International investment liberalization, transnational corporations and NCD prevention policy non-decisions: a realist review on the political economy of tobacco, alcohol and ultra-processed food

Abstract

Background Public health concerns relating to international investment liberalization have centred on the potential for investor-state dispute settlement (ISDS)-related regulatory chill. However, the broader political and economic dimensions that shape the relationship between the international investment regime and non-communicable disease (NCD) policy development have been less well explored. This review aimed to synthesise the available evidence using a political economy approach, to understand why, how and under what conditions transnational corporations may use the international investment regime to promote NCD prevention policy non-decisions. Main body Methods: Mechanisms explaining why/how the international investment regime may be used by transnational health-harmful commodity corporations (THCCs) to encourage NCD prevention policy non-decisions, including regulatory chill, were iteratively developed. Six databases and relevant grey literature was searched, and evidence was extracted, synthesized and mapped against the various proposed explanatory mechanisms. Findings: Eighty-nine sources were included. THCCs may be incentivised to use the ISDS mechanism since the costs may be outweighed by the benefits of even just delaying regulatory adoption, particularly since the chilling effect tends to ripple out across jurisdictions. Drivers of regulatory chill may include ambiguity in treaty terms, inconsistency in arbitral rulings, potential arbitrator bias and the high cost of arbitration. Evidence indicates ISDS can delay policy adoption both within the country directly involved but also in other jurisdictions. Additionally, governments are adopting standard assessments of public health regulatory proposals for trade and ISDS risk. Various economic, political and industry-related factors likely interact to increase (or decrease) the ultimate risk of regulatory chill. Some evidence indicates that THCCs take advantage of governments’ prioritization of foreign investment over NCD prevention objectives to influence the NCD prevention regulatory environment. Conclusions While ISDS-related regulatory chill is a real risk under certain conditions, international investment-related NCD prevention policy non-decisions driven by broader political economy dynamics may well be more widespread and impactful on NCD regulatory environments. There is therefore a clear need to expand the research agenda on investment liberalization and NCD policy beyond regulatory chill and engage with theories and approaches from international relations and political science, including political economy and power analyses.

Generating political priority for alcohol policy reform: A framework to guide advocacy and research

“…While our results support the need for multiple actions to influence political will, two strategies had broad relevance at all levels: information gathering [8, 12, 15, 39, 41, 42, 44, 48, 54–59] and investing in relationships [8, 12, 15, 39, 41–45, 47, 51, 54, 55, 57, 59–64]. Information gathering related to the ongoing importance of evidence, particularly on industry behaviour [8, 42, 48, 54, 58], while relationship building related to the benefits of information exchange, new alliances and dissemination.

‘A good relationship between advocacy organizations, researchers and practitioners can give everybody the courage to act.

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“…We identified two ‘overarching’ barriers to political will: neoliberal or free trade ideology [7, 15, 16, 33–40] and the globalised alcohol industry [15, 16, 35, 36, 41–53]. These factors were characterised as creating overarching challenges to all levels of policymaking, specifically by creating environments that facilitate the cross‐border sale and supply of alcohol at the expense of efforts to regulate it.

‘A main barrier is the vested interests of the global alcohol industry wanting to increase sales and growth for their businesses.

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“…We identified two 'overarching' barriers to political will: neoliberal or free trade ideology [7,15,16,[33][34][35][36][37][38][39][40] and the globalised alcohol industry [15,16,35,36,[41][42][43][44][45][46][47][48][49][50][51][52][53]. These factors were characterised as creating overarching challenges to all levels of policymaking, specifically by creating environments that facilitate the cross-border sale and supply of alcohol at the expense of efforts to regulate it.…”

“…The second global strategy was to expand global networks, particularly in low-income countries, and to include more people who work in policy advocacy [15,41,45,47,49,50,54].…”

Acknowledge the Elephant in the Room: The Role of Power Dynamics in Transforming Food Systems Comment on "What Opportunities Exist for Making the Food Supply Nutrition Friendly? A Policy Space Analysis in Mexico"

“…Global trade agreements have been shown to delay actions in global health policy to alleviate non-communicable diseases. 12 Power dynamics, therefore, play out at a global as well as a national stage.…”