International Trade and Investment Agreements as Barriers to Food Environment Regulation for Public Health Nutrition: A Realist Review

Garton, Kelly; Thow, Anne Marie; Swinburn, Boyd

doi:10.34172/ijhpm.2020.189

Cited by 29 publications

(31 citation statements)

References 55 publications

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“…The use of an evidence-based NPM built on a scientific basis that supports non-discriminatory policy measures is necessary in the international trade context [ 109 , 110 ], where limitations imposed by international trade and investment agreements have been found to impede public health policies [ 111 ]. A scientific basis of measure in policy development ensures trade and investment agreements are respected and do not place undue limitations on public health priorities [ 109 , 112 ].…”

Section: Discussionmentioning

confidence: 99%

A Fit-for-Purpose Nutrient Profiling Model to Underpin Food and Nutrition Policies in South Africa

Frank

Thow

et al. 2021

Nutrients

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South Africa (SA) is facing a rising prevalence of obesity and diet-related chronic diseases. The government is seeking to develop effective, evidence-based policy measures to address this. A well-designed, fit-for-purpose nutrient profiling model (NPM) can aid policy development. The aim of this study was to develop a fit-for-purpose NPM in SA. Steps included: (1) determining the purpose and target population; (2) selecting appropriate nutrients and other food components to include; (3) selecting a suitable NPM type, criteria and base; and (4) selecting appropriate numbers and thresholds. As part of the evaluation, the nutritional composition of packaged foods containing nutritional information (n = 6747) in the SA food supply chain was analyzed, a literature review was undertaken and various NPMs were evaluated. Our findings indicated that it is most appropriate to adapt an NPM and underpin regulation with a restrictive NPM that limits unhealthy food components. The Chile 2019 NPM was identified as suitable to adapt, and total sugar, saturated fat, sodium and non-sugar sweetener were identified as appropriate to restrict. This NPM has the potential to underpin restrictive policies, such as front-of-package labelling and child-directed marketing regulations in SA. These policies will support the fight against obesity and NCDs in the country.

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Section: Discussionmentioning

confidence: 99%

A Fit-for-Purpose Nutrient Profiling Model to Underpin Food and Nutrition Policies in South Africa

Frank

Thow

et al. 2021

Nutrients

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“…Previous studies have established that contextual factors can have a moderating effect on the mechanisms through which TIA constrain policy space for restricting marketing of unhealthy food and beverages to children (29) . Our findings suggest that domestic political/regulatory contexts, as well as actors/institutions involved at both domestic and international spheres, may constitute relevant contextual factors in this policy space.…”

Section: Resultsmentioning

confidence: 99%

“…The three authors developed the policy scenario vignettes collaboratively and with input from a trade and investment legal expert advisor, based on our knowledge of best practice recommendations in marketing restriction and policy settings that had been previously identified as having potential interactions with TIA (29) . These stepped qualitatively from a minimally burdensome and generally non-controversial baseline (a mandatory restriction of persuasive techniques to advertise unhealthy food/beverages to children through television advertising during children’s programs), to a ‘comprehensive’ policy that more closely resembles best practice from a population health perspective but was also expected to be more politically difficult to achieve (Table 2).…”

Section: Methodsmentioning

confidence: 99%

“…Overall, however, countries have found it difficult to move beyond voluntary restrictions and to adopt more comprehensive regulations. Key challenges include concerns about economic impacts (28) , and concerns about the potential for formal constraints in the form of costly legal challenges from international trade and/or investment agreements (TIA) (29–31) . In particular, the use of TIA to challenge other forms of nutrition policy, such as mandatory interpretive labelling, suggest a need for investigation into whether such agreements may constrain governments ‘policy space’ to regulate food environments through mandatory marketing restrictions.…”

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confidence: 99%

“…However, these analyses do not elucidate the specific implications for public health nutrition policy design, and there is little written on this topic in public health journals. Emerging research from civil society as well as a recent academic review identified the interaction of policy design settings with certain international trade and investment rules as a key factor resulting in the constraint or preservation of governments’ policy space for food environment regulations such as marketing restrictions (29,38) . A more detailed understanding of the specific interactions of TIA commitments with mandatory marketing restrictions is needed in order to guide the development of robust regulations that will avoid or withstand challenges on the basis of TIA.…”

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confidence: 99%

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Implications of international trade and investment agreements on policy space for restricting marketing of unhealthy food and beverages to children: lessons from inter-disciplinary expert interviews

Garton

Swinburn

Thow

2021

Public Health Nutr.

