David Cruz e Silva 🎙

The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.

In response to stalling progress in NCD related premature mortality, the Portuguese government declared the ‘Promotion of Healthy Eating’ a national priority and convened a multisectoral task force with representatives from several ministries in order to tackle unhealthy diets [1]. With the inputs from civil society, non-governmental organisations and health authorities, this task force developed the Integrated Strategy for the Promotion of Healthy Eating (Estratégia Integrada para a Promoção… Exibir mais

In response to stalling progress in NCD related premature mortality, the Portuguese government declared the ‘Promotion of Healthy Eating’ a national priority and convened a multisectoral task force with representatives from several ministries in order to tackle unhealthy diets [1]. With the inputs from civil society, non-governmental organisations and health authorities, this task force developed the Integrated Strategy for the Promotion of Healthy Eating (Estratégia Integrada para a Promoção da Alimentação Saudável – “EIPAS”). The strategy – endorsed by the Portuguese Ministers Council in December 2017 – included fiscal measures, co-regulation agreements with the food industry, enhanced cooperation with municipalities, and measures to change the food environments in public settings among many other initiatives [1].

In December 2016, the Portuguese Parliament approved a special consumption tax on sweetened beverages which has been associated with product reformulation and a fall in sales [2]. Inspired by the success of the tax on sweetened beverages, in December 2018, the government proposed a tax on salty processed foods; as salt is the leading dietary risk factor for NCDs in Portugal [3]. Even though the average consumption is 10.7g/d [3] far above of the WHO recommended threshold of <5g/d, the majority of the Portuguese Parliament Members voted against this proposal, recommending instead a co-regulation agreement with the food industry to achieve similar changes in consumption of salt [4]. After one year of negotiations, the Portuguese Ministry of Health (MoH) and the food industry representatives signed a broad ‘Food Industry Co-regulation Agreement’ on the 2nd of May 2019.

The agreement covers the main food products high in salt, sugar, and trans fatty acids as well as the main dietary sources of these nutrients for the Portuguese population. Exibir menos

8 years after the adoption of the WHO European Action Plan on Alcohol (EAPA), the region has the highest prevalence of drinkers, heavy episodic drinking, alcohol consumption per capita, and the lowest proportion of abstainers, compared with other WHO region. Most worryingly, one in every four deaths in young adults (aged 20–24 years) is caused by alcohol. Furthermore, alcohol is a substantial contributor to inequalities in health. According to WHO, the most cost-effective policy options for… Exibir mais

8 years after the adoption of the WHO European Action Plan on Alcohol (EAPA), the region has the highest prevalence of drinkers, heavy episodic drinking, alcohol consumption per capita, and the lowest proportion of abstainers, compared with other WHO region. Most worryingly, one in every four deaths in young adults (aged 20–24 years) is caused by alcohol. Furthermore, alcohol is a substantial contributor to inequalities in health. According to WHO, the most cost-effective policy options for member states to reduce the harmful use of alcohol are the so-called best buys for the prevention and control of non-communicable diseases. However, member states' efforts to introduce these measures are often diluted by trade agreements, economic interests, or exposure to cross-border issues (eg, online advertising and sales).
In January 2019, the WHO Regional Office convened a consultation process to revisit the implementation of the policy areas for action defined in the EAPA. Policies with the lowest levels of implementation in the European region were examined for the 13 participating member states (appendix). Exibir menos

Noncommunicable diseases (NCDs) are the leading causes of death, disease and disability in the WHO European Region and are largely preventable. The private sector has long been using marketing to influence and change people’s lifestyles. In some cases, particularly the food sector, health-compromising content is prioritized over health-promoting content. However, this case study aims to illustrate how governments working on tight budgets can partner with private media companies to their own… Exibir mais

Noncommunicable diseases (NCDs) are the leading causes of death, disease and disability in the WHO European Region and are largely preventable. The private sector has long been using marketing to influence and change people’s lifestyles. In some cases, particularly the food sector, health-compromising content is prioritized over health-promoting content. However, this case study aims to illustrate how governments working on tight budgets can partner with private media companies to their own advantage in order to increase the impact of health messages and thus improve the health literacy of the population. The omnichannel communication platform and associated campaigns initiated by the Portuguese government and described in this case study serve as a practical example of a national health literacy initiative successfully reaching a wide audience. Indeed, the Portuguese National Health Service entered high on the list of the most impactful communication campaigns in Portugal. Exibir menos

Objective: To model the reduction in premature deaths attributed to noncommunicable diseases if targets for reformulation of processed food agreed between the Portuguese health ministry and the food industry were met.

