
==== Front
Global Health
Global Health
Globalization and Health
1744-8603
BioMed Central London

39252038
1069
10.1186/s12992-024-01069-1
Research
How can advocates leverage power to advance comprehensive regulation on ultra-processed foods? learning from advocate experience in Argentina
https://orcid.org/0000-0002-7481-8214
Wahnschafft Simone simone.wahnschafft@uni-goettingen.de

12
Spiller Achim 2
Graciano Beatriz Andrea 3
1 https://ror.org/01y9bpm73 grid.7450.6 0000 0001 2364 4210 Research Training Group in Sustainable Food Systems, Georg-August-Universität Göttingen, Heinrich-Düker-Weg 12, 37073 Göttingen, Germany
2 https://ror.org/01y9bpm73 grid.7450.6 0000 0001 2364 4210 Marketing for Food and Agricultural Products, Department of Agricultural Economics and Rural Development, Georg- August-Universität Göttingen, Platz der Göttinger Sieben 5, 37073 Göttingen, Germany
3 https://ror.org/0081fs513 grid.7345.5 0000 0001 0056 1981 Free Chair of Food Sovereignty, School of Nutrition of the Faculty of Medical Sciences, Universidad de Buenos Aires, Marcelo Torcuato de Alvear 2202, Buenos Aires, Argentina
9 9 2024
9 9 2024
2024
20 6813 2 2024
12 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Background

The use of corporate power to undermine public health policy processes is increasingly well understood; however, relatively little scholarship examines how advocates can leverage power to promote the successful adoption of public health policies. The objective of this paper is to explore how advocates leveraged three forms of power – structural, instrumental and discursive – to promote the passage of the Promotion of Healthy Eating Law (Ley 27,642) in Argentina, one of the most comprehensive policies to introduce mandatory front-of-package (FOP) warning labels and regulate the marketing and sales of ultra-processed foods (UPFs) adopted to date.

Methods

We conducted seventeen semi-structured interviews with advocates from different sectors, including civil society, international agencies, and government. Both data collection and analysis were guided by Milsom’s conceptual framework for analyzing power in public health policymaking, and the data was analyzed using hybrid deductive and inductive thematic analysis.

Results

Advocates harnessed structural power through the leveraging of revolving doors, informal alliances, and formal coalitions, enabling them to convene discussion spaces with decision-makers, make strategic use of limited resources, and cultivate the diverse expertise (e.g., research, nutrition science, advocacy, law, political science, activism and communications) needed to support the law through different phases of the policy process. Advocates wielded instrumental power by amassing an armada of localized evidence to promote robust policy design, building technical literacy amongst themselves and decision-makers, and exposing conflicts of interest to harness public pressure. Advocates exercised discursive power by adopting a rights-based discourse, including of children and adolescents and of consumers to transparent information, which enabled advocates to foster a favorable perception of the law amongst both decision-makers and the public. Key contextual enablers include a political window of opportunity, the COVID-19 pandemic, and the ability to learn from the regional precedent of similar policies.

Conclusions

Public health policymaking, particularly when encroaching upon corporate interests, is characterized by stark imbalances of power that hinder policy decisions. The strategies identified in the case of Argentina provide important insights as to how advocates might harness and exercise structural, instrumental, and discursive power to counter corporate influence and promote the successful adoption of comprehensive UPF regulation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-024-01069-1.

Keywords

Power analysis
Food governance
Ultra-processed foods (UPFs)
Political economy of health
Georg-August-Universität Göttingen (1018)Open Access funding enabled and organized by Projekt DEAL.

issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
==== Body
pmcBackground

Since their emergence in the mid-20th century, ultra-processed foods (UPFs) have rapidly taken center stage in changing dietary patterns around the world. Including such products as packaged sweet and savory snacks and sugary drinks, UPFs are generally energy dense, high in dietary components with health-harming effects (e.g., sodium, sugar, saturated fats, and trans-fatty acids), and laden with cosmetic food additives and/or other industrial ingredients, many with unknown health effects [1]. In some high-income countries (HICs), UPFs already account for 50–60% of daily energy intake, and low- and middle-income countries (LMICs) are following suit [2]. In fact, annual sales growth of UPFs in middle-income countries (MICs) already far surpass that of HICs [3] and sales volume are anticipated to reach HIC levels by 2024 [4]. Chronic consumption of UPFs is associated with higher risk for a suite of chronic diseases, including obesity, cardiovascular disease, cancer, type II diabetes, asthma, and depression [5]. The agro-industrial complex needed to support the cultivation of basic ingredients, manufacturing and mass distribution of UPFs, increasingly at the expense of traditional, minimally processed foods, contributes to a host of adverse environmental outcomes, such as land degradation, climate change, and agrobiodiversity loss [6, 7].

For the past two decades, scholars have sought to identify explanations for shifting dietary patterns and the consequent burden of chronic disease. For example, the ‘nutrition transition’ emerged in the early 2000s as a prevailing model to explain shifts from traditional dietary patterns towards ‘Western’ diets characterized by high UPF consumption, pointing to variables like economic development, modernization, urbanization, and increased wealth as drivers of the transition [8, 9]. More recently, scholars have stressed the importance of adopting a political economy approach, placing actors and the power relationships between them at the heart of analysis, to examine how power has been consolidated amongst national and transnational food and beverage companies to favor the widespread availability, affordability and accessibility of UPFs [10–12]. Such analyses have pointed to factors such as trade and investment liberalization [13, 14], increasing market concentration [15], and the rise of hybrid food governance arrangements, such as public-private partnerships [16, 17], as key drivers of corporate power in food governance. This consolidation of power is not unique to food: in 2018, of the world’s largest economies, 29 were countries and 71 were corporations [18]. The commercial determinants of health (CDoH) have emerged as an increasingly prominent area of research and discourse to call attention to this formidable influence corporations now wield in shaping health outcomes [19].

This emerging body of literature on corporate power in food governance has also increasingly been called upon to explain why, despite calls to action on the need for regulatory approaches [16], and guidance on policies needed to ameliorate unhealthy food environments characterized by widespread UPFs [20–23], policy responses to date have been glaringly inadequate [12]. Indeed, country governments to date have predominantly favored the adoption of interventions targeting individual behavior change, such as education (75% of countries) and media campaigns (61%) over regulatory actions on UPFs, such as front-of-pack (FOP) labelling schemes (25%), and restrictions on child-directed marketing (31%) [24]. Corporate political activity (CPA), referring to industry efforts to influence public policy, research and practice, plays a major role in preventing, weakening, or delaying regulatory approaches for improving food environments [25]. Researchers have increasingly sought to catalogue and monitor CPA in policy processes to regulate UPFs [26], as well as on other health-harming commodities like breastmilk substitutes [27] and alcohol [28], around the world [29–31].

Despite pervasive challenges to regulate UPF consumption in the face of contemporary corporate power dynamics, a small precedent of success has been set by a handful of countries in the adoption of UPF regulatory policies. Most of these countries are in Latin America, where UPF consumption has grown exponentially in the 21st century [32], alongside the prevalence of diet-related disease morbidity and mortality [33]. In 2016, Chile became the first country worldwide to jointly introduce a package of three policy measures to address unhealthy food environments: (1) mandatory FOP warning labels on UPFs, (2) restrictions on child-directed marketing of UPFs, and (3) a ban on UPF sales in schools [34]. This approach to bundle, or package, several policy measures into one intervention aligns with international guidance to comprehensively address multiple drivers of unhealthy food environments [21, 22]. Other countries in the region have since followed suit to adopt similar policies, though with quite variable outcomes in terms of policy design (e.g., type of FOP label, types of food marketing restricted), stringency (e.g., nutrient profile model specifications), and comprehensiveness of policies adopted (i.e., FOP labels packaged with additional measures or labels alone) [35]. CPA to prevent, delay, or weaken regulatory action has been well-documented as a major challenge through these policy processes, including in Chile [36], Colombia [37], Mexico [38], Uruguay [39], and Brazil [40].

While a growing scholarship has been dedicated to de-mystifying the ins and outs of how CPA – or the ‘corporate playbook’ – is used to protect industry interests and stymie public health policy, comparatively little scholarship has been devoted to examining how public health advocates can counter this activity and successfully promote the adoption of public health regulatory policies. Those studies that have been conducted predominantly examine the role and strategies of advocates, particularly within civil society, to counter industry interference and advance regulation in the realm of tobacco control [41–46], as well as sugary drink taxes [47–51], and health-harming commodities more broadly [52–54]. A small body of studies were identified that sought to learn from the experience of advocates in UPF regulation in Latin America to date, including in Chile [34, 55], Mexico [55], Brazil [55], Uruguay [39], and Peru [56]. However, only a few of these studies [49, 51, 52, 56] directly engage with concepts and/or empirical analyses of power in these policy processes. Power analysis is an important tool to build a nuanced understanding of how and why the strategies employed by different stakeholders to further their interests do (or do not) result in desired outcomes [10]. Empirical analyses of power in real-world policy experiences have been identified as a key gap in research in public health governance [57, 58], and are sorely needed to develop a ‘public health playbook’ of strategies to counter and proactively minimize corporate influence [59]. The aim of this paper therefore is to examine how advocates were able to exercise power to promote the recent adoption of the food environment policy package, the Promotion of Healthy Eating Law (Ley 27,642), in Argentina. The remainder of this section provides an overview of key concepts and trends in UPF regulation, as well as an overview of the Argentinian regulation, before delving into the methods.

Regulating ultra-processed foods: key concepts and trends

Though the concept first emerged in the 1980s [60], the term ‘ultra-processed foods’ began to rise to prominence in 2009 with the emergence of the NOVA classification, a system that categorizes food products across four different levels (e.g., (1) unprocessed or minimally processed foods, (2) processed culinary ingredients, (3) processed foods, and (4) ultra-processed foods) according to the type, intensity, and purpose of food processing [61]. Within this system, UPFs refer to those foods with the highest level of processing, I.e., those that have ‘undergone intense industrial physical, chemical, or biological processes (e.g., hydrogenation, moulding, extruding, preprocessing by frying) or that contains industrial substances not usually found in domestic kitchens (e.g., maltodextrin, hydrogenated oils, or modified starches), cosmetic additives (e.g., dyes, emulsifiers, artificial sweeteners), or flavouring agents’ [61, 62].

While the most prominently used definition of UPFs hinges on the level of processing, several countries have begun to move forward on UPF regulation using a ‘nutrient based’ approach rather than one based on the level of processing. That is to say that these policies aim to regulate the labelling, marketing, and sales of UPFs based on their level of ‘critical nutrients,’ such as added sugars, sodium, saturated fats, and trans fats. This approach continues to be subject to debate, as the nutrient-based approach to regulation generally does not take into account several components of UPFs with detrimental effects on health, such as artificial sweeteners, colorants, preservatives, thickeners, and emulsifiers [62].

