L’objectif de cette thèse était de développer un cadre conceptuel et méthodologique permettant d’évaluer l’impact global de l’alimentation sur la santé des consommateurs, en prenant en compte les dimensions microbiologiques, chimiques et nutritionnelles. Cette méthodologie a été développée à l’aide d’un cas d’étude portant sur l’alimentation des nourrissons (lait maternel et formules infantiles), incluant les facteurs suivants : C. sakazakii, Cryptosporidium, arsenic, polychlorobiphényles de type dioxine et acide docosahexaénoïque. Cinq modèles mathématiques probabilistes ont été développés pour quantifier les risques / bénéfices associés à chaque facteur. Ils ont été ensuite harmonisés, quand cela a été possible, à l’aide d’un indicateur commun de santé publique, le DALY. Les résultats ont été obtenus par simulation de Monte Carlo de second ordre afin de quantifier séparément l’incertitude et la variabilité. Les techniques probabilistes ont permis de prendre en compte d’une part la variabilité inhérente à la biologie (hétérogénéité entre individus d’une même population) et d’autre part l’incertitude liée au manque de connaissances et de données. De plus, la séparation de la variabilité et de l’incertitude a consolidé l’évaluation, permettant une interprétation plus cohérente des résultats et donc fournissant des informations plus complètes aux décisionnaires. La méthode mise en oeuvre dans ce travail de thèse pourra servir de base pour d’autres cas d’études et pourra aussi être utilisée pour continuer le développement méthodologique de l’évaluation risque-bénéfice. Cette démarche s’inscrit dans une approche plus générale d’analyse multi-critères des systèmes agronomiques et alimentaires / The objective of the present PhD project was to develop a conceptual and methodological framework to assess the overall impact of food consumed on human health, including microbiological, chemical and nutritional dimensions. This methodology was developed using a case study on infant milk-based diet (breast milk and infant formulas) taking into account the following selected factors: C. sakazakii, Cryptosporidium, arsenic, dioxin like polychlorinated biphenyls and docosahexaenoic acid. Five probabilistics mathematicals models were developed to quantify risks / benefits associated with these factors. When possible, they were harmonized using a common public health indicator, the DALY. Results were obtained by second-order Monte Carlo simulations in order to quantify separately the uncertainty and the variability. Probabilistic techniques enabled to take into account on the one hand the biology related to variability (heterogeneity between individuals of the same population) and on the other hand the uncertainty linked to the lack of knowledge and data. In addition, separation of variability and uncertainty strengthened the evaluation by enabling a more accurated interpretation of results and by providing more comprehensive information for policy makers. The method used in this PhD thesis can be considered as a robust basis for other case studies and can be also used to continue methodological development in risk-benefit assessment. This approach is also part of a broader area: the multi-criteria decision analysis of agronomic and food systems

Orientador: Walter Belik / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Economia / Made available in DSpace on 2018-08-11T12:14:47Z (GMT). No. of bitstreams: 1 Turpin_MariaElena_M.pdf: 1234997 bytes, checksum: 60b34cad5c669a8b503a139f2b15215f (MD5) Previous issue date: 2008 / Resumo: Este trabalho busca avaliar a atual contribuição e as potencialidades do PNAE ¿ Programa Nacional de Alimentação Escolar, como instrumento para o DL ¿ Desenvolvimento Local por meio de apoio aos agricultores familiares. Da mesma forma procuramos aferir a importância desse programa para a política de SAN ¿ Segurança Alimentar e Nutricional. O estudo foi motivado pela magnitude do PNAE e pela necessidade de conhecer melhor as suas conexões com a agricultura familiar, segmento de destacada importância econômica e social e elemento fundamental para o Desenvolvimento Local. A integração de políticas públicas com o foco na agricultura familiar pode ser um modelo efetivo de redução da desigualdade social em uma região. A pesquisa mostrou, comparativamente aos programas latino-americanos, a abrangência e a estabilidade do PNAE como um programa de Estado, e não mais como programa de governo; e a atual estrutura do programa baseada não só em diretrizes claras fundamentadas nos princípios da SAN, mas também na participação social e no fortalecimento da economia local. O estudo também mostrou que a ligação entre a alimentação escolar e a agricultura familiar segue uma trajetória histórica culminando em três aspectos que estão presentes na legislação atual: exigência ao respeito à vocação