Methods: The 2015 co-regulation agreement sets voluntary targets for reducing sugar, salt and trans-fatty acids in a range of products by 2021. We obtained government data on dietary intake in 2015-2016 and on population structure and deaths from four major noncommunicable… Exibir mais

Objective: To model the reduction in premature deaths attributed to noncommunicable diseases if targets for reformulation of processed food agreed between the Portuguese health ministry and the food industry were met.

Methods: The 2015 co-regulation agreement sets voluntary targets for reducing sugar, salt and trans-fatty acids in a range of products by 2021. We obtained government data on dietary intake in 2015-2016 and on population structure and deaths from four major noncommunicable diseases over 1990-2016. We used the Preventable Risk Integrated ModEl tool to estimate the deaths averted if reformulation targets were met in full. We projected future trends in noncommunicable disease deaths using regression modelling and assessed whether Portugal was on track to reduce baseline premature deaths from noncommunicable diseases in the year 2010 by 25% by 2025, and by 30% before 2030.

Findings: If reformulation targets were met, we projected reductions in intake in 2015-2016 for salt from 7.6 g/day to 7.1 g/day; in total energy from 1911 kcal/day to 1897 kcal/day due to reduced sugar intake; and in total fat (% total energy) from 30.4% to 30.3% due to reduced trans-fat intake. This consumption profile would result in 248 fewer premature noncommunicable disease deaths (95% CI: 178 to 318) in 2016. We projected that full implementation of the industry agreement would reduce the risk of premature death from 11.0% in 2016 to 10.7% by 2021.

Conclusion: The co-regulation agreement could save lives and reduce the risk of premature death in Portugal. Nevertheless, the projected impact on mortality was insufficient to meet international targets. Exibir menos

Marketing initiatives can influence and change people's lifestyles. Similarly, they can be used in innovative ways to encourage healthier lifestyles. Governments can improve health by implementing collaborative initiatives with different sectors of society, as recently exemplified in Portugal.
In Portugal, television has the largest share of advertising investment, accounting for around 46%. According to a study led by the Portuguese Regulatory Authority for the Media, 99% of all people… Exibir mais

Marketing initiatives can influence and change people's lifestyles. Similarly, they can be used in innovative ways to encourage healthier lifestyles. Governments can improve health by implementing collaborative initiatives with different sectors of society, as recently exemplified in Portugal.
In Portugal, television has the largest share of advertising investment, accounting for around 46%. According to a study led by the Portuguese Regulatory Authority for the Media, 99% of all people surveyed regularly watch television. Therefore, television stations could be key partners in promoting public health. However, because of high broadcasting costs, health authorities have not generally been able to use these platforms.

In 2018, the Portuguese Ministry of Health approached all major national television stations, appealing to their social responsibility. The four major Portuguese television stations (RTP, SIC, TVI, and Porto Canal) accepted this challenge and signed a 3-year agreement with no cost to the government. These stations committed to broadcasting three non-communicable disease prevention campaigns per year, for 3 weeks each and with at least two broadcasts per day. For 2018, the campaigns addressed healthy eating, tobacco control, and physical activity.