This nutrient-based approach underpins the UPF regulatory approaches that have emerged in several countries in Latin America over the past decade, particularly with the adoption of mandatory FOP warning labels and, in some cases, accompanying marketing and sales restrictions, that began in Chile and that have since been adopted in Peru, Uruguay, Mexico, Colombia, and Venezuela [35]. While these policies follow a similar general approach, they are characterized by important nuances in policy design that enable some to be considered more robust than others from a regulatory perspective.

First, with regard to FOP labelling schemes, these nuances include aspects such as the mandated size of the label and the use of contrasting background devices to improve the salience of the label on product packaging [35]. Which nutrients are to be labelled is also a key issue, with some countries expanding beyond the scope of those nutrients such as sugars, sodium, and fats to also label artificial sweeteners and caffeine [35]. Another important aspect is the phrasing of the warning label itself, with some countries moving towards the use of the stronger “excess in” rather than “high in” phrasing [35]. The nutrient profile model (NPM) used to define the threshold of the label is also critical, with the NPM developed by the Pan-American Health Organization (PAHO) [63] considered to be best practice for the region of the Americas [35]. Finally, with regard to those measures that accompany FOP labels, important differences are present in the scope of marketing restrictions, with some countries moving beyond those focused solely on child-directed marketing to also include restrictions on health or nutrition claims, endorsements, and other persuasive elements for products with warning labels [35]. These nuances are further explored in the following section, which lays out the key tenets achieved in the Argentinian regulation, as well as how they compare to other regulatory precedents in the region.

The Promotion of Healthy Eating Law

In keeping with regional trends, sales and consumption of UPFs in Argentina have increased throughout the 21st century, now constituting nearly 26% of daily energy intake [64]. The Promotion of Healthy Eating Law (Ley 27,642) [65], also commonly referred to as the ‘front-of-package nutrition labelling law’ (ley de etiquetado frontal) was adopted in 2021 to regulate the labelling, marketing, and sale of UPFs. Since its passage, the law has been deemed to be one of the strongest and most comprehensive food policy laws globally due to several aspects of the policy design, expanded upon below [66].

First, the FOP labelling system adopted follows the latest regional guidance [67] and nationally generated evidence [68–72] on the most effective design for decreasing UPF consumption. Specifically, the law includes the mandatory introduction of black octagonal warning labels, which are to be added to the front of UPFs deemed in “excess” of sugars, total fats, saturated fats, sodium, and/or calories, taking the phrasing of the labels further than those of several others in the region, including Chile, Colombia and Peru [35]. In addition, the labelling system adopted by the law includes two pre-cautionary labels related to the presence of caffeine and sweeteners in UPFs to be avoided by children and prohibits the use of health claims on products containing at least one warning label, both of which are otherwise only addressed in UPF regulation in Mexico [35]. The Argentinian regulation has also been identified as the strongest in the region with regard to the mandated size of the warning labels on product packaging, meeting the PAHO recommendation that all labels together should occupy at least 30% of the main product display panel [35, 67] Finally, the adoption of PAHO’s NPM as the basis of the warning labels in Argentina can be regarded as a critical success, which has otherwise only been achieved in Mexico [35]. Other countries in the region, including Uruguay, Peru, and Venezuela, sought to adopt the PAHO NPM, but ultimately adopted less stringent systems [35, 39].

Another strength of the policy is the presence and scope of accompanying measures included in the policy package related to marketing, namely the prohibition of advertising, marketing, and sponsorship of all products with at least one warning label towards children and adolescents, including the use of children’s characters, cartoons, celebrities, athletes, influencers and more. These restrictions apply both to product packaging and advertising in traditional and digital media. Finally, the law stands out for the comprehensiveness of included measures directed towards improving food environments. For instance, the law prohibits the sale, offering, and marketing of products with at least one warning label on school premises and introduces mandatory nutrition education at all levels of mandatory education. Public procurement, such as that which would affect social support programs, is also affected by the law, obligating the prioritization of products without warning labels when comparing procurement offers.

There are also several notable aspects of the law related to the policy process itself that distinguish it as a robust policy case. For example, the fact that UPF regulation in Argentina was ultimately adopted through the Legislative branch in the form of a law, rather than the Executive branch in the form of a decree, is important, as it offers the policy a greater degree of protection from changing political forces. This can be distinguished from, for instance, the labelling policy adopted in Uruguay, which was adopted as a decree through the Executive branch and became subject to several changes throughout the policy adoption process that eroded the scope of the initial proposal [39]. The Argentinian case is also notable for the degree of support with which it was passed through both chambers of the National Congress: first in the Senate (64 votes in favor, 3 votes against, 0 abstentions) and then the Chamber of Deputies (200 votes in favor, 22 votes against, 16 abstentions). This degree of support is notable in a country where industry holds high financial and political power. Agriculture and agro-industry together constitute one of the most important industries in Argentina, accounting for an estimated 8% of GDP, 20% of employment and 54% of exports [73]. In addition, food and beverage processing accounts for over half of agro-industrial production [73]. Sugar is also an important agricultural product, particularly in the northwest provinces of Salta, Jujuy, and Tucumán, where politicians have previously leveraged their power to prevent the introduction of regulatory policies, such as a sugary drinks tax [74]. A final notable facet regarding the politics of UPF regulation in Argentina is that of trade, as Argentina is a member of the Southern Common Market (MERCOSUR), a regional trade agreement between Argentina, Brazil, Uruguay and Paraguay. Argentina’s membership in MERCOSUR is relevant in the context of a growing literature on the role of trade agreements in hindering regulation of health-harming commodities [75–80] and emerging evidence on the strategy used by food industry actors to hinder advancement on national front-of-package labelling policies in the bloc by insisting on the need for a regional (I.e., bloc-wide) regulatory approach to FOP labelling to avoid threats to international trade [39, 40].

Methods

Conceptual framework

We utilized Milsom’s conceptual framework for analyzing power in public health policymaking [78] to guide the conduct and analysis of in-depth, semi-structured interviews with identified advocates of the law leading up to its adoption in 2021. Drawing upon a synthesis of existing political economy and power frameworks –most notably Fuchs and Lederer’s framework on business power in global governance [81], Lukes’ Three Dimensions of Power [82], the ‘Three Is’ framework [83–86], and Gaventa’s power cube [87] – this framework details how actors can harness power to either successfully promote health policy decisions or hinder them, delineating three key forms of power that actors can exercise: instrumental, structural and discursive (see Fig. 1).

Fig. 1 Milsom’s conceptual framework for analyzing power in public health policymaking

The former, which is usually the most visible, refers to direct influence actors can exercise to advance their interests through their actions. The latter two forms are generally more hidden, with structural power encompassing aspects like agenda-setting and rule-setting power, as well as the capacity to secure a ‘seat at the table’ in decision-making spaces. Finally, discursive power refers predominantly to how actors influence the way in which issues are discussed (e.g., framing) in decision-making spaces. These forms of power can be exercised through several mechanisms, such as existing institutional structures, the use of knowledge and evidence, and the cultivation of relationships, and can be exercised across different dimensions, including at local, national or global levels, and in spaces that are either closed, open, invited or claimed. Though presented separately, these forms, mechanisms and dimensions of power are not necessarily independent, and rather can interact. Together, these aspects of power, and respective policy (non-)decisions sit within political, economic, socio-cultural or situational contexts that either hinder or enable the exercise of power. Milsom and colleagues recently applied this framework to examine how corporations exercise power through the international trade regime to hinder policy decision-making on UPFs [78–80]. In this paper, we turn rather to the context of a successful policy decision (I.e., policy adoption) to examine, from their own perspective, how advocates were able to leverage power to advance the passage of the Promotion of Healthy Eating Law (Ley 27,642).

Identifying policy advocates

We used three types of documents to identify policy advocates for interviews: media articles, press releases, and grey literature (I.e., reports). We devised the following set of search terms to identify and collate these documents: ‘etiquetado frontal,’ ‘rotulado’, ‘promoción de alimentación saludable,’ ‘restricción de la comercialización’. First, we applied these terms to a systematic search of nine media outlets that represent a range of political leanings from left-wing to conservative, as identified from the BBC media guide in Argentina [88] (see Supplementary Materials, Table A1). Then, through an initial screening of these documents, we identified websites of stakeholder organizations that were identified as working to advance the law through the policy process, which we searched with the same terms for press releases and grey literature relevant to the analysis (see Supplementary Materials, Table A2. We then screened all sources identified using the search terms to ensure they met the following inclusion criteria: (1) focused on Ley 27,642 or reference to agenda-setting on policy measures ultimately included in the law in Argentina (I.e., FOP labelling, marketing restrictions, and/or improving school food environments); (2) included a description of policy process milestone(s) (e.g., meetings held, stakeholders involved, actions and decisions taken, industry arguments and counter-arguments, etc.); (3) were published in English or Spanish; and (4) were published up until the adoption of the law in 2021 (see Supplementary Materials Table A3). We then used these sources to construct a database of relevant organizations and individuals who were highlighted as advocates of the policy, subsequently inviting a first set of advocates from civil society to participate in the study by email. Email outreach included a description of the project aims, a document with additional information for participants, and a copy of the consent form. These outreach materials were reviewed and approved, alongside the interview guide, by the Ethics Committee at Georg-August-Universität Göttingen prior to data collection. This phase of the research was also used to construct an overview of key stakeholders and milestones in the policy process, both of which are available in the Supplementary Materials(Table A4, Table A5).

Conducting interviews

We conducted seventeen policy advocate interviews between November 2022 and April 2023, including stakeholders with roles across civil society, academia, international development agencies, and both the Executive and Legislative branches of government (see Table 1). While we conducted our initial outreach to civil society stakeholders, we decided not to limit our definition of ‘advocate’ to civil society stakeholders alone, but rather to allow participants to define who would be important stakeholders to speak to who fit this description. We accomplished this by way of snowball sampling, as each participant was asked at the end of the interview to identify additional advocates they would recommend be included in the study. We followed recently published guidance on the principle of determining sample size for saturation (I.e., the point at which little or no relevant new codes and/or categories are to be found in data) a priori in qualitative research, which is identified as 9–17 interviews for studies with homogenous populations and narrow research objectives, as in this case [89]. In addition, we ensured that we continued with interviews until we continued to hear the same names recommended and no new themes emerged during interviews. Based on indicated participant preferences, interviews were conducted either directly in English, or in Spanish with the support of simultaneous interpretation. Apart from one interview conducted with two policy advocates simultaneously, participants were interviewed alone. Interviews were conducted in person in Buenos Aires or online using teleconferencing, again depending on participant preference. Participants were required to provide informed consent that they agreed to have the interview recorded. Recordings were transcribed in the original language of the participant’s interview and, in the case of Spanish transcriptions, translated into English with the support of a professional translation service in Argentina.

