Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean

Abstract

Objective

To identify examples of the ‘corporate political activity’ (CPA) of the industry producing and selling ultra-processed food and drink products (UPP) in Latin America and the Caribbean.

Design

Searches were conducted on the national websites and social media accounts of large industry actors. Coding was deductive and based on a framework for classifying the CPA of the food industry.

Setting

Fifteen countries in Latin America and the Caribbean.

Participants

Twelve members of the International Food and Beverage Alliance (IFBA) and major trade associations and chambers of commerce in the region.

Results

During the current pilot study, more than 200 examples of CPA were found in Latin America and the Caribbean. The UPP industry lobbied governments during the development of national health policies. UPP companies tried to build alliances with health professionals, but also with communities where they operated and with policy makers. In addition, the UPP industry fought against regulation in court and proposed weaker alternatives to public health policies, such as self-regulation.

Conclusions

Food systems in low- and middle-income countries, including in Latin America and the Caribbean, are increasingly penetrated by the UPP industry. These countries are at risk of being influenced by the CPA strategies described in the present study. There is a need to further identify, monitor and evaluate the impact of these CPA strategies on public health policies and public opinion in the region, in order to develop mechanisms to effectively prevent such interference.

Ultra-processed food and drink products (UPP) are ‘formulations made mostly or entirely from substances derived from foods and additives, with little if any intact (unprocessed or minimally processed) food’ and their consumption has been linked with an increased risk of developing non-communicable diseases (NCD)^{( 1 )}. Regulatory measures to control and prevent NCD have yet to be developed and implemented in many countries, in part due to the influence and opposition from the UPP industry^{( 2 , 3 )}. Recently, UN Member States shared their concerns with regard to undue influence from this industry^{( 4 )}. In response, the WHO is developing risk assessment, disclosure and management tools to safeguard against possible conflicts of interest in policy development and implementation of nutrition programmes^{( 4 , 5 )}.

The term ‘corporate political activity’ (CPA) is defined as ‘corporate attempts to shape government policy in ways favorable to the firm’^{( 6 )}. CPA strategies are used by actors in the UPP, alcohol and tobacco industries when trying to influence public health policies and public opinion, thus delaying efforts to prevent and control NCD^{( 7 – 12 )}. In the 1990s, after litigation against the tobacco industry, internal documents were released to the public^{( 13 , 14 )}. There is strong evidence, from the tobacco industry’s own words, that CPA was successful in interfering with tobacco control^{( 10 , 12 , 15 )}. For many decades, CPA has undermined regulations that could have saved millions of lives. For the UPP industry, access to internal documents is limited. To fill this gap, in 2015, Mialon et al. developed an approach for identifying the CPA of the food industry at the country level, using publicly available information only^{( 6 )}. This has been implemented in several parts of the world^{( 7 , 8 , 16 , 17 )}. To date, there is, however, little evidence of the CPA of the UPP industry in Latin America and the Caribbean. Some charities or journalists have reported about these issues in Mexico or Colombia, for example, but the present study is the first systematic one of its kind in the region, to our knowledge^{( 18 – 20 )}.

The aim of the current pilot study was to identify examples of CPA strategies of the UPP industry in Latin America and the Caribbean.

Methods

The recommendations of Mialon et al. were used as follows^{( 6 )}.

1. 1. Selection of UPP industry actors: twelve members of the International Food and Beverage Alliance (IFBA), given it comprises the largest UPP corporations operating in the region^{( 21 )}. See Appendix 1 for the list of industry actors included in the current pilot study.

2. 2. Identification of trade associations in the UPP industry and chambers of commerce in the region (see Appendix 1).

3. 3. Selection of a purposive sample of fifteen countries (alphabetical order): Argentina, Barbados, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Jamaica, Mexico, Panama, Peru, Trinidad and Tobago, and Uruguay. Table 1 presents, for each country, the policies implemented to promote healthy diets and reduce obesity.

4. 4. For each industry actor and each country, identification of their official national websites and Twitter accounts (see Appendix 1). Other sources such as government or professionals’ associations materials were not explored in the current pilot study.

5. 5. Deductive coding of data, where examples of CPA were classified in one of the six categories presented in Appendix 2. These categories are not mutually exclusive, as some examples may belong to one strategy or another. Agreement about the categorisation of examples was reached after discussion between the two authors. An article published in September 2018 proposed a different terminology^{( 9 )}. Data collection and analysis for the current pilot study took place in spring 2018, therefore this terminology was not used here. This new terminology could be used in future analyses of the CPA of the food industry.

6. 6. Reporting of illustrative examples in the present study. Searches were limited to information published from May 2017 to April 2018 inclusive. All data were collected in April 2018. Documents retrieved were in Spanish, Portuguese and English.