The four stations involved represent a total of 19 television channels. Four of these are open access channels, and include the most watched channels in Portugal, with an audience share of 57.5% in 2017. The remaining 15 channels are pay television channels, which have a strong affinity with their target audience, and increase the coverage of the campaigns. Exibir menos

Recent evidence suggests that Nutri-Score significantly improves consumers’ ability to better understand nutritional information and make healthier food choices. Nutri-Score has been developed by the French Ministry of Health and defined as the national reference. More than ninety food manufacturers and retailers have followed suit and deployed (or committed to deploying) Nutri-Score on all their products. Furthermore, other Ministries of Health (i.e. Belgium and Spain) have published… Exibir mais

Recent evidence suggests that Nutri-Score significantly improves consumers’ ability to better understand nutritional information and make healthier food choices. Nutri-Score has been developed by the French Ministry of Health and defined as the national reference. More than ninety food manufacturers and retailers have followed suit and deployed (or committed to deploying) Nutri-Score on all their products. Furthermore, other Ministries of Health (i.e. Belgium and Spain) have published national recommendation towards adopting Nutri-Score. Nutri-Score also counts with the strong support of European consumers’ associations.

In contrast, little progress has been made in Portugal. Lack of decisive action has been promoted by policy and regulatory levers lying outside the health sector, limited collaboration between different governmental areas, and strong opposition by several food manufacturing companies and retail sectors. As a result, several different FOP labelling systems are used at the national level without any type of standardization. The overload of different FOP labelling systems available in the market may confuse consumers instead of improving their decision capacity. Therefore, a national and harmonized FOP labelling system should be implemented.

In this context, the Portuguese Government, by the hand of the Minister of Health has requested stewardship to the Regional Office for Europe of the World Health Organisation (WHO) regarding the development of an evidence base framework for FOP labelling.

Better evidence on the effectiveness of FOP labelling systems enables the definition of evidence-based national policies and regulations, including a single national coherent nutritional information model. Exibir menos

Food labels are a challenge for most consumers, and the development of easily understandable labelling is essential when it comes to empowering consumers in making healthier food choices.

Countries across Europe (such as France and the UK) have adopted approaches to convey additional nutritional information in an easy-to-understand way. Evidence suggests, that the uniform colour-coded interpretative labelling, which has been implemented in the UK and France, can improve people's ability… Exibir mais

Food labels are a challenge for most consumers, and the development of easily understandable labelling is essential when it comes to empowering consumers in making healthier food choices.

Countries across Europe (such as France and the UK) have adopted approaches to convey additional nutritional information in an easy-to-understand way. Evidence suggests, that the uniform colour-coded interpretative labelling, which has been implemented in the UK and France, can improve people's ability to understand nutritional information and make healthier food choices. Additionally, signposting foods that might be considered less healthy enable more nutritionally-balanced food baskets. The French Ministry of Health (MOH) developed the Nutri-Score model and defined it as the national reference model for food labelling. To date, more than 90 food manufacturers and retailers have committed to use the Nutri-Score labels on their products. The Belgian and Spanish MOH have also announced their endorsement of this model.

However, in other countries little progress to standardise food labelling has been made. This inertia is because policy and regulatory levers lie outside the health sector, with scarce collaboration between different areas of government, and a strong opposition to some labelling schemes from the food manufacturing and retail sectors. In these countries, the absence of national and uniform food labelling schemes and the presence of several non-coherent interpretative food labelling models hinders the efforts towards improved understanding and use of food labels.

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In 2017, the Portuguese Government created the special consumption tax levied on sweetened beverages. This tax is divided into two tiers: drinks with sugar contents below 80 g/L of final product (charged at €8·22 per 100L) are the lower tier and those above 80 g/L of final product (charged at €16·46 per 100L) are the upper tier. During the first year of implementation, this tax collected about 80 million Euros and all revenue was invested towards the Portuguese National Health Service… Exibir mais

In 2017, the Portuguese Government created the special consumption tax levied on sweetened beverages. This tax is divided into two tiers: drinks with sugar contents below 80 g/L of final product (charged at €8·22 per 100L) are the lower tier and those above 80 g/L of final product (charged at €16·46 per 100L) are the upper tier. During the first year of implementation, this tax collected about 80 million Euros and all revenue was invested towards the Portuguese National Health Service funding.

