Pilot study: Reduction of salt (sodium) in bread and its contribution to the decrease of cardiovascular diseases Health Impact Assessment of the introduction of new legislation - Screening report

Follow-up support documentation under the scope of the workshop " Health Impact Assessment (HIA) and health in environmental assessments – Enhancing HIA practice in Portugal" (13-15 November 2017) organized by National Institute of Health Dr Ricardo Jorge in collaboration with the World Health Organization.

Coordinators: Teresa Caldas de Almeida and Luciana Costa (DPSDNT – INSA). Technical team: Alexandra Costa (DPSDNT – INSA), Joana Santos (DEP – INSA), Paula Braz (DEP – INSA), Mariana Coelho (DAN – INSA), Roberto Brazão (DAN – INSA), Ricardo Assunção (DAN – INSA), Isabel Lopes (DGE), Ana Cristina Guerreiro (ARS-Algarve), with WHO technical support.

Introduction: The importance of using a Health Impact Assessment (HIA) methodology to evaluate a new policy, program or project resides in the possibility of using the results to increase knowledge about the proposal, inform decision makers and affected population, and minimize potential effects and maximize the positive effects on health and well-being. The methodology of HIA is thus an essential tool in assessing the potential effects of interventions on the health of a population by its contribution to decision making for health and equity protection. In Portugal there is a growing interest in understanding the extent to which health interventions and policies in other sectors have an impact on health and equity. The new Public Health Law (Number49 / XIII) which is being discussed in the special field in Parliament, defines the competences of public health services and proposes to carry out at national level studies to assess the impact on health, from a "whole of government" perspective. Following this Law, a model is being developed to guide the implementation of health impact studies at the national, regional and local levels. In this way, the initiatives that promote technical training in this field are of particular importance, particularly to the National Institute of Health Doctor Ricardo Jorge, IP (INSA, IP) regarding its mission. It is therefore important to develop technical skills, tools and methodologies for impact assessment from a "whole of society" perspective. In this sense, within the scope of the Biennial Collaborative Agreement between the World Health Organization (WHO) and the Ministry of Health of Portugal, INSA, IP is implementing in collaboration with technical experts from WHO a "capacity building HIA training program”. In this context, a Workshop on HIA was held in November 2017 in Lisbon. This Workshop included a Policy Dialogue, with the main objective of training health professionals and other sectors to develop health impact studies and discuss strategies for implementing HIA as a tool to support a "Health in all policies" approach. This strategy is considered essential for governance in health and for equity and well-being, not only for other sectors to recognize their responsibility in Health, but also for Health to recognize the impact of its interventions in other sectors. Following this initiative, three stakeholder groups were organized for the implementation of three pilot studies on HIA, with WHO expert follow-up. Online meetings and seminars based on a "Learning by doing" program, were organized and supported by "Screening" and "Scooping" tools described in the HIA Guidance of the Institute of Public Health in Ireland [1] intending in the end to build from the case studies a guide to the national context. This report concerns to one of the studies carried out in this context, and serves to present the preliminary results of the study “Reduction of salt (sodium) in bread and its contribution to the decrease of cardiovascular diseases Health Impact Assessment of the introduction of new legislation”.

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