotion of plant-based foods in our diet and the integration of these concerns into food production models, or issues of circular economy and proximity. Once again, these themes are scattered or absent in the documents read.

In light of the electoral programs analyzed previously, in the 2019 and 2022 elections, there is now an increase in references to the importance of food issues, some nutritional questions, and the role of nutritionists by parties that we can place further to the left of the political spectrum, such as the Left Bloc and particularly Livre , which is the party that pays the most attention to nutrition issues in these elections. These parties are beginning to link food with the environment and to reference and quantify the needs for nutritionists.

In contrast, the electoral programs of the parties that traditionally have the most weight in Portuguese society and that will most likely be in a position to govern, in particular the AD, but also the PS, reveal in these elections a lack of attention to the problems of food and nutrition in their electoral programs.

In some cases, even regressing compared to programs presented in previous elections, in the case of IL and Chega these issues are practically non-existent. 

The extreme fragility of the National Health Service (SNS) and its inability to address the discontent of doctors may help explain the focus on these issues, but it cannot explain the lack of strategic thinking about the prevention and treatment of the main chronic food-related diseases affecting millions of Portuguese people, and on which the WHO is calling for urgent intervention.

We hope that, similarly to mental health, which has rightfully gained its place in public discussion, issues of food and nutrition will soon receive the attention they deserve from political candidates.

Final notes : The authors have no political affiliation and the opinions expressed in this text reflect solely their personal views.

The PAN (People-Animals-Nature) electoral program was not analyzed because it was not yet available at the time this document was produced. It is regrettable that, with electoral debates already underway and less than a month until the elections, certain parties have only now presented their letters of intent, which are their electoral programs.