Search

In January 2014, Mexico introduced a soda tax of 1 Mexican Peso (MXP) per litre. The aim of this paper is to examine the political context out of which this policy emerged, the main drivers for the policy change, and the role of stakeholders in setting the policy agenda and shaping the policy design and outcomes. Thirty-one semi-structured interviews were conducted with key stakeholders, and 145 documents, including peer-reviewed papers, policy briefs, press releases, industry, government, and CSO reports, were analysed. An iterative thematic analysis was conducted based on relevant theories of the policy process using a complementary approach, including Stages Heuristic Model, Policy Triangle Framework, and Multiple Streams Model. Results showed that a major motivation was the new administration seeking funds as they entered government. The soda tax was supported by a key group of legislators, civil society actors and by academics promoting evidence on health effects. However, the policy measure was challenged by the food and beverage industries (F&BI). Non-state actors were both formally and informally involved in setting the agenda, regardless of some of them having opposing interests on the soda tax policy. Approaches used by non-state actors to influence the agenda included: calls for action, marketing strategies, coalition building, challenging evidence, and engaging in public–private partnerships (PPPs). The effectiveness of the soda tax was highly debated and resulted in public polarization, although the framing of the outcomes was instrumental in influencing fiscal policies elsewhere. This study contributes to the debate around implementing fiscal policies for health and how power is exercised and framed in the agenda-setting phase of policy development. The article examines how the F&BI sought to influence the national strategy for obesity prevention. It argues that the experience of the soda tax campaign empowered policy advocates, strengthening national and international civil society networks.

Trans fatty acids (TFA) are a major risk factor for cardiovascular disease (CVD), and are consumed in large quantities in low- and middle-income countries as they are used to produce low cost, commonly eaten processed food products. International organizations agree that evidence linking TFA and CVD is strong enough to warrant public health action. This study investigates barriers and opportunities that exist for TFA policy development in low- and middle-income countries, through a literature review of international TFA policy and stakeholder analysis. Previous national policy responses have mostly been in developed countries. Voluntary reduction of TFA by the food industry, following food labelling and/or consumer lobbying, has been the approach in several countries but with varying levels of success, and resulting in major differences in formulation of products between countries. Canada and New York have now moved from voluntary to mandatory approaches. Only three countries have regulated the TFA content of food. Common factors for successful TFA reduction include increased consumer and political awareness of the health impacts of TFA and the need for champion consumer organizations. A stakeholder analysis, using the Mexican policy context as a case study, explored contextual issues influencing implementation of TFA regulation in low- or middle-income countries. Although the public health context seemed to be appropriate to promote TFA policy, the issue is not on the political agenda because it lacks legitimacy and support as a health or regulatory issue. The food industry and government resist the need for regulation, and there is no organized health or consumer lobby to counter this. This is likely to be the case in other middle- and low-income countries.

BACKGROUND: The OECD countries and the United Nations have agreed to co-ordinate their work around a series of International Development Targets. The targets for health are based on improvements in infant, child and maternal mortality. Progress towards these goals will be used to assess the effectiveness of development policies. OBJECTIVES: To assess the potential impact of achievement of the International Development Targets on health in Russia, and to identify possible alternatives that may be more relevant to transition countries. DESIGN: The study covered the population of the Russian Federation from 1995-99.The effects of reducing infant, child and maternal mortality on Russian life expectancy at birth were modelled using construction of life tables. Three scenarios were modelled, reducing rates to those of the best performing regions in Russia, those required to achieve the International Development Targets and current UK rates. The results were compared with the effect on life expectancy at birth of policies to reduce adult mortality in different ways. RESULTS: Achieving the International Development Targets for infant, child and maternal mortality (66.7 and 75% reductions) will contribute very little to improving life expectancy in Russia (0.96 years). In contrast, even a 20% reduction in adult mortality would give rise to an increase in male life expectancy at birth of 1.86 years. CONCLUSION: Targets for health improvement in transition countries such as Russia should take account of adult mortality as well as the indicators contained in the International Development Targets.