To evaluate the effect of this tax, the Portuguese Government created an interministerial taskforce, to study changes in consumption patterns, industry offering, reformulation of existing products, launch of new products, and competitiveness of national companies versus those overseas. A preliminary analysis showed no substantial change in sales of sweetened beverages between 2013 and 2016.3 According to official data, after the implementation of the tax in 2017, sales had a 7% reduction due to price elasticity and reputational effects. The taskforce identified the reduction of the sugar contents of several beverages as the most important public health effect of the tax.Reformulation processes led to an 11% reduction of total energy intake through sweetened beverages' consumption by the Portuguese population. WHO Regional Office (Europe) collaborated with the taskforce by undertaking an impact analysis. The aforementioned sales reduction and reformulation should result in 1600 fewer obese people and, according to WHO, should avoid or delay at least 27 deaths directly related to excessive sugar consumption in Portugal every year. The taskforce argued that the creation of additional taxation tiers could further promote product reformulation by the industry given its more progressive nature and the incentive for companies to shift their products towards lower taxation tiers.

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Background: Unhealthy eating habits are among the main risk factors associated with the loss of healthy life years in the Portuguese population. Excessive consumption of fat, sugar and salt is the main factor contributing to mortality. In fact, eight out of ten deaths in European countries are caused by noncommunicable diseases.

Implementation: To tackle the complex challenges brought about by noncommunicable diseases, a Health in All Policies approach was implemented. The role of… Exibir mais

Background: Unhealthy eating habits are among the main risk factors associated with the loss of healthy life years in the Portuguese population. Excessive consumption of fat, sugar and salt is the main factor contributing to mortality. In fact, eight out of ten deaths in European countries are caused by noncommunicable diseases.

Implementation: To tackle the complex challenges brought about by noncommunicable diseases, a Health in All Policies approach was implemented. The role of behavioural determinants in morbidity and premature mortality led the Portuguese Government to recognize the promotion of healthy eating as a priority by involving several ministries.

Results: The Integrated Strategy for the Promotion of Healthy Eating (2017– 2020) devised by the Portuguese Government identifies a broad set of health promotion and disease prevention measures. Furthermore, it provides the framework for several other initiatives that have already been implemented or are being implemented at the moment.

Conclusion: The current Portuguese Government has shown political commitment to implementing the Integrated Strategy for the Promotion of Healthy Eating and significant achievements are evident merely a few months into its implementation. However, if Portugal is to maintain the current speed of implementing this strategy, future governments must ensure continued commitment with equal clear-sighted long-term national policies. Unless future problems are anticipated and planned for, overwhelming health care challenges may threaten entire societies. Exibir menos

Unhealthy eating habits are among the main risk factors for the loss of healthy life years in the Portuguese population. Excessive consumption of fat, sugar and salt is the most contributing factor towards mortality.

The adoption of the Integrated Strategy for the Promotion of Healthy Eating by the Portuguese Government was an urgent requirement. Within this strategy a broad set of measures were defined, including the use of taxation to curb sweetened beverages’ consumption.

This… Exibir mais

Unhealthy eating habits are among the main risk factors for the loss of healthy life years in the Portuguese population. Excessive consumption of fat, sugar and salt is the most contributing factor towards mortality.

The adoption of the Integrated Strategy for the Promotion of Healthy Eating by the Portuguese Government was an urgent requirement. Within this strategy a broad set of measures were defined, including the use of taxation to curb sweetened beverages’ consumption.

This report analyses preliminary results of the Portuguese Special Consumption Tax levied on Sweetened Beverages in order to advice and support the future Government's policies in this area. Namely, by understanding its impact on sales of sweetened beverages and on reformulations done by the industry. Data provided by the Portuguese Association for Non-alcoholic Drinks and by the Portuguese National Tax and Customs Authority were used.

The report concludes that if the Government intend to further reduce the excessive consumption of sugar through Sugar Sweetened Beverages, among the Portuguese population, the addition of intermediate tiers to the actual taxation model shall be considered. The improvement of the higher tier sugar content Sugar Sweetened Beverages taxation shall also be considered by the Portuguese Government. Exibir menos