Table 1 Number and type of policy advocates interviewed

Stakeholder type*	Number of policy advocates	
Civil society	6	
Professional nutrition organization	3	
Academia	1	
International development agency	2	
Executive branch (Ministry of Health)	2	
Legislative branch (Advisor, Legislator)	3	
Total	17	
*Refers to identified main role during the policy process, not necessarily current role

Informed by Milsom’s conceptual framework, the interview guide first prompted participants to reflect on both the perceived challenges and key strategies to their work in advocating for the law. This line of questioning often brought participants naturally to the topic of grappling with corporate influence; however, if not, this topic was then broached with direct questions on perceived power asymmetries and intervention points upon CPA. Participants were also asked to reflect on lessons learned from the policy process and contextual factors they believed enabled the law to advance. See Supplementary Materials, Annex 2 for the interview guide.

Analyzing data

The interview transcripts were analyzed using thematic analysis, following a hybrid deductive and inductive approach [90, 91]. First, the primary researcher (S.W.) developed a codebook based on Milsom’s conceptual framework, applying it to the analysis of the interview transcripts in MAXQDA software. Throughout this process, additional codes were developed inductively to capture key themes, including advocate challenges, strategies, lessons learned, contextual enablers, and reflections on power and outcomes through the policy process. Then, a second researcher (B.A.G.) coded two of the transcripts using both the deductive and inductive codes, which were then reviewed by both researchers to resolve any discrepancies in coding. Following a brief overview of the policy process, the findings are presented in the results section according to the three forms of power of Milsom’s conceptual framework, with relevant information related to the mechanisms and dimensions of power integrated throughout each of the three sections. Additional sections on contextual enablers and reflections on outcomes of the policy process are also included. Some data sourced from the document review is integrated throughout the results to provide additional context to the analysis of the interview data.

Results

Overview of the policy process

Proposals on FOP warning labelling in Argentina began to emerge in 2016 [92], the same year in which Chile officially implemented its law on food labelling and advertising (Ley 20,606) and PAHO published its NPM to define limits for critical nutrients in UPFs. As one advocate emphasized, the latter was particularly impactful for the policy process in Argentina:

“It’s a very small book that was very revolutionary. In the sense that it paved the way, in all countries, to regulate. That is the main precedent.” [Advocate, International Development Agency].

As the topic began to gain momentum in Argentina, two parallel approaches emerged to move forward on FOP labelling: one through the Executive branch and the other through the Legislative branch. The former was developed through the convening of an inter-ministerial working group beginning in 2018, led by the Ministry of Health and in partnership with the Ministry of Agriculture, Livestock and Fisheries and the Ministry of Productive Development. This inter-ministerial initiative emphasized the need to work with stakeholders from different sectors throughout the development of the proposal, including civil society, academia, professional nutrition organizations, and the food and beverage industry [93]. This initiative also sought to advance on labelling through changes agreed upon both within the National Food Commission (CONAL), which oversees the implementation of the Argentine Food Code, and with other members of MERCOSUR [94]. Following several changes to the proposal made between 2018 and 2020, in part due to a change in the government administration in 2019, the Executive branch reached a finalized proposal, which it presented in meetings with both CONAL [95] and MERCOSUR [96] around the same time that the bill began to be debated in the National Congress.

The latter approach, which was ultimately passed into law, was a bill proposed in the Senate in early October 2020. This bill was reached through a negotiation process that unified 15 different bills drafted by legislators from different political parties in the years preceding to address unhealthy food environments [97]. Upon receiving a positive opinion from the internal commissions of Health and of Industry, the bill was swiftly given half sanction by the Senate later the same month, promptly moving to the Chamber of Deputies for consideration by relevant internal commissions. The bill was then assigned to be debated by six commissions, though this was later reduced to four: General Legislation; Social Action and Public Health; Consumer Defense User and Competition; and Industry. Almost a year after the half-sanction in the Senate, and following the positive opinion given by the four commissions in July, the bill was passed into law by the Chamber of Deputies in October 2021.

Contextual enablers

Advocates pointed to several contextual factors that shaped the successful adoption of the law. First, the COVID-19 pandemic opened a window of opportunity by elevating the protection of public health as a priority value both amongst the public and decision-makers, as well as the legitimacy of the public sector as an entity to intervene upon the private sector:

“…the state was recognized, at the moment, as an actor that could guarantee our health; so, it was also related to this bill. If we let the market act independently and autonomously, all factories would be open, all enterprises would be open, and the virus would have spread more and increased the rate of deaths and everything. And people were scared at the time, so the state was seen as a positive influence in society, which has changed now.” [Advocate, Advisor to Legislator].

The COVID-19 pandemic, particularly during the lockdown that characterized the debate of the law in the Senate, was also identified as an important factor that shifted access to discussion spaces with decision-makers throughout the process. For instance, one advocate in civil society noted that the shift to online communication helped their organization, which was newer and characterized by few resources, access discussion spaces where the law was being debated, as well as convene spaces to bring together advocates and legislators to discuss the topic. Another advocate highlighted that the virtual nature of policymaking at this time may have also mitigated lobbying and heightened transparency in the early stages of the legislative process:

“…the legislators were at home, in their provinces. It was not possible for the industry to visit them in their offices. And there are things that are not going to be negotiated via Zoom…Personally, I think the pandemic helped make the committee’s discussion transparent, it’s posted on YouTube. There weren’t any twists, lobbying, or at least it was less common, because people could not travel through the streets here. We had a very strict quarantine.” [Advocate, International Development Agency].

In general, advocates noted that they were readily invited, alongside industry and other stakeholders, to participate in spaces that debated the policy in both the Executive and Legislative branches, enabling them to share data and arguments with decision-makers, with the only notable exception related to discussions undertaken at the level of MERCOSUR.

Advocates also pointed to several political factors that shifted perceptions of the bill in Congress, including shortened ideological distances in Congress following the change in administration in 2019 and the fact that FOP labelling laws passed in other countries in the region were adopted by governments that came from similar ideological perspectives as the two major coalitions in Congress at the time. The latter lent the bill a degree of credibility as an innovative and politically viable measure:

“…the previous experience in other countries was helpful because they leaned more towards the center-right, Chile, for example; and my coalition, [Party A], also center-right, saw them as an inspiration. And if Chile was doing this, then it was a modern dynamic and innovative proposal and not some old-fashioned policy. But we also saw the experience in Uruguay, which is center-left, so [Party B] could learn from them too. So, we had this context.” [Advocate, Advisor to Legislator].

Another political factor that enabled the law’s successful passage was its bi-partisan support in Congress. This support was due in part to the fact that the bill that was ultimately debated in Congress was reached through the negotiation process that unified previous bills drafted by legislators from different political parties in the years preceding. This political neutrality was also further reinforced by the fact that the unified bill was proposed by two Senators who came from the same province but each from a different political party that constituted the two main coalitions at the time.

“The fact that we managed to present a bill that was not affiliated to any political party is very important because it allowed us to receive support from both parties without any political divide.” [Advocate, Civil Society].

Structural power

Convening spaces and knowledge exchange

As early momentum began to build on UPF regulation in Argentina, advocates were able to capitalize on growing attention to the topic to elevate it on the legislative agenda by organizing a series of conferences, beginning in 2016 and continuing through the legislative debate of the law [92, 98–101], which convened stakeholders across civil society, the Executive branch (e.g., national ministries), the Legislative branch, academia, and professional nutrition organizations, amongst others. These spaces were convened via a partnership of international agencies, led by PAHO. A key activity facilitated by advocates throughout these meetings was to invite champions of UPF regulations passed in other countries in the region, beginning with representatives from Chile, and proceeding with those from Uruguay, Mexico, Peru, and Colombia. Inviting stakeholders to learn from regional precedents was not only advantageous for building political momentum, but for learning from previous experiences to foresee challenges, such as CPA, that would ensue as the proposal for regulation began to gain ground:

“It was like a regional training, not only were we debating this, but other countries as well; so, before Argentina, also other countries went along, Perú went along, Uruguay went along, then Mexico went along, and each country benefiting from the previous experience of other countries. So, when we learned from the experience in Chile, we knew how the food industry would react, what their strategies would be…” [Advocate, Academia].

Revolving doors

The ability to convene these spaces with decision-makers was enabled in part by existing relationships advocates held, some of which were cultivated through prior health policy processes, including tobacco control and regulation on sodium content in foods. Several participants pointed to the importance of ‘revolving doors’ in this respect, referring to the importance of seasoned advocates who either held multiple roles at one time or changed roles across sectors during the policy process, bringing their knowledge, expertise, and networks with them to new positions:

“We have the same people in different organizations, for instance, I mentioned three that I belong to, and you take this to the agenda of the organization.” [Advocate, Academia].

The most commonly noted shifts between sectors that advocates highlighted were between civil society, international development agencies, and the Ministry of Health; however, specific reference to these shifts is omitted here for anonymity purposes.

Informal alliances

Informal alliances were identified as key to overcoming roadblocks faced by any one organization or sector. This emerged, for instance, in the context of the tension between the Executive and Legislative proposals that were developing simultaneously in the years leading up to the official proposal of the bill in Congress. Both proponents and opponents sought to leverage these two institutional approaches to UPF regulation to their respective advantage to either promote or hinder the law from advancing. For example, the Coordinator of Food Product Industries (COPAL), an umbrella entity representing the interests of the food and beverage industry, supported the proposal furthered by the Executive branch rather than the bill. Advocates identified this as CPA, as the Executive proposal was inferior to the Legislative approach for several reasons, including higher susceptibility to shifts in political climate, lower alignment with best practice in both scope and stringency of proposed regulation, and the fact that pursuing a regional agreement with other members of MERCOSUR would significantly delay the process, as well as place the debate in an arena in which industry and trade interests were paramount. Indeed, stakeholders representing industry interests often used their resources to disseminate the argument that Argentina was not allowed to regulate without agreement at the level of MERCOSUR to stifle support for the bill in Congress:

“…they started to say that we could not move forward with the law because it went against our integration within the MERCOSUR, even though legally it was not the case. But they still claimed this, which confused legislators.” [Advocate, Advisor to Legislator].

Advocates leveraged structural power in the face of this challenge through informal alliances with advocates across different positions. Particularly for those advocates facing institutional constraints, such as those positioned within the Executive branch, the importance of informal alliances was key:

“…the best option was always the bill, and even then, we knew that a bill would not involve the Executive Branch we worked at. So, it was our priority to ally with the organizations that would work closely with deputies and senators to try and convince them to be in favor of this policy.” [Advocate, Ministry of Health].

