Who influences nutrition policy space using international trade and investment agreements? A global stakeholder analysis

Abstract

Background Regulation of food environments is needed to address the global challenge of poor nutrition, yet policy inertia has been a problem. A common argument against regulation is potential conflict with binding commitments under international trade and investment agreements (TIAs). This study aimed to identify which actors and institutions, in different contexts, influence how TIAs are used to constrain policy space for improving food environments, and to describe their core beliefs, interests, resources and strategies, with the objective of informing strategic global action to preserve nutrition policy space. Methods We conducted a global stakeholder analysis applying the Advocacy Coalition Framework, based on existing academic literature and key informant interviews with international experts in trade and investment law and public health nutrition policy. Results We identified 12 types of actors who influence policy space in the food environment policy subsystem, relevant to TIAs. These actors hold various beliefs regarding the economic policy paradigm, the nature of obesity and dietary diseases as health problems, the role of government, and the role of industry in solving the health problem. We identified two primary competing coalitions: 1) a ‘public health nutrition’ coalition, which is overall supportive of and actively working to enact comprehensive food environment regulation; and 2) an ‘industry and economic growth’ focussed coalition, which places a higher priority on deregulation and is overall not supportive of comprehensive food environment regulation. The industry and economic growth coalition appears to be dominant, based on its relative power, resources and coordination. However, the public health nutrition coalition maintains influence through individual activism, collective lobbying and government pressure (e.g. by civil society), and expert knowledge generation. Conclusions Our analysis suggests that industry and economic growth-focussed coalitions are highly capable of leveraging networks, institutional structures and ideologies to their advantage, and are a formidable source of opposition acting to constrain nutrition policy space globally, including through TIAs. Opportunities for global public health nutrition coalitions to strengthen their influence in the support of nutrition policy space include strategic evidence generation and coalition-building through broader engagement and capacity-building.

On the Pathogenicity of the Oral Biofilm: A Critical Review from a Biological, Evolutionary, and Nutritional Point of View

“…Within the social rituals, processed foods containing large amounts of sugar were embedded in a variety of recurring habits such as sugared coffee, sugared cakes in the afternoon, and sugary foods on birthdays, Easter, Halloween, and Christmas, as only some examples [ 81 , 82 ]. Within the capitalized system, food industries influence “consumers” through advertisements and political lobbyism to continue a Western type of diet [ 83 , 84 , 85 ]. Even in the field of dental research, the sugar industry influenced the research agenda of the U.S. National Institute of Dental Research (NIDR) to avoid research dealing with sugar reduction strategies [ 86 ].…”

The interface between international trade and investment agreements and food environment policymaking: A conceptual framework

“…The lead author systematically coded each of the interviews and literature review sources according to themes in line with the ACF, in NVivo . The methods used and findings of this phase of the study are described in detail elsewhere (Garton et al, 2021c).…”

“…Our stakeholder analysis (combining the realist review and interview data), identified five strategies used by industry and economic growth coalitions to constrict policy space through TIAs: (1) influencing government trade ministries' internal vetting of regulatory proposals; (2) convincing and supporting host governments to raise specific trade concerns and trade disputes, or raising own disputes in ISDS; (3) influencing TIA negotiations; (4) participation in Codex standards-setting; and (5) using transparency and consultation rules to influence food environment policymaking processes (Garton et al, 2021c).…”

“…(2) civil society organizations and other actors collaborate for greater collective influence; and (3) academics and other experts, including inter-governmental organizations (e.g., WHO, PAHO), provide technical support and evidence to legitimize advocacy and food environment policy development (Garton et al, 2021c). However, broader health advocacy literature describes additional strategies used by health coalitions confronting corporate influence on policy space through TIAs, such as in access to pharmaceuticals and tobacco control.…”

Rapid review of the front‐of‐pack labelling schemes in Thailand

“…Newer interpretive summary indicator FoPL systems are possibly more effective at influencing identification and choice of healthy foods by consumers than non‐interpretative systems, such as the GDA (Croker et al, 2020). However, the food industry prefers the GDA and is lobbying and leveraging networks to influence country FoPL schemes in numerous countries (Garton et al, 2021; Mialon et al, 2021; Pedroza‐Tobias et al, 2021). Pioneering FoPL countries, like Thailand and Chile, have taken different paths over the last decade to implement their current schemes, offering examples of new elements to consider, such as the possible value of regional momentum and cross‐country solidarity in successfully developing effective national FoPL schemes (Boza et al, 2020; Pérez‐Escamilla et al, 2021; World Cancer Research Fund International, 2019).…”