Table 1 Policies implemented to promote healthy diets and reduce obesity in the fifteen Latin American and Caribbean countries included in the current pilot study (data extracted from the WHO Global database on the Implementation of Nutrition Action^{( 25 )})

The current pilot study focused on public health and diet only (i.e. information collected did not include data on water scarcity and/or sustainability; employment/workforce). Information about baby food products and dietary supplements was not included, as these products are covered by public policies and international codes of conduct which strictly prohibit some CPA strategies. Sources of information related to specific products from the companies included in the current pilot study were not studied.

Results

In the fifteen countries analysed, more than 200 examples of CPA were found for the period May 2017–April 2018 inclusive. Most examples found for the present study were part of the ‘information and messaging’ and the ‘constituency building’ strategies. General Mills and Mars did not have Twitter accounts at the national level, and their respective national websites, in all fifteen countries, did not have information about their CPA.

Table 2 gives an overview of the different CPA strategies used by the twelve IFBA industry members, for each country.

Table 2 Overview of the different corporate political activity strategies used by the twelve International Food and Beverage Alliance industry members for each Latin American and Caribbean country included in the current pilot study*

* For a better reading of this table, letters have been attributed to each strategy: I=information and messaging; F=financial incentives; C=constituency building; P=policy substitution; L=legal strategies; O=opposition fragmentation and destabilisation.

In the following sections, illustrative examples of the CPA of the UPP industry in Latin America and the Caribbean are presented, with each example allocated a code starting with the letter A (see the online supplementary material for a full list of examples found during the present study).

Information and messaging strategy

Most examples found in the present study were categorised under this CPA strategy.

Lobby policy makers

On several occasions, UPP industry actors lobbied governments to try and influence their decisions when health regulation was discussed. This was the case in Costa Rica, Ecuador, Guatemala and Uruguay (A95–A98, A106–A110, A113–A116, A131, A133, A134, A222).

Stress the economic importance of the industry

Actors in the UPP industry also stressed their importance in the economy of the countries in which they operate, such as Argentina, Brazil, Colombia, Ecuador, Mexico, Peru, Trinidad and Tobago, and Uruguay (A3, A10, A13, A18, A35, A40, A70, A73, A80, A105, A112, A156, A164, A193, A197, A219, A223, A225).

Frame the debate on public health- and diet-related issues

In most countries of the region, the UPP industry used messages and provided information that framed the debate in ways favourable to the companies. The UPP industry claimed to be part of the solution in the NCD epidemic (see e.g. A87, PepsiCo, Colombia). There was a strong emphasis on physical activity to maintain good health, while the role of UPP, central to the activities of food companies, was seldom mentioned.

Across the region, events for children were used to promote information about healthy eating. All industry actors included in the present study were members of the IFBA and therefore pledged to adopt the IFBA’s commitments with regard to responsible marketing to children^{( 22 )}. However, several companies did not comply with their own commitment and worked in schools. This was the case for the Programa Nestlé Niños Saludables (Nestlé Healthy Kids Program; A125, Nestlé, Ecuador) or the PespiCo ActivaRSE programme (A62, PepsiCo, Chile). In some instances, children were exposed to the brands of the companies (see e.g. A12, A72, A86, A120, A123, A1244, A203). In Brazil, as part of its ‘Education and Nutrition Program’, and after a visit to the Grupo Bimbo factory, pupils and their teachers were offered a kit that contained several products and material from the company (A25, Grupo Bimbo, Brazil).

Shape the evidence base on diet- and public health-related issues

There was evidence that the UPP industry tried to shape the evidence base on diet- and public health-related issues in Latin America and the Caribbean.

There was one example where a major trade association in the region tried to discredit scientific evidence on the role of ultra-processed food products, by qualifying the science of ideological or ‘easy science’ (v. ‘robust science’; A69). Industry actors also tried to shape evidence on diet-related issues by engaging with public health professionals during scientific conferences. For example, a manager from Nestlé participated in the Diabetes Association Trinidad & Tobago Expo 2017 (A211, Nestlé, Trinidad and Tobago).

Financial incentives

No publicly available evidence of use of the ‘financial incentives’ strategy by the UPP industry between May 2017 to April 2018 was found in the countries included in the current pilot study. This could be due to the fact that this type of information is usually found in official documents or registries from governments, which were not included in the present study. Another reason might be related to the fact that financial incentives are usually more evident during political campaigns prior to elections, and most countries analysed herein have not had any provincial or presidential elections during the study period.

Constituency building strategy

There were numerous examples of the ‘constituency building’ strategy in Latin America and the Caribbean, where the UPP industry tried to build relationships with health professionals, universities, communities and policy makers.

Establish relationships with health professionals and universities

In Latin America and the Caribbean, there was evidence that the UPP industry tried to establish relationships with health professionals and universities. For example, Unilever was a partner of the Instituto Nacional del Corazón (National Heart Institute) and the World Heart Federation (WHF; A89, Unilever, Colombia). In Mexico, Nestlé launched a Corporate Chair, specifically targeting nutrition education, with the Anáhuac University (A173, Nestlé, Mexico).

