Strategies to Tackle Childhood Obesity: a Comparison of the UK and Portugal
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Departamento de Políticas Públicas Strategies to Tackle Childhood Obesity: A Comparison of the UK and Portugal Rosette Sandra Kiesse Melão Dissertação submetida como requisito parcial para obtenção do grau de Mestre em Políticas Públicas Orientadora: Professora Doutora Maria de Lurdes Rodrigues, ISCTE-IUL Co-orientadora: Mariana Vieira da Silva, ISCTE-IUL Setembro 2015 Acknowledgements I would like to acknowledge some of the people who have contributed their time and effort in assisting me with completing this dissertation. Thank you to my University and supervisor, for supporting me over the two years of the Master’s Degree and throughout the course of my project writing. I would lastly like to thank my wonderful family Alfredo, Suzana, Helena and Miriam Melao for the moral support they have given me throughout my dissertation progress. They understood the menacing task of having to complete a dissertation and provided me with a haven to work in. Had it not been for our talks at the dinner table, or your interest in the topic, I would have struggled to come up with a subject I really cared about to carry out research on. The lessons you have taught me about hard work and dedication while I was growing up have culminated in this dissertation and I realised that it does in fact pay off in the end. I love you all dearly. Thank you. i Abstract Childhood obesity is a major public health crisis, contributing to major health issues around the world. The need for nutritional standards in schools is not a new phenomenon due to the increase in prevalence and the concern with respect to the health and well-being of the child. In both the United Kingdom and in Portugal, it was only from the early 2000s that childhood obesity had reached such a preoccupying level that the state, through both education and public health interventions, introduced a number of policies to attempt to resolve this health crisis. This project will use an institutional approach to understand the differences in strategies between the UK and Portugal in tackling childhood obesity. It will reflect on the impacts of the challenges which may affect future policies, such as junk food providers in the school vicinity and by doing so, acknowledge environmental and social influences affecting food choice and contemplate whether educational interventions alone offer a way to tackle the growing problem of childhood obesity. This analysis aims to contribute to the discussion on the similarities and differences on the evolution of educational systems and their policies and the comparison aims to gives an insight to how they can improve. ii Contents Acknowledgements .................................................................................................................................. i Abstract ................................................................................................................................................... ii List of Abbreviations ............................................................................................................................. iv List of Figures and Tables ....................................................................................................................... v 1 INTRODUCTION - Problem statement, aims and objectives ........................................................ 1 2 RESEARCH STRATEGY & CONCEPTUAL FRAMEWORK.................................................... 4 3 LITERATURE REVIEW ............................................................................................................... 9 3.1 Approaches and efforts in food policy .................................................................................... 9 3.2 Role of the schools ................................................................................................................ 11 3.3 Institutions............................................................................................................................. 12 4 UK & PORTUGAL: THE EVOLUTION OF POLICIES FOR SCHOOL MEALS .................... 16 4.1 UK ......................................................................................................................................... 17 4.1.1 The Return of the Labour Party .................................................................................... 17 4.1.2 New Nutritional Standards for School Meals ............................................................... 18 4.1.3 School Meals in the Future ........................................................................................... 21 4.2 PORTUGAL ......................................................................................................................... 21 4.2.1 Canteens in the Estado Novo (1933-1970) .................................................................... 22 4.2.2 From the de Veiga Simao Reform to a Transitioning Democracy: (1971-1983) ......... 22 4.2.3 Beginning to decentralise school meals (1984-93) ....................................................... 23 4.2.4 School Meals in the Consumer Society (1994-2005) ................................................... 23 4.2.5 School Meals and Childhood Obesity (2006-2012) ...................................................... 24 5 STRATEGY DIFFERENCES: Institutions, schools and parents ................................................. 26 5.1 Institutions............................................................................................................................. 26 5.1.1 Government Bodies....................................................................................................... 26 5.1.2 School system ............................................................................................................... 28 5.2 Actors .................................................................................................................................... 30 5.2.1 Schools .......................................................................................................................... 30 5.2.2 Families ......................................................................................................................... 31 6 CHALLENGES TO FUTURE POLICIES ................................................................................... 34 6.1 Home Life and Longer Working Hours ................................................................................ 34 6.2 The Marketing of Unhealthy Foods ...................................................................................... 34 6.3 Issues within the Policy Making Process .............................................................................. 36 7 Conclusion .................................................................................................................................... 38 8 Bibliography ................................................................................................................................. 40 iii List of Abbreviations APAN - Associação Portuguesa de Anunciantes (Portugal) ASE- Acção Social Escolar BIS- Department for Business, Innovation and Skills (UK) BMI- Body Mass Index DE- Department of Education (UK) DEFRA- Department for the Environment, Food and Rural Affairs (UK) DfES – Department for Education and Science (UK) DGEstE- Direcção-Geral dos Estabelecimentos Escolar (Portugal) DGS- Direcção-Geral da Saúde (Portugal) DH- Department of Health (UK) DHSSPS- Department of Health, Social Services and Public Safety (UK) EFSA- European Food Safety Authority ENHPS- European Network for Health Promoting Schools FIPA- Federação Das Indústrias Portuguesas Agro Alimentares (Portugal) FSA- Food Standards Agency (UK) IASE- Instituto de Acao Social Escolar ICAP- Instituto Civil da Autodisciplina da Comunicação Comercial (Portugal) LA- Local Authority LBSE – Lei de Bases do Sistema Educativo MEN- Ministério da Educação Nacional (Portugal) NASE- Núcleo de Acção Social Escolar NPLAN- National Policy and Legal Analysis Network OMEN- Obra das Mães pela Educação Nacional (Portugal) PERA- Programa Escolar de Reforço Alimentar (Portugal) PREMAC- Plano de Redução e Melhoria da Administração Central (Portugal) SASE- Serviços de Acção Social Escolar SMRP- School Meals Review Panel WHO- World Health Organisation iv List of Figures and Tables Figure 1: 'Behavior Change Ball (Hendriks et al. 2013) Table 1: Percentages of governments with highest level of decision-making power. Batista (2012:) Adopted from OECD (2008) v 1 INTRODUCTION - Problem statement, aims and objectives Childhood obesity is a major public health crisis nationally and internationally (Karnik and Kanekar, 2012: 1), and it is increasing in both developed and third world countries (Reilly, 2007: 392). It has been called “one of the most serious public health challenges of the 21st century” (WHO, 2011: 13) due to the increase in prevalence and the concern with respect to the health and well-being of the child. The need for nutritional standards in schools is not a new phenomenon; however, it appears that only recently suitable and somewhat effective methods have been undertaken across the world. In both the United Kingdom and in Portugal, it was only from the early 2000s that childhood obesity had reached such a preoccupying level that the state, through both education and public health interventions, introduced a number of policies to attempt to resolve this health crisis. Children are barely getting their daily nutritional needs, through no fault of their own.