In 2001, we wrote the article “Municipal Nutritionist as a Factor of Local Development in Portugal” (1). However, much has changed. The legal framework has changed and many municipalities have invested in food and nutrition issues for the health of their citizens. Almost 20 years after this inaugural text, it is time to reflect again on the role and future of Nutritionists in municipalities and their place in the current national food policy.
Since 1976, the Constitution of the Portuguese Republic has stipulated that local authorities are bodies responsible for pursuing the common and specific interests of their respective populations. The organization of local power is thus established by law, with the Constitution defining the bodies that make up the municipalities: the Municipal Assembly, as the deliberative body, and the Municipal Council, as the executive body. The local authority or Municipal Council is the collegiate executive body of each municipality. The term "Municipal Council" also refers to the set of departments and services of the municipal administration.
The decentralization of the State, enshrined in the 1976 Constitution, allowed for the creation of legislation granting new powers and responsibilities to local authorities. Between 1976 and 1999, several legal instruments were produced in this regard, but it was in 1999, through Laws No. 159/99 of September 14 and No. 169/99 of September 18, amended and republished by Law No. 5-A/2002 of January 11, that the framework for the transfer of powers and responsibilities to local authorities was established, as well as the delimitation of the intervention of the central administration and the local administration, thus implementing the principles of administrative decentralization and the autonomy of local power.
Municipalities then gained powers in areas such as Education; Leisure and sports; Health; Social action; Environment and basic sanitation; Consumer protection; Land use planning and urbanism are essential areas for designing food and nutrition policies, and where nutritionists can actively participate by integrating nutrition into all policies and giving shape to a strategy that we could call "Nutrition in all policies". Law No. 159/99 allowed nutritionists, endowed with an interdisciplinary and comprehensive vision of various fields of knowledge, to identify areas where the greatest health gains can be achieved and to intervene there. This includes not only the areas of health and education, where local authorities gained the capacity to build and manage facilities and participate in defining their respective local health and education policies, for example, but also to actively participate in other areas such as social action or consumer protection, where there was a great deal of work to be done.
The first nutritionists in local authorities
This opened up a new area with great potential for intervention and change in society, where nutritionists could make a difference. In this sense, several municipalities innovated and recruited nutritionists during this period, with the primary area of work almost always being primary education (1st cycle) and kindergartens, and the management of school canteens. This was precisely the area that would be worked on from September 1999 at the Vila Nova de Gaia City Council, when it began to integrate a nutritionist into its staff.
Most of the interventions of the first municipal nutritionists would be focused on the management of school canteens, from the preparation of the technical clauses of the tender specifications and monitoring their compliance to verifying hygiene and sanitation requirements, as well as in the field of nutritional education. But gradually the areas of intervention are diversifying, as teams are consolidated and the role of the nutritionist is recognized as an agent of change, and as the power of food and nutrition policies on inadequate nutrition becomes clearer.
The progressive involvement and consolidation of nutritionists in the daily work of local authorities in Portugal has been evident in the projects and work presented since 2006, when we began organizing, through FCNAUP, the 1st Portuguese Congress on Food and Local Authorities at the Misericórdia Auditorium in Figueira da Foz. Since then, and since we began to more closely monitor the local work of Municipal Nutritionists, the diversity and quality of interventions has grown significantly. At the last congress dedicated to this theme (6th Portuguese Congress on Food and Local Authorities), held in 2019 in Vila Nova de Gaia, more than 50 best practices from North to South were presented, reflecting this innovative, high-quality, and intellectually vibrant landscape in the field. From Alcochete to Vila Real, we can identify a growing demand for projects that link local resources (whether human, natural, and locally produced, or even historical) with the pursuit of improving the food and nutritional well-being of the population, generating a huge diversity of interventions that are now also beginning to be evaluated for their real value in improving the well-being of those affected by them.
Currently, it is an area of innovation and multidisciplinary development
In these most recent interventions by nutritionists in local authorities, it is possible to observe different dimensions of innovation that we can summarize as follows: establishing partnerships and seeking partners to amplify interventions; increasing the capacity to diagnose the nutritional and dietary status of the population and produce quality science that aids political decision-making; the ability to intervene to combat social inequalities in the food sector; the growing integration of environmental sustainability practices in local government food interventions, particularly in the acquisition of food products produced organically and locally; wealth creation by contributing to improved incomes for local producers, giving them greater visibility, or fostering new income sources, for example by linking tourism, gastronomic routes, and healthy eating; and the ability to integrate local practices with more global intervention models and connect local authorities in global networks interested in improving nutrition, as is the case with the Milan Pact.
This tremendous diversity and innovation make this area a laboratory of very important experiments for the future of the profession and for the consolidation of food and nutrition policy , which is worth following closely.
In parallel with this extraordinary dynamic, several laws were published in 2018 and 2019 that consolidate and increase the possibility for local authorities to outline interventions in the food sector. For example:
– Decree -Law No. 20/2019 , which implements the framework for the transfer of powers to municipal bodies in the areas of animal protection and health and food safety.