Within civil society, informal alliances also allowed advocates to collectively permeate spaces where misinformation was spread to decision-makers to undermine the bill. This was the case, for instance, for some conferences held by professional nutrition organizations with known conflicts of interest. As one advocate explained:

“…thankfully we were able to work together with other civil society organizations. Whenever one was not able to participate, the others would be there to support them. So, in certain meetings they would say: “Let’s invite [Organization A] because they aren’t as antagonistic as [Organization B]”. But, thanks to our alliance with other organizations, we were always able to speak for each other, to empower each other.” [Advocate, Professional Nutrition Organization].

Coalition building

Formal alliances, in the form of coalitions [102–104] also helped advocates harness structural power through different stages of the policy process. For example, the resources developed by the National Coalition to Prevent Childhood Obesity [105], formed in 2017 with support from UNICEF Argentina [106], lent a collective voice of legitimacy to the positions advocated by a handful of organizations working at the forefront of the process:

“…that was also a very important support because it is different to say to the legislature “[Organization A] has this policy brief”, no, this policy brief is supported by more than 40 organizations representative from all the country. That is, well, the legislators paid a lot of attention.” [Advocate, Civil Society].

During the legislative debate, formal coordination across civil society organizations also became an important strategy for building capacity both within and across organizations. This was particularly the case when five civil society organizations collectively secured a grant funded by Bloomberg Philanthropies and managed by the Global Health Advocacy Incubator (GHAI). With the support of the grant, these organizations were able to expand and diversify their own activities in support of the law, as well as to organize activities collectively. The latter was identified as a challenge by several advocates, as it required novel coordination across organizations with different reputations, approaches, and leadership structures; however, it was also noted as a key strategy to harness collective action and effectively counter corporate power:

“I mean, the inequality of arms was evident from the beginning: the industry has all the means for advertising, for paying nutritionists, to go in the media to demonize the law, and we had nothing. But this influx of money through GHAI to the organization allowed us to counteract that.” [Advocate, Academia].

Instrumental power

Wielding evidence

The generation and dissemination of knowledge and evidence was one of the key activities advocates led to influence the policy process (see Table 2 for a summary of key studies). For instance, a series of studies led by the research-oriented civil society organization, the Inter-American Heart Foundation - Argentina (FIC-Argentina) in 2015–2018 demonstrated the widespread exposure of children and adolescents to different forms of UPF marketing in Argentina [107–109], elevating the issue of the need for regulation. Along a similar vein, two studies conducted by the Ministry of Health – the 4th National Survey of Risk Factors (2018) [110] and the 2nd National Survey of Nutrition and Health (2019) [111] - provided updated evidence on UPF consumption trends in Argentina and the burden of diet-related chronic disease to underscore the extent of the challenge in Argentina.

Table 2 Knowledge and evidence documents generated by policy advocates in Argentina

Document	Relevance to policy process	Year of publication	Author(s)*	
- Food advertising aimed at boys and girls on Argentine TV	Examine prevalence of and exposure to UPF marketing amongst children and adolescents	2015	FIC	
- Marketing techniques aimed at boys and girls in processed food packaging in Argentina	2017	
- Food advertising on Argentinean television: are ultra-processed foods in the lead?	2018	
- Exposure of boys, girls and adolescents to digital marketing of food and beverages in Argentina	2021	UNICEF	
- 4th National Survey of Risk Factors	Examine the nutrition and prevalence of diet-related diseases and associated risk factors in the population	2018	MOH	
- Argentina National Survey of Nutrition and Health, 2018–2019 (ENNyS 2)	2019	
- Sugary drinks in Argentina: burden of disease and impact of health interventions	2020	IECS	
- Lessons learned from tobacco control: court decisions that ratify public health policies	Develop an understanding of the political and regulatory landscape	2020	FIC	
- Front warning labelling bill: economic arguments that support it	2020	
- Regulatory mapping: front food labelling	2020	FIC and IDEC	
- Front food labelling in Argentina and Brazil: legal barriers and facilitators	2020	
- Conflict of interest and interference of the food industry in the design of healthy eating policies	2020	Various	
- Evaluation of the performance of the front of package warning labelling compared to other models in Argentina	Supporting evidence for effective policy design	2020	MOH	
- Analysis of the level of concordance of nutrient profile systems with the Dietary Guidelines for the Argentine Population	2020	
- Evaluation of nutrient profile systems Nutritional for the definition of a front of package labelling policy in Argentina	2020	FIC	
- Survey to evaluate the influence of three front of package labelling systems in the perception of healthiness and the purchase intention of certain products

- Opinion survey on front labelling of warnings in food and drinks

	2021	
*FIC = Inter-American Heart Foundation; MOH = Ministry of Health; IECS = Institute of Clinical and Health Effectiveness; IDEC = Brazilian Institute for Consumer Protection; Various = published by the National Coalition to Prevent Obesity in Children and Adolescents representing a network of civil society organizations in Argentina

Generating evidence was also key to influencing the design of the regulation. As discussions in both the Executive and Legislative branches began to gain momentum, industry and associated stakeholders sought to influence the design of the proposed regulation in ways that would be more favorable to corporate interests, such as the type of FOP labelling scheme and the NPM to be adopted. In 2017, for example, COPAL released a proposal calling for the adoption of a label following the Guideline Daily Amount (GDA) model used in the United Kingdom [112], which has been demonstrated in studies to be less effective than warning labels in shaping consumer understanding, attitudes, and choices [67, 69]. Similarly, the industry argued for a NPM that defined excess nutrients on a ‘per gram’ basis [113], which would have made it easier for companies to evade the labels than with the PAHO NPM. To counter these instances of CPA in the policy process, advocates pointed to the importance of locally generated evidence to support arguments for the proposed policy design:

“What was one of the arguments of the industry? “Okay, okay, how do we know that the, let’s say, this front labelling with this black octagon, is the most effective for Argentina? Because this has been effective in Chile, but how do we know if it is effective in Argentina?” So, we have evidence, we have scientific evidence, but this scientific evidence has not been validated here.” [Advocate, Academia].

As such, both the Ministry of Health and FIC conducted studies to compare the performance of different labelling schemes amongst the Argentine population [68–70], as well as to demonstrate that the proposed PAHO NPM was in the greatest accordance with the dietary guidelines for the Argentine population compared to other models [71, 72]. One participant pointed to the importance of involving multiple organizations in the generation of evidence to support effective policy design:

“Another strategy was to work hand to hand with the Ministry of Health,and we agreed on what evidence we have to produce, at the same time, both of us: to have a study from the Ministry of Health that says that the octagon warning level was the best, and another study, that says the same, but from the Civil Society. So, it is not only the Civil Society that has this evidence, but the Ministry of Health, too. And the same with the nutrient profile system.” [Advocate, Civil Society].

Building technical literacy

This tenet of instrumental power refers both to the building of technical literacy amongst advocates themselves and amongst decision-makers. Regarding the former, advocates synthesized knowledge on key aspects of the policy process, such as the legal and political landscape surrounding the law. For instance, advocates in civil society led a series of analyses on legal aspects that would influence the policy process, particularly through a collaborative regional study with other countries in MERCOSUR. This included a mapping of the national regulatory framework on FOP labelling [114], an analysis of legal barriers and facilitators to FOP labelling [115], and a report on legal lessons learned from the precedent of tobacco control [116]. Civil society advocates also worked to consolidate knowledge of the political landscape, such as by mapping decision-makers in Congress to understand their stances and guide targeted advocacy:

“One of our main strategies was to monitor and study the members of the Senate and the Chamber of Deputies; to identify how much power of decision they had within their commissions…. We also wanted to identify who our champions were going to be, also the ones who were never going to agree to this law, and the ones we could be able to sway in our favor. So, we mostly focused on those we could convince, and that’s when we asked legislators to have meetings with them and their advisors.” [Advocate, Civil Society].

Conducting targeted advocacy efforts, such as through one-on-one meetings with key legislators and/or their advisors, was used as a strategy to build technical literacy on the bill in Congress. This proved to be particularly important in the face of CPA that targeted technical aspects of the law. For example, resistance during the later phases of the legislative debate did not oppose the law itself, but rather focused on the need for ‘modifications’ to the text of the law, which, if heeded, would have stalled the passage of the bill. This was particularly the case with Article 6, which established the PAHO NPM as the foundation for the adoption of FOP warning labels and was highlighted by industry stakeholders as a system that would unfairly affect their products [117]. In this context, advocates described the importance of holding meetings with legislators to clarify key concepts:

“We talked to legislators and advisors; we explained why the bill was written the way it was written; that we must use PAHO’s nutrient profile system; that the industry kept insisting on using a different profile system. You can base the law on unlimited profiles and the law would end up a mess. So, we explained to them the importance of each and every article of the law, that the law must be approved unchanged.” [Advocate, Professional Nutrition Organization].

In addition, conducting targeted advocacy was identified as an important approach to advocacy in the context of unequal resources:

“….they [the industry] knew that they had to engage with all political actors, not just “some”. On the other hand, NGOs and civil society have fewer resources, so they concentrated their relationships with key stakeholders.” [Advocate, Advisor to Legislator].

Exposing conflicts of interest and harnessing public pressure

Another key population that advocates sought to influence was the public, accomplished through the strategic use of communication channels. For example, advocates described using traditional and social media to expose industry tactics and encourage accountability of decision-makers, including ‘naming and shaming’ those who had conflicts of interest. Other identified strategies to harness public pressure included conducting communication campaigns with national coverage in public spaces, radio, digital and print media, such as the, “Don’t let them cover your eyes,” (“Que no te tapen los ojos”) [118] campaign, and making use of a digital platform, ‘Activá el Congreso’ [119], which enabled individuals to write directly to legislators. The involvement of advocates who could more effectively reach the public, such as journalists, influencers, youth activist groups and celebrities, was vital to harnessing public pressure. Bringing the debate surrounding the law into the public domain was noted as a key strategy to counter imbalances of power through the policy process:

“…one more thing about this imbalance is that it is only possible to restore it if civil society plays a very aggressive role on the internet, in the media, employing certain communication strategies….If the discussion had only taken place within the Chambers, we probably would have lost the case.” [Advocate, Legislator].

Leveraging public pressure proved particularly critical at junctures in the legislative debate where it seemed that the bill would not successfully advance due to interference. For example, following the half-sanction of the bill in the Senate, the bill was assigned for consideration by an unusually high number of commissions within the Chamber of Deputies [120], a strategy advocates identified as one motivated by conflicts of interest held by the president of the Chamber of Deputies to hinder the passage of the bill. Here, one advocate stressed the importance of public pressure in overcoming this obstacle:

“that’s when Civil Society launched campaigns on Twitter denouncing the number of committees that the bill was assigned to; that made [the president of the Chamber of Deputies], who in another context would not have changed his mind, feel singled out and decide to reduce the number of committees to three, although they finally ended up being four.” [Advocate, Legislator].

