Ultra-Processed Profits: The Political Economy of Countering the Global Spread of Ultra-Processed Foods - A Synthesis Review on the Market and Political Practices of Transnational Food Corporations and Strategic Public Health Responses.

Rob Moodie,Phillip Baker,Liza Pratiwi,Edwin Jit Leung Kwong,Elizabeth Bennett,Joanna Williams,Thiago M Santos

doi:10.34172/ijhpm.2021.45

Abstract

Background: Ultra-processed food (UPF) and Ultra-processed beverage (UPB) consumption is associated with higher risks of numerous non-communicable diseases (NCDs). Yet global consumption of these products is rising due to profound changes in production, processing, manufacturing, marketing, retail, and consumption practices, alongside the growth of the resources and political influence of Big Food. Whilst the sales of UPFs and UPBs in high-income countries (HICs) are stagnating, sales are rapidly expanding in more populous middle-income countries (MICs). In this paper, we adopt a political economy of food systems approach to understand how growth of Big Food in MICs drives the NCD pandemic. Methods: We conducted a mixed methods synthesis review. This involved quantitative data collection and development of descriptive statistics; a search for academic, market and grey literature on the expansion of UPF in MICs; and the development of themes, three illustrative case examples (South Africa, Colombia, and Indonesia), and synthesis of the enablers of successful campaigns in MICs into recommendations for public health campaigns. Results: We project that the combined sales volume of UPFs in MICs will reach equivalency with HICs by 2024, and the total sales volume of UPBs in MICs is already significantly higher than in HICs. Similarly, annual growth in UPF sales is higher in MICs compared to HICs. We also show how Big Food has entrenched its presence within MICs through establishing global production and hyper-local distribution networks, scaling up its marketing, challenging government policies and scientific expertise, and co-opting civil society. We argue that public health can counter the influence of Big Food by developing an expanded global network of driven and passionate people with diverse skillsets, and advocating for increased government leadership. Conclusion: The projected increase in sales of UPFs and UPBs in MICs raises major concerns about the global capacity to prevent and treat NCDs.

Highlights

The commercial determinants of health (CDOH) are the “strategies and approaches used by the private sector to promote products and choices that are detrimental to health.”[1]
What explains the rapid growth in the size and global reach of the Ultra-processed food (UPF) industry in middle-income countries (MICs)? How do these transnational corporations (TNCs) sustain these high consumption levels? To answer these questions, we examine this global expansion within its historical context and the growing power of TNCs to shape food systems on a global scale
Survey data show that UPFs contributed 42%, of dietary energy intake in Australia in 2011-201238 and 58% in the US in 2009-2010.39 The contribution of UPFs to dietary energy intake is currently much lower in upper-middle income countries (UMICs) and lowand middle-income countries (LMICs) than in high-income countries (HICs), ranging from 21.5% in Brazil in 2008-200941 to 29.8% in Mexico in 2012.42 whilst growth is relatively stagnant in HICs, UPF market sales, and the contribution of these products to energy intake are rapidly growing in UMICs and LMICs.[43]

Summary

Introduction

The commercial determinants of health (CDOH) are the “strategies and approaches used by the private sector to promote products and choices that are detrimental to health.”[1]. We adopt a political economy approach that is increasingly being used to understand how growth of the UPF industry drives the current pandemics of obesity and diet-related NCDs.[3,5,6,7,8,9] This relationship is informed by a rapidly growing body of evidence which shows that UPF consumption is associated with poorer diet quality, and higher risks of obesity, cardiovascular disease, type 2 diabetes, certain cancers, depression, and all-cause mortality.[10,11,12] Greater production and intensive marketing of UPF products are generating

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Discussion

Conclusion