agrícola e hábitos alimentares regionais; compras dentro dos limites geográficos regionais; e uso de produtos in natura, típicos daquela produção. A análise das tabelas, documentos e experiências do Prêmio Gestor Eficiente da Merenda Escolar de 2006 permitiu avaliar que, embora o PNAE ainda seja pouco estudado como uma política federal integrada, já apresenta incontáveis exemplos de como promover a inserção competitiva da agricultura familiar no mercado institucional, com aumento na apropriação e circulação de riqueza, gerando efeito multiplicador na economia local. Várias ações municipais relativas à alimentação escolar foram identificadas, especialmente as comerciais. A participação no PAA ¿ Programa de Aquisição de Alimentos da agricultura familiar, por exemplo, embora ainda em fase de revisão, apresentou significativos impactos institucionais e organizacionais na produção familiar. As principais iniciativas, geralmente associadas a ações de educação alimentar e contratação de nutricionistas, apesar de não estarem ligadas a uma participação social atuante, foram dirigidas: ao incentivo no uso de máquinas, insumos e infra-estrutura de beneficiamento, a programas de geração de renda, à valorização cultural, à adaptação às normas da vigilância sanitária, à formalização e capacitação; e à organização política, institucional, administrativa e comercial. Quanto à contribuição do PNAE à garantia de SAN, embora ainda seja prematuro afirmar seus impactos por falta de indicadores mais específicos e atualizados, foram constatados indícios de que seu papel é relevante, especialmente para a população mais carente, por meio de ações de educação alimentar e oferta de refeições complementares / Abstract: This study evaluates both the current contribution and potentialities of the National School Feeding Program (PNAE ¿ Programa Nacional de Alimentação Escolar) as an instrument for local development, by means of supporting family farmers, and its importance on Food Safety and Nutrition (SAN ¿ Segurança Alimentar e Nutricional). The research was motivated by the magnitude of PNAE, and by the need of better knowing its connections with the family-based agriculture, segment of great economical and social importance and fundamental element for the local development. The integrated public policies focusing the family-based agriculture can be an effective model towards the reduction of social inequality in a region. The research showed, comparatively to the Latin-American programs: the extensiveness and stability of PNAE as a State program, and no more as a government one; and the program¿s current structure based not only on clear guidelines¿ principles of SAN, but also on social participation and on the strengthening of the local economy. The dissertation also showed that the connection between the school feeding and the family-based agriculture follows an historical trajectory culminating in three aspects: the demand for respect to the regional agricultural vocation; the purchase inside the regional geographical limits; and the use of in natura products, characteristic of that agriculture. The analysis of the tables, documents and experiences in the 2006 Efficient Manager of School Feeding Award allowed to evaluate that, although PNAE is still not much studied as an integrated federal policy, it already presents countless examples of how to promote the competitive insertion of the family-based agriculture in the institutional market, with increase in the appropriation and circulation of wealth, generating a multiplier effect in the local economy. Many municipal actions concerned about school feeding were identified, especially the commercial ones. The participation of the family-based agriculture in the Program of Food Acquisition (PAA ¿ Programa de Aquisição de Alimentos) - although still in a reviewing phase - has presented significant institutional and organizational impacts in the family production. The main municipal initiatives, usually associated to actions of alimentary education and nutritionists hiring - in spite of not associated to an active social participation - were focused: on the incentive to the use of machines, inputs and improvement infrastructure; on the programs of income generation; on the cultural valorization; on the adaptation to the norms of the sanitary surveillance; on the legalization and training; and on the on the political, institutional, administrative and commercial organization. In terms of the contribution of PNAE to SAN¿s guarantee - although it is yet too early to know its impacts by lack of specific and up-to-date indicators - there were evidences that its role is relevant, especially for the poorest people, through the actions of alimentary education and offer of complementing meals / Mestrado / Economia Agricola e Agraria / Mestre em Desenvolvimento Econômico