Once the commissions in the Chamber of Deputies issued a positive opinion on the bill, the final vote in the Chamber of Deputies remained as the final step to adopt the bill. Advocates described another instance at this point in the process where political factors almost prevented the passage of the law, in which one of the two major political parties did not present with a quorum at the session in which the law was to be put to a vote, placing the bill at risk of losing parliamentary status if not approved before the end of the year [121]. Again, advocates pointed here to the importance of public pressure to overcome this obstacle:

“Another enabling factor appears when society starts to personally start caring about the law. This was very apparent when the Chamber of Deputies didn’t reach a quorum on the bill… then began to circulate a very strong campaign in social media, where the public would call out these people and say, “How come they don’t want to vote on a bill that involves the health of the people?”. To me, that was a very compelling moment, I didn’t know that the bill had affected society in this way.” [Advocate, Professional Nutrition Organization].

Discursive power

Generating counterarguments

Over the course of roughly a year from when the bill was first proposed in 2020 to its passage in 2021, the topic of FOP labelling transformed from a relatively niche and technical topic predominantly discussed within institutional spaces, to one of great political and public interest, with its own hashtag (#EtiquetadoClaroYA) on social media. This transformation reflects a shift in the dominant discourse surrounding the implications of the law for society. Advocates worked to shape the discourse surrounding the law, which required that they be poised to counter a range of economic, technical, legal, and ethical arguments made by the industry and associated stakeholders throughout the policy process (see Table 3 for a summary of key arguments and counterarguments). The knowledge and evidence generated by advocates, as previously detailed in Table 2, played a key role in supporting several of these counterarguments.

Table 3 Common arguments used to oppose the proposed regulation and advocate counterarguments through the policy process of the Promotion of Healthy Eating Law in Argentina [122–124]

Type of argument	Argument	Counterargument	
	The proposed regulation…		
Economic	…will cause job losses and low wages in the food sector.	In Chile, minimal negative impacts have been observed regarding industry employment with the adoption of FOP labelling.	
…will generate additional costs for the sector of the food industry.	The food industry has the resources to adopt the measures without suffering significant economic impacts.	
…will negatively affect the Argentine sugar sector.	Sugar is mostly produced for biofuels, which would not be impacted by the law.	
…will reduce sales.	Food companies generally have a portfolio of different products, some with and some without labels. Companies can also reformulate.	
…will harm companies by prohibiting them from advertising their products.	The regulation does not prohibit all advertising. In addition, it is an opportunity for companies to advertise the absence of seals for a competitive advantage.	
…will disproportionately punish small- and medium-sized enterprises (SMEs).	The law contemplates deadlines for major adaptations with the possibility of extension for SMEs.	
Legal	…is not legal because it would not be standardized across MERCOSUR countries.	The economic bloc of MERCOSUR recognizes the States Parties the right to legislate for the protection of the public health of its citizens. Other countries in the bloc have introduced FOP labels at the national level.	
…is not legal because it would not align with WTO standards.	WTO recognizes the right of States to legislate and take measures that they deem necessary to protect public health. See the precedent of tobacco.	
…is not legal because it contradicts provisions of the Codex Alimentarius.	Codex Alimentarius guidelines constitute a minimum floor on which to advance in terms of public policies, but not a limit.	
…will introduce barriers to free trade due to differing packaging requirements.	The regulation applies only to Argentina and would not affect products exported to other countries.	
…will harm the export of Argentine food by creating barriers to international trade	Provisions under the WTO TBT agreement would ensure that the labelling regulation would not introduce undue barriers to trade.	
…contravenes the Argentine Food Code because it will present false information about the real nutrient content of food.	The use of the PAHO NPM and warning labels has been shown to be the most effective at communicating the nutrient content of food and would enhance transparency rather than hinder it.	
…will violate intellectual property	This has been refuted through the precedent of tobacco and UPF regulation in Chile, where such lawsuits have been dismissed.	
Technical/

scientific

	…has not been shown to decrease overweight or obesity rates.	A period of ample time is needed to observe public health impacts; The motivation for the law should remain consistent with its objective, which is to offer people timely, clear, accurate and true information that enable healthier consumption choices.	
…does not address the root problem of poor diets, which are based on individual choices.	There is ample evidence to support the role of UPF consumption as the root cause of obesity epidemic.	
…has no empirical evidence to show that it will change consumer choices.	Empirical evidence was collected in Argentina demonstrating that the warning label had the highest impact on consumer intention to purchase.	
…uses a NPM with no empirical evidence behind it and is against the dietary guidelines in Argentina.	A comparison of eight nutrient profile systems found that the PAHO nutrient profile demonstrated the highest accordance with the dietary guidelines in Argentina.	
…uses a NPM that does not promote reformulation.	The aim of the labels is not to encourage reformulation, but to inform consumers. However, evidence from Mexico demonstrates the potential for reformulation.	
…will result in over 90% of products being labelled, completely overwhelming consumers.	The law applies only to UPFs, which do not encompass such a high percentage of foods sold in retail settings.	
Ethical/social	…misrepresents the nutritional value of certain products.	The label’s use depends on the chemical composition of each product.	
…demonizes packaged food.	The law seeks to protect consumers’ right to information, not to demonize.	
…is a law for rich people/the first world in a context of economic decline and rising food insecurity.	Consumption of UPFs carries disproportionately negative health and economic ramifications for the most vulnerable sectors of the population, and thus is a high priority in this context.	
…will prevent the free delivery of products containing at least one label, preventing donation of food to vulnerable populations in the context of rising food insecurity.	The law will not prohibit the donation of products without warning labels, which would be better for the health of the most vulnerable sectors of the population.	
…confuses consumers and therefore harms individual freedom of choice.	This law upholds the consumer right to transparent information, thereby better enabling freedom of choice, particularly in the context of misleading marketing practices.	
…is not the appropriate approach to shift diets. Education is needed for better choices.	Education and campaigns are important components and should be part of a comprehensive policy to improve food environments. Campaigns are not substitutes to labels, but complements.	
Acronyms: MERCOSUR = Southern Common Market, WTO = World Trade Organization; TBT = Technical Barriers to Trade Agreement, PAHO = Pan-American Health Organization, UPFs = Ultra-Processed Foods

Advocates noted that economic arguments, particularly given the context of economic instability and decline in Argentina, gained the most traction against the law.

“…the strongest argument in a country in Latin America is about, we are going to lose jobs, employment is going to be affected, which is also an argument that the industry is going to go broke, that the industry cannot endure this… I mean, the rest is more debatable, but the economic factor is important and that is where the industry went.” [Advocate, International Development Agency].

In this context, emerging evidence from Chile demonstrating that neither aggregate employment nor average real wages were affected by food labelling regulation helped support advocates to address these concerns in Argentina [125–127]. Advocates also spoke to the importance of emphasizing the economic ramifications of not acting in the form of rising healthcare costs.

Rights-based framing

To address ethical arguments, framing was key. Namely, advocates spoke to the importance of framing the law in communication with decision-makers not just within the paradigm of public health, but other values, such as the right of consumers to transparent information regarding the content of their food:

“…that was very important, to focus on the consumers’ right, not focusing only on that eating better was important, but you have to know what you are eating, then you decide, no? And that was very important to convince the legislators.” [Advocate, Civil Society].

This rights-based framing was also important in harnessing public support, and was pursued in communication campaigns led by civil society, such as the aforementioned “Don’t let them cover your eyes,” (“Que no te tapen los ojos”) campaign, with the slogan, “It is our right to know if a food has excess fat, sugar and/or sodium” [118]. This framing helped to turn the commonly used argument by the industry of individual responsibility and choice on its head by presenting the labels as a tool to enhance individual autonomy rather than hinder it. Another key framing for the law that fostered public support was the protection of vulnerable populations, particularly children and adolescents, from deceptive industry practices:

“I think it was a combination of different narratives, but I would say that the need to protect children and vulnerable social groups was what penetrated the most through society and, also, the industry’s lies…All of this sparked interest and a feeling of alarm at the same time.” [Advocate, Civil Society].

Extending narratives beyond the confines of a nutritional perspective to align the framing of the law with the priority values of different movements also brought more advocates into the fold, such as consumer organizations and environmental activists, reaching a broader audience over time.

Reputation management

The credibility that advocates carried in the arguments they made hinged on their reputation. As such, reputation management was an important aspect of advocates’ work throughout the policy process. For some organizations, particularly those comprised of nutrition professionals, managing internal conflicts of interest was critical. This was the case with the Argentine Federation of Graduates in Nutrition (FAGRAN), an umbrella organization of the Colleges and Associations of Graduates in Nutrition. The work done by the organization to reach an organizational position free of conflicts of interest, spearheaded by a change in leadership in 2018, was a critical factor in providing a degree of legitimacy to the voice of these advocates coming from the field of nutrition. The ability of organizations like FAGRAN to position themselves as entities free of conflicts of interest became a useful tool to spotlight those entities who could not do the same:

“…we told everyone who we were and we told them that we had no conflict of interest. And when you work on the law, people are more willing to listen to what you are saying. On the other hand, whenever we would hear arguments against the law, we knew those people and organizations always had conflict of interest. So, we requested that everyone who participated in the discussion must state whether they had any conflict of interest or not, and if they did, then what kind of conflict of interest it was.” [Advocate, Professional Nutrition Organization].

Outcomes of power: reflections on policy decision

The law was seen as a key milestone in a broader effort to regulate the widespread availability of UPFs and promote healthier food environments. Advocates spoke particularly of the importance of adopting mandatory FOP warning labels, which define the parameters of products that should be targeted by future regulations. As one advocate explained:

“…these labels are a gateway to other regulations. That is, everything works together: environment, advertising, sponsorship, labelling and taxes. Increasing taxes on sugary drinks. But the gateway is FOP labelling. It will make it easier to discuss a tax when the product has three labels” [Advocate, International Development Agency].

Advocates also spoke to the importance of the fact that the law included not only FOP labels, but other components that work synergistically to promote healthier food environments:

“I think that one of the greatest advantages is that you have in a piece of regulation a lot of – you are able to regulate a lot of the aspects included in what should be a healthier food environment. And that’s also something coming from tobacco. When you regulate and you have a tobacco control law, it’s not only about regulating the environment. It’s also about regulating the cigarette package. It’s also about regulating the promotion and advertising and sponsorship of tobacco products. So, this was a similar rationale.” [Advocate, Civil Society].

Ultimately, despite pervasive attempts to prevent or hinder the passage of the law, as well as undermine its scope, the law was passed in accordance with the recommendations made by advocates throughout the policy process. Though advocates pointed to many challenges regarding the road ahead for successful implementation of the law, this milestone was regarded as an important success:

“We enacted the exact law we wanted to enact. I thought it was going to be modified. Because sometimes they propose a good bill and it ends up as a weak law. Ours was whole. It was complete.” [Advocate, International Development Agency].

