International trade and investment agreements and policy space for food environment regulation

Abstract

Background. Malnutrition in all its forms is a major global health challenge. The World Health Organization has developed ‘best practice’ policy recommendations for creating healthier food environments. However, uptake has been limited, and there is evidence that international trade and investment agreements (TIAs) can act as ‘upstream’ barriers to public health nutrition policy. Aim. To examine how TIAs constrain policy space for food environment regulation (through what mechanisms, in what contexts), and what can be done to preserve this policy space. Methods. This thesis presents a realist review of global evidence for nutrition policy space constraint by TIAs, a series of scenario analyses on food environment policies using in-depth interviews with expert informants, and a stakeholder analysis to examine the interests, power and influence of different actor-stakeholder groups engaged in either supporting or constraining nutrition policy space through TIAs. The research is grounded in political economy analysis and uses a theoretical framework of ‘substantive,’ ‘procedural,’ and ‘structural’ policy space constraints. Findings. The review and scenario analysis identified a number of points at which existing TIA rules could constrain national policy autonomy for regulating food environments. However, for the most part, they are unlikely to pose ‘substantive’ constraints to well-designed nutrition policies. TIAs are more likely to pose ‘procedural’ constraints to public health nutrition policy insofar as they are used and interpreted by different actors. The stakeholder analysis indicated power and resource imbalances within this policy space between public health nutrition actors and those interested in industry and economic growth, particularly regarding participation in TIA governance institutions and processes, posing ‘structural’ constraints to nutrition policy space. Conclusions. Well-designed food environment regulations are unlikely to encounter substantive constraints due to TIAs. However, procedural and structural constraints pose significant risks of deterring, delaying or diluting such efforts. Policy space may be preserved through awareness of potential TIA-related legal issues, as well as their limitations, and strategic policy design to mitigate any realistic legal threats. Regulators should also be attuned to the actor-stakeholders and institutions with vested interest in, and power to influence, this policy space.