Corporate power and the international trade regime preventing progressive policy action on non-communicable diseases: a realist review.

Penelope Milsom,Helen Walls,Phillip Baker,Richard Smith

doi:10.1093/heapol/czaa148

Abstract

Transnational tobacco, alcohol and ultra-processed food corporations use the international trade regime to prevent policy action on non-communicable diseases (NCDs); i.e. to promote policy ‘non-decisions’. Understanding policy non-decisions can be assisted by identifying power operating in relevant decision-making spaces, but trade and health research rarely explicitly engages with theories of power. This realist review aimed to synthesize evidence of different forms and mechanisms of power active in trade and health decision-making spaces to understand better why NCD policy non-decisions persist and the implications for future transformative action. We iteratively developed power-based theories explaining how transnational health-harmful commodity corporations (THCCs) utilize the international trade regime to encourage NCD policy non-decisions. To support theory development, we also developed a conceptual framework for analysing power in public health policymaking. We searched six databases and relevant grey literature and extracted, synthesized and mapped the evidence against the proposed theories. One hundred and four studies were included. Findings were presented for three key forms of power. Evidence indicates THCCs attempt to exercise instrumental power by extensive lobbying often via privileged access to trade and health decision-making spaces. When their legitimacy declines, THCCs have attempted to shift decision-making to more favourable international trade legal venues. THCCs benefit from structural power through the institutionalization of their involvement in health and trade agenda-setting processes. In terms of discursive power, THCCs effectively frame trade and health issues in ways that echo and amplify dominant neoliberal ideas. These processes may further entrench the individualization of NCDs, restrict conceivable policy solutions and perpetuate policymaking norms that privilege economic/trade interests over health. This review identifies different forms and mechanisms of power active in trade and health policy spaces that enable THCCs to prevent progressive action on NCDs. It also points to potential strategies for challenging these power dynamics and relations.

Highlights

Understanding how corporations constrain public health policy action, or in other words, promote policy ‘non-decision-making’, has been a growing concern for nearly half a century
While evidence is included from countries across all income groups, we focus, where possible, on low- and middle-income countries (LMICs) since they have become the focus for expansion by many transnational health-harmful commodity corporations (THCCs) ( Lawrence, 2011; Savell et al, 2015; Walls et al, 2020) but generally have limited capacity—financial, institutional, technical and strategic—to resist attempts by THCCs’ to influence health policy processes (Walls et al, 2015)
Australia drew on the Framework Convention on Tobacco Control (FCTC) in its World Trade Organization (WTO) defence over plain packaging (Drope and Lencucha, 2014; Crosbie et al, 2018). While through their discursive power, THCCs can foster and reinforce neoliberal framings and norms, our findings suggest the pervasive individualistic interpretation of non-communicable diseases (NCDs), limited scope of solutions and ‘trade over health’ policy norms cannot be explained by TRCC agency alone

Summary

Introduction

Understanding how corporations constrain public health policy action, or in other words, promote policy ‘non-decision-making’, has been a growing concern for nearly half a century. Scholars have focused on analysing corporate use of trade rules and disputes, finding that by shaping trade rules, THCCs can limit future domestic public health policy space for regulating health-harmful commodities (Labonte et al, 2011; Baker et al, 2014) and by threatening or triggering a trade dispute it may be possible to generate regulatory chill across multiple countries (Hawkins et al, 2019). These analyses have led to calls by public health advocates for transparency and accountability in trade agreement processes with greater participation of health actors; and ensured protection of public health policy space in trade agreements (McNeill et al, 2017b). We argue this may be in part due to a failure to expose and adopt strategies that challenge the underlying power dynamics and relations at the nexus of trade and health

Methods

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Discussion

Conclusion