– Decree -Law No. 23/2019 implements the framework for the transfer of powers to municipal bodies and intermunicipal entities in the field of health, transferring to municipalities the establishment of strategic partnerships with the National Health Service (SNS) regarding disease prevention programs, with a particular focus on promoting healthy lifestyles and active aging. This fulfills a long-standing demand of municipalities, and it is expected that they will be able to actively participate in and influence health policy plans at their territorial level. Thus, local authorities will be able to develop or participate in activities related to disease prevention, namely in the promotion of healthy eating, regular physical activity, and active and healthy aging, in partnership with the ACES (Local Health Units) and the Regional Health Administration, within the framework of their respective action plans and the Municipal Health Plan.
– Decree -Law No. 21/2019 implements the framework for the transfer of powers to municipal bodies and intermunicipal entities in the field of education, through which the provision of meals in school canteens in the 2nd and 3rd cycles of basic education and secondary education will be managed by the municipalities. Management includes, among other factors, the definition of nutritional criteria for menus in the specifications, actions taken to verify and monitor what is offered, as well as measures to promote adequate food and nutritional consumption involving the school environment. From 2021 onwards, this transfer of powers will be mandatory for all national municipalities, namely the responsibility for the management of school canteens at all levels of education, but also the entire management of school social action, which will allow for a more detailed understanding of the social reality at all levels of education and more effective intervention in addressing social inequalities where food/nutritional issues are very relevant.
Within the context of intervention in schools, it is important not to forget the legal framework for School Health and its organizational model. School health has undergone several reforms over time, and is currently an area overseen by the Ministry of Health, with school health teams integrated into the staff of the Regional Health Administrations. Until 1971, the Ministry of Education organized medical intervention in schools through the Centers for Pedagogical Medicine; between 1971 and 2001, the Ministries of Education and Health shared responsibilities in the exercise of School Health, and in 1993, the Centers for Pedagogical Medicine were abolished, with their professionals being integrated into the staff of the Regional Health Administrations in 2002. From this date onwards, the Ministry of Health has been responsible for School Health . Following this change, the National School Health Program through Decree No. 12,045/2006 (2nd series), published in the Official Gazette No. 110 of June 7th. It is coordinated by the Directorate-General of Health, in conjunction with the Ministry of Education, with its implementation at the local level being the responsibility of the Health Centers. It should be noted that healthy eating is one of the priority areas for promoting healthy lifestyles in the National School Health Program. Therefore, coordinated action is also expected between municipal nutritionists and school health teams for an effective strategy to improve school health.
In fact, and using the examples mentioned, there is already a long history of fruitful work in partnership between schools and their health education teams, and school health teams and municipal technical teams. This work, based on genuine synergies and resource optimization, is an essential condition for schools to be recognized with the Healthy School Seal. Although, naturally, there are many aspects that need improvement.
The most recent documents from the Ministry of Education itself, namely the National Strategy for Citizenship Education, point to the importance of working in partnership. Only in this way can resources be optimized and fundamental strategies be aligned for political decisions and the definition of local priorities, directed towards the needs of each population.
This model for future articulation hardly seems to contemplate the existence of the so-called "School Nutritionist" under the Ministry of Education, as it would create a new professional profile (the category of Nutritionist is not foreseen in the Ministry of Education's organizational structure), which would duplicate the activity of colleagues who legitimately and by force of law intervene in the same area. Under the current legislative conditions, it would give rise to a professional practice with little autonomy and very limited scope of action, and little ability to influence political decision-making, which today, in this area, belongs mostly to local government. Furthermore, it is not consistent with the capacity for intervention and change in society that is desired for the profession. A central area of intervention for municipal nutritionists that emerged at the end of the 20th century, but which has fortunately evolved, in the last 20 years, in a safe and exponential way into other domains. Currently, a more active participation of nutritionists in the school environment should involve greater integration of these professionals into the structures with legally assigned competencies. In other words, local authorities, whose powers will allow them a real capacity to intervene in modifying the food supply, as well as school health teams, under the Regional Health Administrations, in the area of health education.
The future
Given this enormous potential for intervention—diverse, interdisciplinary, and legally supported within the framework of the decentralization of powers to national municipalities—municipal nutritionists, or those working in a local authority, now have the tools for a broader intervention across the entire population, with a promising future. Today, we know that the capacity to intervene systemically and in an integrated way to improve the eating habits of a broad segment of society, from urban planning to school management, is only possible at the level of local government and local policies with an explicit mandate to do so. We believe that this will be the path to quality intervention, with responsibility and autonomy, also in schools, where the municipal nutritionist sees their area of action and competence expanded, being able to intervene not in isolation (school by school), but in an integrated perspective and framed within the overall strategy of the municipality for the quality of life of the population it serves.
Looking back, and knowing what our colleagues working in the field have achieved for the profession in the meantime, we can conclude this text with the phrase we wrote in 2001 at the end of our article:
"We therefore believe that the appointment of a Municipal Nutritionist by the local government will greatly contribute to strengthening the image of local government and its ability to improve the lives of citizens."
(1) Graça P, Alves E, Camarinha B et al. The Municipal Nutritionist as a Factor of Local Development in Portugal. Human Nutrition, 2001. Vol. 7, no. 1, pp. 3-20.
Written by
Pedro Graça, Director of the Faculty of Nutrition and Food Sciences at the University of Porto