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Objective: To determine the implications of international trade and investment agreements (TIAs) for national governments’ policy space to restrict the marketing of unhealthy food and beverages to children. Design: In-depth interviews based on a series of policy scenario ‘vignettes,’ guided by an adapted scenario analysis methodology. Setting: Global Participants: Nine key informants from relevant sectors, with expertise regarding the intersection of public health nutrition policy, international trade law, and international investment law. Results: Participants consistently identified the relevance of several principles, common to many TIAs: non-discrimination, necessity and justification, market access requirements and quantitative restrictions, intellectual property rights and trademark protections, and fair and equitable treatment of investors. Two main policy design factors that interact heavily with TIA-related policy space were the framing of objectives, and regulatory distinctions drawn. Contextual factors may shape the analysis of TIA-related policy space on a case-by-case basis, while the relative power of the actors and institutions involved in both domestic and international policy spheres may influence whether and how such legal constraints to policy space are activated. Conclusions: Regulatory marketing restrictions run the risk of incurring challenges under World Trade Organization (WTO) agreements and other free trade and investment agreements. However, concerned policy makers should be aware of the difference between theoretical risk, threat of a challenge, and realistic initiation and/or loss of a formal dispute. Our findings indicate that there is policy space to adopt significant marketing restrictions, though an understanding of these legal risks, and strategic policy design, are important.

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Advisory groups in realist reviews: Systematically mapping current research and recommendations for practice

Power,

Dada,

Booth

et al. 2024

Cochrane Evidence Synthesis and Methods

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IntroductionRealist reviews may involve groups or panels external to the research team who provide external and independent perspectives informing the review based on their experience of the topic area. These panels or groups are termed in this study as an “advisory group.” This study aims to map current practice of advisory groups in realist reviews and provide guidance for planning and reporting.MethodsA “best‐fit” framework synthesis methodology was used by first searching for a best‐fit framework and then conducting a systematic search to identify a sample of realist reviews and rapid realist reviews (RRRs) from the most recent year, 2021. Nine databases were searched: CINAHL Complete, Cochrane, Embase, ERIC, MEDLINE, PsycInfo, Social Services Abstracts, Sociological Abstracts, and Web of Science Core Collection. Screening and data extraction was conducted by two researchers. The chosen best‐fit framework (ACTIVE framework) informed the data extraction tool.ResultsOne hundred and seven reviews (93 realist reviews, 14 RRRs) were identified for inclusion. Of these, 40% (n = 37) of realist reviews and 71.5% (n = 10) of RRRs mentioned use of an advisory group, though there was considerable variation in terminology used. Individuals in advisory groups were involved at varying stages of the review and tended to bring experience in the topic area from the perspective of (i) a lived experience, i.e., patients, carers, family members (n = 15 realist reviews; n = 4 RRRs); (ii) professional experience, such as healthcare professionals (n = 20 realist reviews; n = 6 RRRs); or (iii) policy or research experience in the topic area (n = 19 realist reviews; n = 7 RRRs).ConclusionsThis study proposes a definition of advisory groups, considerations for advisory group use, and suggested items for reporting. The purpose of the advisory group should be carefully considered when deciding on their use in a realist review.

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International Trade and Investment Agreements as Barriers to Food Environment Regulation for Public Health Nutrition: A Realist Review

Cited by 29 publications

References 55 publications

A Fit-for-Purpose Nutrient Profiling Model to Underpin Food and Nutrition Policies in South Africa

A Fit-for-Purpose Nutrient Profiling Model to Underpin Food and Nutrition Policies in South Africa

Implications of international trade and investment agreements on policy space for restricting marketing of unhealthy food and beverages to children: lessons from inter-disciplinary expert interviews

Advisory groups in realist reviews: Systematically mapping current research and recommendations for practice

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