Seek involvement in the community

In all fifteen countries included in the present study, UPP industry actors sought involvement in the community in which they operated. Here again, some of these initiatives targeted children and included branded material (see e.g. the portions of cereal and snacks provided by Kellogg’s to children and families; A78, Kellogg’s, Colombia). In Ecuador, Nestlé, in partnership with other organisations, presented an event for children affected by a recent earthquake, during which they distributed a ‘Nestlé kit’ that consisted of seventeen Nestlé products (A122, Nestlé, Ecuador). Actors in the UPP industry also participated in programmes focusing on sustainability and water scarcity (see e.g. the cleaning of beaches in Peru; A189, Coca Cola, Peru).

Establish relationships with policy makers

For many countries in the region, there was evidence that actors in the UPP industry established relationships with policy makers (A2, A23, A28, A44, A68, A94, A102, A103, A111, A123, A132, A137, A138, A142, A148, A150, A151, A166–A171, A181, A184, A191 A19, A198, A204, A205, A221). For example, the Chilean programme CHILE CRECE SANO (Chile grows healthily) from Chilealimentos, a trade association, worked ‘in conjunction with the FAO against obesity’ (A44, Chilealimentos, Chile). On at least one occasion, members of CGAB (Camara Guatemalteca de Alimentos y Bebidas/Guatemalan Chamber of Food and Beverage) met with the Guatemalan Minister of Health (A132, CGAB, Guatemala). Some of these examples could also be categorised under the ‘policy substitution’ strategy.

Legal strategies

There was one example of a legal strategy and it was reported in the media, where PepsiCo and Kellogg’s went to court, in Chile, to challenge a new regulation on food labelling and marketing (A66, PepsiCo and Kellogg’s, Chile).

Policy substitution strategy

There was evidence of the ‘policy substitution’ strategy for many countries in Latin America and the Caribbean. These included, for example, the signature of a Memorandum of Understanding (MOU) between the industry and the government in Jamaica (A142, Nestlé, Jamaica), but also voluntary initiatives to reduce the level of sodium in food products, or to limit marketing to children (A5, A21, A22, A26, A31, A33, A38, A88, A100, A130, A144, A146, A155, A158, A177, A178, A183, A187, A195, A220). Here, some examples might also have been categorised under the ‘constituency building’ strategy.

Opposition fragmentation and destabilisation strategy

Three articles published by journalists^{( 18 , 19 , 23 )} reported on personal threats made against public health professionals who were working on the role of UPP in the NCD epidemic: a researcher in Brazil, the director of nutrition policy at Mexico’s National Institute of Public Health and the head of a consumer advocacy group in Colombia (A43, A91, A227). No direct links were made with specific industry actors for these three cases.

Discussion

In Latin America and the Caribbean, there is evidence that the UPP industry used four of the six CPA strategies between May 2017 and April 2018. A majority of examples found for the present study were part of the ‘information and messaging’ and the ‘constituency building’ strategies. The UPP industry framed the debate by focusing on individuals when discussing NCD, with a particular emphasis on physical activity and personal responsibility. They never mentioned the role of UPP in this epidemic. They shaped the evidence base on diet- and public health-related issues by providing education materials to children and by organising events in schools, some of which might be considered as promotional activities. The UPP industry tried to build relationships with public health professionals, universities, communities and policy makers. There was, finally, one example of the ‘legal strategies’.

There are some limitations with the current pilot study and the recommendations below might guide future studies that aim at capturing the full spectrum and extent of CPA used by the UPP industry at a regional or global level. First, it was not a detailed analysis of all CPA strategies, which was beyond the scope of the study, due to time and financial constraints. The pilot study was meant to set the ground for further work on that issue in the region. The reliance on publicly available information, and on certain sources only (industry material), certainly constrained the possible identification of some CPA practices. Future analyses could include other sources of information: governments’ websites (Minister’s diary disclosures, websites of commissions in charge of elections, etc.), professional associations’ websites and the media, among others^{( 6 )}. It is likely that practices such ‘financial incentives’ might only be observed during specific periods of time, such as elections. For these reasons, future studies should aim at an ideal time frame of 3–5 years or more, in order to capture these political changes. In addition, some some CPA strategies such as ‘legal strategies’, ‘opposition, fragmentation and destabilisation’ and ‘policy substitution’ may be employed when a regulatory policy is under discussion, or triggered by other specific political contexts. This could be verified in future studies. Finally, some practices, such as free lunches, phone calls or other interactions are usually not known to the public. Previous studies indicated that, in these cases, interviews with key actors in public health could help in identifying these practices^{( 16 , 24 )}. Finally, future studies could assess the extent to which these CPA strategies influenced the policy process and public opinion, and classify them depending on their relative importance in undermining efforts to prevent and control NCD.

Economic objectives of actors in the UPP industry generally conflict with public health goals to prevent and control NCD. The examples presented in the current pilot study could raise awareness among public health professionals and policy makers (but also communities) about practices that have been used by other industries, particularly tobacco industry actors, for which there is clear evidence of their detrimental nature.