In this text we provide a brief analysis of the State Budget for 2020, reflecting on how its approval may affect the area of nutrition, in particular public policies promoting healthy eating.
The State Budget (OE) is an annual budgetary exercise under the responsibility of the Government that identifies where the State intends to spend/invest the money generated by our taxes. Therefore, it contains a detailed forecast of the State's revenues and expenditures and must be presented to the Assembly of the Republic in the form of a bill. The OE includes "Public or current expenditures," which are the expenses that guarantee the functioning of the public administration, i.e., the money the Government has to pay the salaries of public employees, namely nutritionists, doctors, or nurses who work in public health units, and "Capital expenditures," which is the money the State spends on roads, bridges, schools, hospitals, libraries, i.e., on assets that increase the country's productive capacity.
The State Budget reflects the Government's strategic direction and where it intends to invest. Although the Government has defined four strategic challenges for the coming years ("combating climate change, addressing demographic dynamics, leading the digital transition and reducing inequalities"), which do not directly address the health sector, the proposed State Budget for 2020 considers "Strengthening the supply and quality of services provided by the National Health Service" as one of its four strategic axes, along with "Preserving structural budgetary consolidation (sound and balanced public accounts)", "Intensifying social protection and poverty reduction policies" and "Promoting policies aimed at addressing demographic dynamics". This raises the expectation that investment in health will be one of the political priorities for the coming years.
In the area of health, this budget aims to reinforce the National Health Service (SNS) budget for 2020 by €926 million compared to the 2019 budget, through a 10% increase, with a view to increasing the SNS's response capacity, including the planned increase of 8,400 health professionals, increased investment in facilities and equipment, and improvements in the monitoring and evaluation of the management of SNS units. In other words, the Government has publicly committed to reinforcing the health sector with €800 million and hiring an additional 8,400 health professionals.
From the analysis of the 2020 State Budget , it is possible to identify some areas that constituted the Government's priorities for strengthening the health sector, and some of the measures that will represent changes for the provision of care in the area of nutrition can be highlighted:
1) Reinforcement of professionals in the NHS , with the hiring of approximately 8,400 health professionals planned for 2020 – “Between October 2015 and 2019 there was an increase of 15,273 workers (12.8%) in the various professional categories of the NHS: 3,820 more (15%) doctors, 6,629 more (17.3%) nurses, 929 more (12.3%) diagnostic and therapeutic technicians and 3,895 more (8.1%) staff from other professional categories. In 2020, the NHS budget will be reinforced by 942 million euros compared to the previous budget, through the planned hiring of approximately 8,400 health professionals.” (p. 181)
2) Strengthening the responsiveness and differentiation of primary health care, explicitly reinforcing the provision of care in the area of nutrition - “Improving the efficiency of functional primary health care (PHC) units with a balanced workforce mix in terms of senior health technicians, senior diagnostic and therapeutic technicians, technical assistants and operational assistants;” (p. 21) and “With a cost of 1.8 and 2 million euros, respectively, the total consolidated effective expenditure of the Health Program will see a reinforcement of the provision of psychology and nutrition care in each group of health centers (ACES).” (p. 183).
3) Digital transition in healthcare , through a strategy for modernizing the NHS information systems – “Modernizing information systems;” (p. 21).
4) Investment in public health – “In the field of public health, in order to increase disease prevention and health promotion, measures are foreseen such as the expansion of the National Vaccination Program (costs of 10.9 million euros), the continued implementation of the strategies defined in the priority health programs and health programs, investment in the population's health literacy, and the evaluation of the National Health Plan and the preparation of a new 2021-2030 plan (600 thousand euros).” (page 183).
Of these measures, it is important to highlight the significance of this budget proposal in increasing access to and quality of primary healthcare, including expanding the capacity to respond in the area of nutrition. This was already a proposal that was part of the electoral program presented by the Socialist Party for this year's legislative elections and now seems to have a place in the budget foreseen for the health sector for 2020. We recall, in an analysis done here at Pensar Nutrição on the proposals of political parties for the area of food and nutrition in the 2019 legislative elections , that the Socialist Party's electoral program presented the following proposal: “Primary health care with more responses; Primary health care is the basis of the Portuguese health system and the best way to achieve the goal of universal health coverage. Therefore, it is necessary to strengthen primary health care and, with this purpose, the PS will: Continue to differentiate primary health care, improving its effectiveness, not only by generalizing oral and visual health care, psychology and nutrition and diagnostic means, but also by offering other specialties, such as gynecology or pediatrics;”.
Another area we can highlight is the importance of increasing disease prevention and health promotion, particularly regarding the implementation of strategies for priority health programs, within which the National Program for the Promotion of Healthy Eating (PNPAS) is included. This is particularly relevant, as the PNPAS has received support but has not yet had any allocated funds in the State Budget.
The Ministry of Health's commitment to modernizing the NHS information systems also deserves a brief mention. The investment that the PNPAS has made in recent years, exclusively supporting the development of the nutrition module of the Clinical System for hospital care and primary health care, can contribute to a significant improvement in the working conditions of nutritionists working in the NHS and, consequently, to ensuring better nutritional care for our population. The continuous improvement of these information systems and the development of new functionalities, namely the extraction of indicators, should continue to be a priority, supporting the work of nutritionists and valuing their production and contribution to the proper functioning of the National Health Service.
Finally, the special consumption tax on sugary drinks, which the health sector has technically supported since its inception, remains in the 2020 State Budget, with a slight increase for drinks that fall into the brackets with a higher sugar content. This maintains one of the measures considered cost-effective for promoting healthy eating habits and has shown positive results in terms of its impact on reducing the consumption of these drinks and reformulating their sugar content.
In any case, this budget proposal, as the name indicates, is not yet finalized nor has it been approved by Parliament. The budget discussion will begin on January 6th, with hearings in the Budget and Finance Committee with the Ministers of Finance and Labour, Solidarity and Social Security. After the general discussion and vote, between January 13th and 27th, the detailed discussion and vote will take place, for which several topics have been postponed, between February 3rd and 5th. The final discussion and vote will take place on February 6th, with the aim of the document reaching the President of the Republic, Marcelo Rebelo de Sousa, by February 24th.
Written by
Pedro Graça, Director of the Faculty of Nutrition and Food Sciences at the University of Porto