Discussion

This paper examines how advocates were able to harness and exercise structural, instrumental and discursive power to guide the adoption of a regulation on the labelling, marketing and sale of UPFs. Several lessons can be learned from the insights shared by advocates on the Argentine experience on UPF regulation.

First, advocates must take pages from the ‘corporate playbook’ to effectively counter it, particularly to garner structural power. Corporations often pool political, financial and technical resources to undermine public health action, such as through the activities of umbrella entities like COPAL in Argentina. Capacity building to cultivate a collective voice of advocates to promote public health policy decisions is vital [128]. Through informal alliances and formal coalitions that united organizations across the country, advocates in Argentina were able to collectively access discussion spaces, make strategic use of limited resources, cultivate a unified narrative in their arguments and demands, and harness the diverse expertise needed to counter industry interference and effectively reach both decision-makers and the public. Some of the skillsets of those who worked to advocate for the law in Argentina, such as legal experts, trade analysts, political strategists, and communications specialists, have historically been considered outside the purview of public health, despite being vital to achieving meaningful improvements in health policy [129]. Capacity building initiatives to train, recruit and integrate these skillsets into public health efforts are therefore critical to strengthening the ‘public health playbook’ against corporate power in public health policy decisions [4, 59]. In Argentina and in other public health regulatory policy processes worldwide [44, 45, 48, 50, 130], support from international health groups is an important enabler of capacity building. United Nations (UN) agencies play an important role. In Argentina, for example, PAHO and UNICEF took on many key capacity building roles throughout the process, including convening multi-sectoral discussion spaces for agenda-setting and providing financial and technical support for research, advocacy, and communications in support of the law. Advocates also took a page from the corporate playbook by cultivating structural power through the use of ‘revolving doors,’ where several policy champions either moved between or worked across different roles within civil society organizations, academia, professional organizations, national Ministries, and/or international development agencies throughout the policy process, bringing their knowledge, expertise, and networks with them.

Advocates wielded instrumental power by amassing an armada of evidence - localized to the Argentine population, free of conflicts of interest, and corroborated by both the public sector and civil society - to support the rationale for and robust design of the law. While this degree of scientific output is certainly a testament to the extent of advocates’ work to support the policy process, it also alludes to a key challenge to meaningful health policy change in the face of corporate influence: an over-reliance on a strict evidence-based approach [80, 131]. In other contexts, particularly those with limited capacity to conduct health policy research, consolidating such a wealth of localized evidence may very well not be possible. Fostering international communities of practice in which advocates and decision-makers can exchange the knowledge and evidence cultivated from the experience of other countries that have successfully advanced on adopting UPF regulation, as was also done through regional knowledge exchange facilitated by advocates in Argentina, will be important. As demonstrated in the precedent of tobacco control [45, 132], international networks of advocates can also play an important role in defending national regulations against corporate attempts to undermine them.

Several lessons can also be gleaned from Argentina’s experience cultivating discursive power in the context of this law, particularly on the implications of FOP warning labels. For one, advocates emphasized the importance of framing the labels as autonomy-enhancing tools that provide transparent information as key to building support amongst decision-makers and the public. This framing is particularly important in the context of prevailing neoliberal paradigms that purport the importance of individual responsibility and autonomy in decision-making, which are often exploited by industry actors to undermine regulation [131, 133], as it positioned the law as one that would better enable individual autonomy rather than limit it. Previous literature has demonstrated a limited commitment from both national governments in Latin America and international health groups to adopting a rights-based discourse for UPF regulation [10], indicating an important area for improvement. In addition to this advantage with framing, advocates also understood that mandatory FOP warning labels provided an important foundation for comprehensive UPF regulation by delineating the health-harming commodity that must be regulated. This is particularly important in the context of UPFs where, unlike in the case of tobacco, for example, industry stakeholders can more readily argue health benefits associated with UPFs, in some cases even adding beneficial micronutrients as a tactic to resist regulatory approaches [134]. Together, these insights suggest that pursuing the adoption of mandatory FOP warning labels could be an important foundation for pursuing other important regulations to improve the healthfulness of food environments. Indeed, in Argentina, FOP warning labels were adopted as the foundation of a suite of reinforcing measures that also prohibited the marketing, donation and sales of labelled products in particular settings, including schools and social support programs. FOP warning labels could also support the introduction of additional priority policies to limit the availability and affordability of labelled UPFs and promote that of healthy, minimally processed food products, such as taxes and subsidies [134]. The potential of FOP warning labels to open the door to additional regulation could also be applicable in other contexts; however, additional research, such as that which examines the influence of the order in which policy measures are introduced on political and public support for climate policy [135–137], is needed to examine the generalizability of this strategy outside the Argentine context. In addition, as in Argentina and other cases [138, 139], it must be noted that industry stakeholders can still capitalize on neoliberal narratives of individual responsibility to try and undermine FOP warning labels, despite their function as an information-provision tool.

Besides cultivating greater support amongst decision-makers and the public, advocates observed that expanding the need for UPF regulation beyond the confines of a public health narrative also brought additional advocates into the fold in Argentina, such as consumer associations, youth activists, and influencers, all of which contributed to expanding support for the law. By the late stages of the legislative process, the law was seen by many as not only a matter of public health, but one of protecting human rights, safeguarding against corporate control and political corruption, and fostering a more equitable society. This experience in Argentina corroborates a key strategy that has been identified as vital to building a ‘public health playbook,’ against modern corporate power in public health policymaking: linking with other social movements to cultivate collective solidarity [59]. This is certainly the case for climate and sustainability activism, for example, which continues to garner strong civic engagement worldwide [140]. The connections between the production and consumption of UPFs and environmental outcomes must be strengthened in research, in advocacy, and in policy decisions [141]. Other discursive strategies employed in Argentina further corroborate those that have been identified as vital to building a ‘public health playbook,’ including the importance of debunking corporate arguments, of exposing industry tactics to the public, and of leading by example against conflicts of interest by developing rigorous standards against them within public health organizations [59].

This study is subject to a few limitations. First, this paper focuses on a single case study, limiting the generalizability of the findings to other contexts. For instance, advocates in Argentina noted that they were readily invited alongside other stakeholders, including food and beverage industry actors, to speak within relevant spaces in the Legislative and Executive branch throughout the policy process. This was not the case in Mexico, for example, where civil society actors were excluded from formal participation in relevant institutional discussion spaces for advancing on UPF regulation, reflecting a long legacy of elite-based health policymaking [55]. In general, Argentina has a strong legacy of civil society activities and activism related to health policy issues as demonstrated in the precedent of tobacco control [142] and reproductive rights [143], for example, making it difficult to compare the power dynamics of the policy process to one in which civil society actors have played a different role in health policymaking to date. Another limitation is the retrospective examination of a successful policy decision, which may have introduced bias regarding the importance of certain strategies and enablers. We attempted to mitigate this bias by triangulating information from interviews with that synthesized from a review of media articles, press releases, and reports written leading up to the passage of the law. In addition, we had limited access to stakeholders who participated in certain spaces where the policy was discussed, limiting our insights into power dynamics at play in these spaces. For instance, a burgeoning area of research examines how international trade agreements are being leveraged to hinder nutrition policy action [75–80]. Several advocates spoke broadly to the challenge of an alternative proposal to reach a regional agreement on FOP labelling through MERCOSUR; however, we were not able to explore the influence of corporate power, or strategies to counter it, at this level of governance in depth due to limited access to stakeholders involved in those discussions. The influence of the politicized nature of the topic must also be acknowledged here. Namely, in certain instances, participants noted that they could not be completely forthcoming with their experience for fear of political backlash, though these instances were limited in number and scope. Consolidating lessons learned from advocate experiences addressing corporate power in supra-national food governance, as in the case of tobacco [77, 144], thus constitutes an important area of future research. Finally, lessons learned from the Argentinian experience should not remain static. Future examinations of power dynamics in this case, or others, should encompass the period of policy implementation, which was highlighted by participants as a formidable challenge in the face of continued corporate attempts to undermine it following its adoption. These challenges may have since been compounded with the election of a far-right libertarian president in November 2023, providing a context in which to examine how advocates leverage power, particularly discursive power, in an administration characterized by a prevailing neoliberal ideology.

Conclusions

The use of corporate power to undermine UPF regulatory decisions is increasingly well-documented; however, analyses of how power can be leveraged to promote successful policy decisions are scant. Learning from the small precedent of countries that have managed to successfully adopt robust regulation on UPFs is an important opportunity to strengthen this knowledge in pursuit of a ‘public health playbook’ against corporate power. Leveraging a framework designed to analyze the role of power in public health policymaking, we demonstrate how advocates wielded structural, instrumental, and discursive power to support the passage of the Promotion of Healthy Eating Law in (Ley 27,642) in Argentina. The experience of advocates in Argentina carries important lessons that may be applicable to other countries looking to advance on the topic, including the importance of cultivating a collective movement in support of regulation, the need for synthesis of knowledge and evidence to weather corporate interference, and the promise of shaping dominant discourse so as to better reach both decision-makers and the public.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Acknowledgements

The authors gratefully acknowledge Oscar Cabrera and Valentina Castagnari of the Global Center for Legal Innovation on Food Environments at Georgetown University for their guidance on the conceptualization of the project, and Patricia Aguirre, Lorena Allemandi, and Carolina Delgado for their guidance and support during the fieldwork phase of the project.

Author contributions

S.W.: Conceptualization, methodology, data collection, data analysis (lead), writing-original draft, review and editing; A.S.: review and editing, supervision; B.A.G.: data analysis (support), reviewing and editing.

Funding

The authors gratefully acknowledge the financial support of the German Research Foundation (DFG) through the Sustainable Food Systems Research Training Group (RTG 2654). The DFG had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Open Access funding enabled and organized by Projekt DEAL.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to them containing information that could compromise research participant privacy/consent, but are available, with restrictions applied, from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

All participants provided informed consent to participate in the study. Ethical approval for this work was obtained from the Ethics Committee at Georg-August-Universität Göttingen (21.11.2022).

Consent for publication

Use of data from interviews conducted has been obtained from all research participants.

