Tensions and coalitions: A new trade agreement affects the policy space for nutrition in Vietnam

Abstract

Global trade has shaped food systems over centuries, but modern trade agreements are hastening these changes and making them more complex, with implications for public health and nutrition transition. This study aimed to understand the impact of the 2018 Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) on the policy space for public health nutrition in Vietnam. We conducted comparative document review and key informant interviews, and our analysis drew on a framework of policy space and the theory of advocacy coalitions. We identified 10 CPTPP sections with potential public health nutrition implications; and 50 Vietnamese policies relevant to nutrition having one or more tensions with one or more CPTPP sections. A majority of policy tensions were in sections of the CPTPP relating to technical barriers to trade and government procurement; most tensions related to protecting policy-making from vested interests. Different groups of policy actors hold different beliefs and interests on these issues, and therefore promote different framings and policy approaches. We identified two advocacy coalitions working very separately on issues affecting nutrition policy space: a trade coalition holding the policy position that free trade improves nutrition by default; and a nutrition coalition holding the policy position that nutrition should be explicitly considered in trade policy. The policy space for nutrition in Vietnam has important potential constraints through written policy, and the trade and nutrition coalitions will need to interact more regularly and constructively in order to foresee where these tensions will arise in practice, and create plans for their mitigation. This study adds to global evidence of free trade agreement impacts on nutrition policy space, and we extend previous work by explaining these actor groupings in the policy space through the theory of advocacy coalitions.

Stories of change in nutrition: lessons from a new generation of studies from Africa, Asia and Europe

“…Studies aiming to assess the public policy environment (Adeyemi et al, Forthcoming ; Aryeetey et al, 2021 ; Avula et al, 2022 ; Drimie et al, Forthcoming ; Harris et al, 2022 ; Harris et al, 2021 ; Iruhiriye et al, 2022 ; Salm et al, Forthcoming ; Turowska et al, Forthcoming ) drew on multiple policy analysis frameworks and methods. Policy frameworks included the community readiness framework (Plested et al, 2007 ), the policy space (Grindle & Thomas, 1991 ), advocacy coalitions (Sabatier, 1988 ), and the nutrition-enabling environment (Gillespie et al, 2013 ).…”

“…Meat and milk consumption have increased significantly, and sweets and sweetened beverages have both increased; oils and fat consumption also more than quadrupled between 1985 and 2009. The retail environment in Vietnam is experiencing both continuity and change, with wet markets and (vegetable-rich) food eaten away from the home still common despite a policy of “supermarketization” (Harris et al, 2020 ) and a trade policy process that does not consider the nutrition and health implications of changes to trade (Harris et al, 2022 ).…”

“…The trade policy space analysis in Vietnam found one policy coalition prioritising international trade to enhance economic development (a positive for nutrition) while the nutrition and health implications of specific trade policy provisions were not considered in policy negotiations (a negative for nutrition). This illustrates clear trade-offs even within a single policy process (Harris et al, 2022 ); further research is required to understand the net implications for different forms of malnutrition and in different population groups.…”

“…Many of the studies undertake this as part of the triangulation between different methods, although some studies are focused only on the policy environment (Drimie et al, Forthcoming ). The studies use different policy analysis frameworks to help accomplish this aim – many opting to build on the 2013 Lancet series’ characterisation of an enabling environment (Gillespie et al, 2013 ), while others adapt political, policy science, or health policy frameworks to focus on specific questions such the role of advocacy coalitions in policy processes (Harris et al, 2022 ), or the status of implementation. We partly follow the 2017 synthesis of Stories of Change studies (Gillespie & van den Bold, 2017 ) in using a simplified framework which focuses on key areas of policy and political commitment to nutrition, coherence across sectors (including issues of vertical (implementation) and horizontal (multi-sectoral) co-ordination); and capacity .…”

“…In Africa, studies took place in Ghana (Aberman et al, 2022 ; Aryeetey et al, 2021 ), Nigeria (Adeyemi et al, 2022 ; Adeyemi et al, Forthcoming ), Burkina Faso (Becquey et al, 2022 ; Turowska et al, Forthcoming ), Rwanda (Iruhiriye et al, 2022 ), Zambia (Harris et al, 2019 ) and South Africa (Drimie et al, Forthcoming ). In South-East and South Asia, studies took place in Vietnam (Harris et al, 2020 , 2021 , 2022 ) and across four states of India (Odisha, Tamil Nadu, Gujarat & Chhattisgarh) (Avula et al, 2022 ; Avula et al, Forthcoming ). In Europe, a city-level study took place in Brighton and Hove in the United Kingdom (Salm et al, Forthcoming ).…”