1. Pedro Graça, pedrograca@dgs.pt Inequalities and nutrition status - Portuguese needs and EEA Grants approach Lisboa, June 5 h 2014

2. EEA Grants 2009-2014 Programme Area: Public Health Iniciatives (to improve public health and reduced health inequalities) Focus Area: Reducing inequalities in nutrition Focus Area: National registries, health information systems, data management and use improved

3. Programme motivation and justification The association between socio-economic inequalities, health, food consumption and obesity prevalence is consistent. Population groups of lower socio-economic status have been considered at risk of having a poor health status, an unhealthy diet and a higher risk of developing obesity and obesity-related diseases (diabetes, cardio-vascular diseases, cancer). Available data for Europe, suggests that around 20-25% of obesity found in men and 40-50% of obesity found in women can be attributed to differences in socio-economic status.

4. The concept of Food Security “The access to sufficient, safe and nutritious food to maintain a healthy and active life” World Food Summit, 1996

5. Cycle between poverty, food insecurity and NCDs (Gregório, Graça, Nogueira et al, 2014)

6. IHME, 2014

7. Underweight IMC≤18.5 Normal weight 18.5≤IMC<25 Overweight 25≤IMC<30 Obesity IMC≥30 Overweight and obesity IMC≥25 Food Security level Food SecurityRef. Food Insecurity 0.788 (0.676.0919)* 1.111 (0.620-1.988) 1.174 (1.009-1.365)* 1.109 (0.923-1.332 1.258 (1.079- 1.466)* p<0,05 Food Security and obesity (2011-2013) Adjusted logistic regression analysis results of food insecurity by levels in Portugal by BMI class (n=3622) Adjusted for geographic area, age, sex, highest level of education, occupational status, nationality, presence of children in household, family size and number of household members with income ). (InfoFamília, DGS)

8. (InfoFamília 2013, DGS) Adjusted OR for food insecurity by selected socioeconomic and demographic characteristics INFOFAMÍLIA, 2013 - Portugal

9. (InfoFamília 2013, DGS) Adjusted OR for food insecurity by selected socioeconomic and demographic characteristics INFOFAMÍLIA, 2013 - Portugal

10. The characteristics of the study population (n=1098) Health inequalities in energy balance-related behaviours among schoolchildren across in Europe: Baseline results of the EPHE project (Mantziki K et al, 2014)

11. Child´s energy balance-related behaviours (dietary, sedentary and sleeping behaviour) associated with food insecurity: Baseline results of EPHE project Portugal

13. National Program for Healthy Eating Promotion Portugal 1) Improve the food and nutrition knowledge 2) Improve the availability of healthy food products 5) Improve professionals qualifications 4) Intersectoral nutrition-related actions 3) Improve consumer knowledge (Graça et al, 2013)

14. Objective of Programme and Expected Outcomes Reducing inequalities in nutrition This planned program intends to: -strength the knowledge and skills of vulnerable groups about healthy and low price diets. Produce educational and electronic tools aimed at planning healthy menus concerning questions like price of food items or culinary skills for vulnerable groups. -This programme should also allow sharing experience and good practices and networking between professionals and between different levels of national and regional governments, in order to improve governance related to nutritional inequalities in health care, municipalities and social care.

15. Regional programs to qualify social institutions, NGO's or municipalities to provide adapted food services for adult vulnerable groups Increase the knowledge, intervention capacity and nutritional skills of professionals that work with vulnerable groups Develop and implement regional programs for health professionals from primary care/hospitals who work with older people with the objective of improving the nutritional surveillance and community intervention Development of training programes at regional school level aiming to prepare staff to deal with nutritional inequalities through the collaboration of education with health and other sectors namely municipalities National educational, informative materials and interactive electronic tools developed to promote healthy food at low prices and adapted to populations with low literacy levels Strengthening knowledge and skills of vulnerable groups Improve schools capacity to deal with nutritional inequalities Improve social canteens capacity to provide nutritional quality meals Improve Health/Non Health Professionals intervention capacity Reducing inequalities in Nutrition expected outputs expected outputs Outcomes

16. Objective of Programme and Expected Outcomes This planned program intends to: -Better understand the eating patterns of vulnerable groups, to monitor the evolution of eating habits and evaluate mitigation strategies used by vulnerable groups and institutions that support them. -Improve national registries, health information systems, data management and improve the respective use in infections associated with health care and antimicrobial resistance. National registries, health information systems, data management and use improved

17. Dietary survey and physical activity at the national level and its relationship with the socio- economic situation. Development of the first national nutritional status surveillance in elderly people. Evaluation of prevalence and socioeconomic determinants of food insecurity in the Portuguese population, particularly in socioeconomically disadvantaged groups. Production of a database updatable with identification of good practices at the national level in the promotion of healthy eating for socioeconomically vulnerable groups and guidelines (guidelines) and indicators for the construction of new projects in the area. Information on good practices in the promotion of healthy eating to socio-economically. vulnerable groups Information on prevalence and socioeconomic determinants of food insecurity in the Portuguese population. Information on food intake and physical activity at the national level. National nutritional status surveillance undertaken for elderly people. National registries, health information systems, data management and use improved expected outputs Outcomes

18. The importance of local government participation with improved capacity to evaluate food insecurity Create strong networks between local food producers and consumers Improve the nutritional quality of food assistance programs Integrate traditional diets as a sustainable and healthy diet pattern (Mediterranean diet) Improve public health nutrition workforce capacity to be involved in solutions Looking for potential areas of intervention in Portugal

19. Pedro Graça Director PNPAS pedrograca@dgs.pt Thank you for your attention!