Competing interests

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
==== Refs
References

1. Srour B Touvier M Ultra-processed foods and human health: what do we already know and what will further research tell us? EClinicalMedicine 2021 32 100747 10.1016/j.eclinm.2021.100747 33644723
Srour B, Touvier M. Ultra-processed foods and human health: what do we already know and what will further research tell us? EClinicalMedicine. 2021;32:100747. 10.1016/j.eclinm.2021.100747.33644723 10.1016/j.eclinm.2021.100747
2. Scrinis G Monteiro C From ultra-processed foods to ultra-processed dietary patterns Nat Food 2022 3 9 671 3 10.1038/s43016-022-00599-4 37118150
Scrinis G, Monteiro C. From ultra-processed foods to ultra-processed dietary patterns. Nat Food. 2022;3(9):671–3. 10.1038/s43016-022-00599-4.37118150 10.1038/s43016-022-00599-4
3. Monteiro CA Moubarac J-C Cannon G Ng SW Popkin B Ultra‐processed products are becoming dominant in the global Food System Obes Rev 2013 14 S2 21 8 10.1111/obr.12107 24102801
Monteiro CA, Moubarac J-C, Cannon G, Ng SW, Popkin B. Ultra‐processed products are becoming dominant in the global Food System. Obes Rev. 2013;14(S2):21–8. 10.1111/obr.12107.24102801 10.1111/obr.12107
4. Moodie R Bennett E Kwong EJ Santos TM Pratiwi L Williams J 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 Int J Health Policy Manage 2021 10.34172/ijhpm.2021.45
Moodie R, Bennett E, Kwong EJ, Santos TM, Pratiwi L, Williams J, et al. 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. Int J Health Policy Manage. 2021. 10.34172/ijhpm.2021.45.10.34172/ijhpm.2021.45
5. Monteiro CA Cannon G Levy RB Moubarac J-C Louzada ML Rauber F Ultra-processed foods: what they are and how to identify them Public Health Nutr 2019 22 5 936 41 10.1017/s1368980018003762 30744710
Monteiro CA, Cannon G, Levy RB, Moubarac J-C, Louzada ML, Rauber F, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936–41. 10.1017/s1368980018003762.30744710 10.1017/s1368980018003762
6. Leite FH, Khandpur N, Andrade GC, Anastasiou K, Baker P, Lawrence M, et al. Ultra-processed foods should be central to global food systems dialogue and action on Biodiversity. BMJ Global Health. 2022;7(3). 10.1136/bmjgh-2021-008269.
7. Anastasiou K Baker P Hendrie GA Hadjikakou M Boylan S Chaudhary A Conceptualising the drivers of ultra-processed food production and consumption and their environmental impacts: a group model-building exercise Global Food Secur 2023 37 100688 10.1016/j.gfs.2023.100688
Anastasiou K, Baker P, Hendrie GA, Hadjikakou M, Boylan S, Chaudhary A, et al. Conceptualising the drivers of ultra-processed food production and consumption and their environmental impacts: a group model-building exercise. Global Food Secur. 2023;37:100688. 10.1016/j.gfs.2023.100688.10.1016/j.gfs.2023.100688
8. Popkin BM. The nutrition transition: an overview of world patterns of change. Nutr Rev. 2004;62. 10.1111/j.1753-4887.2004.tb00084.x.
9. Shekar M Popkin B Obesity Health and economic consequences of an impending global challenge 2020 Washington, DC World Bank Group
Shekar M, Popkin B. Obesity Health and economic consequences of an impending global challenge. Washington, DC: World Bank Group; 2020. https://www.worldbank.org/en/topic/nutrition/publication/obesity-health-and-economic-consequences-of-an-impending-global-challenge.
10. Harris J, Anderson M, Clément C, Nisbett N, editors. The Political Economy of Food, IDS Bulletin 50.2, Brighton: IDS. 2019;2(13). 10.19088/1968-2019.112
11. Baker P Lacy-Nichols J Williams O Labonté R The Political Economy of healthy and sustainable Food systems: an introduction to a special issue Int J Health Policy Manage 2021 10 12 734 44 10.34172/ijhpm.2021.156
Baker P, Lacy-Nichols J, Williams O, Labonté R. The Political Economy of healthy and sustainable Food systems: an introduction to a special issue. Int J Health Policy Manage. 2021;10(12):734–44. 10.34172/ijhpm.2021.156.10.34172/ijhpm.2021.156
12. Baker P, Machado P, Santos T, Sievert K, Backholer K, Hadjikakou M, et al. Ultra-processed foods and the Nutrition Transition: Global, regional and national trends, Food Systems Transformations and political economy drivers. Obes Rev. 2020;21(12). 10.1111/obr.13126.
13. Rayner G Hawkes C Lang T Bello W Trade liberalization and the diet transition: a public health response Health Promot Int 2006 21 suppl1 67 74 10.1093/heapro/dal053 17307959
Rayner G, Hawkes C, Lang T, Bello W. Trade liberalization and the diet transition: a public health response. Health Promot Int. 2006;21(suppl1):67–74. 10.1093/heapro/dal053.17307959 10.1093/heapro/dal053
14. Friel S Gleeson D Thow A-M Labonte R Stuckler D Kay A A new generation of trade policy: potential risks to diet-related health from the Trans Pacific Partnership Agreement Globalization Health 2013 9 1 46 10.1186/1744-8603-9-46 24131595
Friel S, Gleeson D, Thow A-M, Labonte R, Stuckler D, Kay A, et al. A new generation of trade policy: potential risks to diet-related health from the Trans Pacific Partnership Agreement. Globalization Health. 2013;9(1):46. 10.1186/1744-8603-9-46.24131595 10.1186/1744-8603-9-46
15. Van Dam I Allais O Vandevijvere S Market concentration and the healthiness of packaged food and non-alcoholic beverage sales across the European single market Public Health Nutr 2022 25 11 3131 6 10.1017/s1368980022001926 36073156
Van Dam I, Allais O, Vandevijvere S. Market concentration and the healthiness of packaged food and non-alcoholic beverage sales across the European single market. Public Health Nutr. 2022;25(11):3131–6. 10.1017/s1368980022001926.36073156 10.1017/s1368980022001926
16. Moodie R Stuckler D Monteiro C Sheron N Neal B Thamarangsi T Profits and pandemics: Prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries Lancet 2013 381 9867 670 9 10.1016/s0140-6736(12)62089-3 23410611
Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, et al. Profits and pandemics: Prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet. 2013;381(9867):670–9. 10.1016/s0140-6736(12)62089-3.23410611 10.1016/s0140-6736(12)62089-3
17. Clapp J Scrinis G Big food, nutritionism, and Corporate Power Globalizations 2016 14 4 578 95 10.1080/14747731.2016.1239806
Clapp J, Scrinis G. Big food, nutritionism, and Corporate Power. Globalizations. 2016;14(4):578–95. 10.1080/14747731.2016.1239806.10.1080/14747731.2016.1239806
18. Anaf J Baum F Fisher M Friel S Civil Society Action against Transnational Corporations: implications for Health Promotion Health Promot Int 2019 35 4 877 87 10.1093/heapro/daz088
Anaf J, Baum F, Fisher M, Friel S. Civil Society Action against Transnational Corporations: implications for Health Promotion. Health Promot Int. 2019;35(4):877–87. 10.1093/heapro/daz088.10.1093/heapro/daz088
19. The Lancet Unravelling the commercial determinants of health Lancet 2023 401 10383 1131 10.1016/s0140-6736(23)00590-1 36966781
The Lancet. Unravelling the commercial determinants of health. Lancet. 2023;401(10383):1131. 10.1016/s0140-6736(23)00590-1.36966781 10.1016/s0140-6736(23)00590-1
20. World Health Organization (WHO). Global action plan for the prevention and control of noncommunicable diseases 2013–2020. World Health Organization; 2013. https://www.who.int/publications/i/item/9789241506236.
21. Hawkes C Jewell J Allen K A food policy package for healthy diets and the prevention of obesity and diet-related non‐communicable diseases: the nourishing framework Obes Rev 2013 14 S2 159 68 10.1111/obr.12098 24103073
Hawkes C, Jewell J, Allen K. A food policy package for healthy diets and the prevention of obesity and diet-related non‐communicable diseases: the nourishing framework. Obes Rev. 2013;14(S2):159–68. 10.1111/obr.12098.24103073 10.1111/obr.12098
22. Swinburn B Vandevijvere S Kraak V Sacks G Snowdon W Hawkes C Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed government healthy food environment policy index Obes Rev 2013 14 S1 24 37 10.1111/obr.12073 24074208
Swinburn B, Vandevijvere S, Kraak V, Sacks G, Snowdon W, Hawkes C, et al. Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed government healthy food environment policy index. Obes Rev. 2013;14(S1):24–37. 10.1111/obr.12073.24074208 10.1111/obr.12073
23. Fanzo J, Arabi M, Burlingame B, Haddad L, Kimenju S, Miller G, Nie F, Recine E, Serra-Majem L, Sinha D. Nutrition and food systems. A report by the High-Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security. 2017. https://www.fao.org/documents/card/en/c/I7846E/
24. World Health Organization (WHO). Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2019 global survey. World Health Organization; 2020.
25. Baker P Hawkes C Wingrove K What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition BMJ Glob Health 2018 0 e000485 10.1136/bmjgh-2017-000485
Baker P, Hawkes C, Wingrove K, et al. What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition. BMJ Glob Health. 2018;0:e000485. 10.1136/bmjgh-2017-000485.10.1136/bmjgh-2017-000485
26. Mialon M Swinburn B Sacks G A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available information Obes Rev 2015 16 7 519 30 10.1111/obr.12289 25988272
Mialon M, Swinburn B, Sacks G. A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available information. Obes Rev. 2015;16(7):519–30. 10.1111/obr.12289.25988272 10.1111/obr.12289
27. Cossez E, Mialon M. Corporate political activity of the baby food industry in France. Eur J Pub Health. 2021;31(Supplement3). 10.1093/eurpub/ckab164.788.
28. Paixão MM Mialon M Help or hindrance? The alcohol industry and alcohol control in Portugal Int J Environ Res Public Health 2019 16 22 4554 10.3390/ijerph16224554 31752119
Paixão MM, Mialon M. Help or hindrance? The alcohol industry and alcohol control in Portugal. Int J Environ Res Public Health. 2019;16(22):4554. 10.3390/ijerph16224554.31752119 10.3390/ijerph16224554
29. Mialon M Mialon J Analysis of corporate political activity strategies of the food industry: evidence from France Public Health Nutr 2018 21 18 3407 21 10.1017/s1368980018001763 29998811
Mialon M, Mialon J. Analysis of corporate political activity strategies of the food industry: evidence from France. Public Health Nutr. 2018;21(18):3407–21. 10.1017/s1368980018001763.29998811 10.1017/s1368980018001763
30. Mialon M Gomes F Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean Public Health Nutr 2019 22 10 1898 908 10.1017/s1368980019000417 30859929
Mialon M, Gomes F da. Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean. Public Health Nutr. 2019;22(10):1898–908. 10.1017/s1368980019000417.30859929 10.1017/s1368980019000417
31. Huse O, Reeve E, Zambrano P, Bell C, Peeters A, Sacks G, et al. Understanding the corporate political activity of the Ultra - processed food industry in East Asia: A Philippines case study. Globalization Health. 2023;19(1). 10.1186/s12992-023-00916-x.
32. Pan-American Health Organization (PAHO) Ultra-processed food and drink products in Latin America: Trends, impact on obesity, policy implications 2015 Washington, D.C PAHO
Pan-American Health Organization (PAHO). Ultra-processed food and drink products in Latin America: Trends, impact on obesity, policy implications. Washington, D.C.: PAHO; 2015. https://iris.paho.org/bitstream/handle/10665.2/7699/9789275118641_eng.pdf.
33. Pan American Health Organization (PAHO) NCDs at a glance: NCD mortality and risk factor prevalence in the Americas 2019 Washington, D.C PAHO
Pan American Health Organization (PAHO). NCDs at a glance: NCD mortality and risk factor prevalence in the Americas. Washington, D.C.: PAHO; 2019. https://iris.paho.org/handle/10665.2/51696#:~:text=Noncommunicable%20diseases%20. (NCDs)%2 C%20principally,the%20Region%20of%20the%20Americas.
34. Villalobos Dintrans P, Rodriguez L, Clingham-David J, Pizarro T. Implementing a food labelling and marketing law in Chile. Health Syst Reform. 2020;6(1). 10.1080/23288604.2020.1753159.
35. Crosbie E Gomes FS Olvera J Rincón-Gallardo Patiño S Hoeper S Carriedo A A policy study on front–of–pack nutrition labelling in the Americas: emerging developments and outcomes Lancet Reg Health - Americas 2022 18 100400 10.1016/j.lana.2022.100400 36844016
Crosbie E, Gomes FS, Olvera J, Rincón-Gallardo Patiño S, Hoeper S, Carriedo A. A policy study on front–of–pack nutrition labelling in the Americas: emerging developments and outcomes. Lancet Reg Health - Americas. 2022;18:100400. 10.1016/j.lana.2022.100400.36844016 10.1016/j.lana.2022.100400
36. Mialon M, Corvalan C, Cediel G, Scagliusi FB, Reyes M. Food industry political practices in Chile: the economy has always been the main concern. Globalization Health. 2020;16(1). 10.1186/s12992-020-00638-4.
37. Mialon M Gaitan Charry DA Cediel G Crosbie E Scagliusi FB Perez Tamayo EM I had never seen so many lobbyists’: Food industry political practices during the development of a new nutrition front-of-pack labelling system in Colombia Public Health Nutr 2020 24 9 2737 45 10.1017/s1368980020002268 32819452
Mialon M, Gaitan Charry DA, Cediel G, Crosbie E, Scagliusi FB, Perez Tamayo EM. I had never seen so many lobbyists’: Food industry political practices during the development of a new nutrition front-of-pack labelling system in Colombia. Public Health Nutr. 2020;24(9):2737–45. 10.1017/s1368980020002268.32819452 10.1017/s1368980020002268
38. Crosbie E Carriedo A Schmidt L Hollow threats: transnational food and beverage companies’ use of international agreements to fight front-of-pack nutrition labelling in Mexico and beyond Int J Health Policy Manage 2022 10.34172/ijhpm.2020.146
Crosbie E, Carriedo A, Schmidt L. Hollow threats: transnational food and beverage companies’ use of international agreements to fight front-of-pack nutrition labelling in Mexico and beyond. Int J Health Policy Manage. 2022. 10.34172/ijhpm.2020.146.10.34172/ijhpm.2020.146
39. Ares G Antúnez L Cabrera M Thow AM Analysis of the policy process for the implementation of nutritional warning labels in Uruguay Public Health Nutr 2021 24 17 5927 40 10.1017/s1368980021002469 34313211
Ares G, Antúnez L, Cabrera M, Thow AM. Analysis of the policy process for the implementation of nutritional warning labels in Uruguay. Public Health Nutr. 2021;24(17):5927–40. 10.1017/s1368980021002469.34313211 10.1017/s1368980021002469
40. Mialon M Khandpur N Amaral Mais L Bortoletto Martins AP Arguments used by trade associations during the early development of a new front-of-pack nutrition labelling system in Brazil Public Health Nutr 2020 24 4 766 74 10.1017/s1368980020003596
Mialon M, Khandpur N, Amaral Mais L, Bortoletto Martins AP. Arguments used by trade associations during the early development of a new front-of-pack nutrition labelling system in Brazil. Public Health Nutr. 2020;24(4):766–74. 10.1017/s1368980020003596.10.1017/s1368980020003596
41. Matthes BK, Kumar P, Dance S, Hird T, Carriedo Lutzenkirchen A, Gilmore AB. Advocacy counterstrategies to tobacco industry interference in policymaking: a scoping review of peer-reviewed literature. Globalization Health. 2023;19(1). 10.1186/s12992-023-00936-7.
42. Patanavanich R, Glantz S. Successful countering of tobacco industry efforts to overturn Thailand’s ends ban. Tob Control. 2020;30(e1). 10.1136/tobaccocontrol-2020-056058.
43. Bhatta DN Crosbie E Bialous SA Glantz S Defending comprehensive tobacco control policy implementation in Nepal from tobacco industry interference (2011–2018) Nicotine Tob Res 2020 22 12 2203 12 10.1093/ntr/ntaa067 32309853
Bhatta DN, Crosbie E, Bialous SA, Glantz S. Defending comprehensive tobacco control policy implementation in Nepal from tobacco industry interference (2011–2018). Nicotine Tob Res. 2020;22(12):2203–12. 10.1093/ntr/ntaa067.32309853 10.1093/ntr/ntaa067
44. Bhatta DN, Bialous S, Crosbie E, Glantz S. 2020. Exceeding WHO Framework Convention on Tobacco Control (FCTC) Obligations: Nepal Overcoming Tobacco Industry Interference to Enact a Comprehensive Tobacco Control Policy. Nicotine & Tobacco Research. 2020;22(12):2213–2223. 10.1093/ntr/ntz177
45. Crosbie E Perez S Copa PC Monje AK Machin N Lopez G Tobacco control in Bolivia: Transnational Civil Society efforts in securing a comprehensive law Nicotine Tob Res 2022 24 8 1300 4 10.1093/ntr/ntac036 35137190
Crosbie E, Perez S, Copa PC, Monje AK, Machin N, Lopez G, et al. Tobacco control in Bolivia: Transnational Civil Society efforts in securing a comprehensive law. Nicotine Tob Res. 2022;24(8):1300–4. 10.1093/ntr/ntac036.35137190 10.1093/ntr/ntac036
46. Willemsen MC, Been JV. Accelerating tobacco control at the national level with the smoke-free generation movement in the Netherlands. npj Prim Care Respiratory Med. 2022;32(1). 10.1038/s41533-022-00321-8.
47. Fuster M Burrowes S Cuadrado C Bernal AV Lewis S McCarthy B Shen GC Understanding policy change for obesity prevention: learning from sugar-sweetened beverage taxes in Mexico and Chile Health Promot Int 2021 36 1 155 64 10.1093/heapro/daaa045 32388550
Fuster M, Burrowes S, Cuadrado C, Bernal AV, Lewis S, McCarthy B, Shen GC. Understanding policy change for obesity prevention: learning from sugar-sweetened beverage taxes in Mexico and Chile. Health Promot Int. 2021;36(1):155–64. 10.1093/heapro/daaa045.32388550 10.1093/heapro/daaa045
48. Carriedo A, Koon AD, Encarnacion LM, Lee K, Smith R, Walls H. The political economy of sugar-sweetened beverage taxation in Latin America: lessons from Mexico, Chile and Colombia. Globalization Health. 2021;17(5). 10.1186/s12992-020-00656-2.
49. Thow AM, Karim SA, Mukanu MM, Ahaibwe G, Wanjohi M, Gaogane L, Amukungo HJ, Ruhara CM, Ngoma T, Asiki G, Erzse A, Hofman K. The political economy of sugar-sweetened beverage taxation: an analysis from seven countries in sub-saharan Africa. Global Health Action. 2021;14(1). 10.1080/16549716.2021.1909267.
50. James E, Lajous M, Reich MR. The Politics of Taxes for Health: an analysis of the passage of the sugar-sweetened beverage tax in Mexico. Health Syst Reform. 2020;6(1). 10.1080/23288604.2019.1669122.
51. Carriedo A Lock K Hawkins B Policy process and non-state actors’ influence on the 2014 Mexican soda tax Health Policy Plann 2020 35 8 941 52 10.1093/heapol/czaa060
Carriedo A, Lock K, Hawkins B. Policy process and non-state actors’ influence on the 2014 Mexican soda tax. Health Policy Plann. 2020;35(8):941–52. 10.1093/heapol/czaa060.10.1093/heapol/czaa060
52. Smith SL Factoring civil society actors into health policy processes in low- and middle-income countries: a review of Research Articles, 2007–16 Health Policy Plann 2019 34 1 67 77 10.1093/heapol/czy109
Smith SL. Factoring civil society actors into health policy processes in low- and middle-income countries: a review of Research Articles, 2007–16. Health Policy Plann. 2019;34(1):67–77. 10.1093/heapol/czy109.10.1093/heapol/czy109
53. Mialon M, Vandevijvere S, Carriedo-Lutzenkirchen A, Bero L, Gomes F, Petticrew M, et al. Mechanisms for addressing and managing the influence of corporations on Public Health Policy, research and practice: a scoping review. BMJ Open. 2020;10(7). 10.1136/bmjopen-2019-034082.
54. Townsend B, Johnson TD, Ralston R, Cullerton K, Martin J, Collin J, et al. A framework of NGO inside and outside strategies in the commercial determinants of Health: findings from a narrative review. Globalization Health. 2023;19(1). 10.1186/s12992-023-00978-x.
55. Gomez E. Getting to the root of the problem: the international and domestic politics of junk food industry regulation in Latin America. Health Policy Plann 36(10):1521–33. 10.1093/heapol/czab100
56. Diez-Canseco F, Cavero V, Cano JA, Saavedra-Garcia L, Taillie LS, Dillman Carpentier FR, Miranda JJ. Design and approval of the nutritional warnings policy in Peru: milestones, key stakeholders and policy drivers for its approval. PLoS Global Public Health 3(6):e0001121. 10.1371/journal.pgph.0001121
57. Marten R Hanefeld J Smith R Commission on global governance for health: what about power? Lancet 2014 383 9936 2207 10.1016/s0140-6736(14)61076-x 24976321
Marten R, Hanefeld J, Smith R. Commission on global governance for health: what about power? Lancet. 2014;383(9936):2207. 10.1016/s0140-6736(14)61076-x.24976321 10.1016/s0140-6736(14)61076-x
58. Gore R Parker R Analysing power and politics in health policies and systems Glob Public Health 2019 14 4 481 8 10.1080/17441692.2019.1575446 30773135
Gore R, Parker R. Analysing power and politics in health policies and systems. Glob Public Health. 2019;14(4):481–8. 10.1080/17441692.2019.1575446.30773135 10.1080/17441692.2019.1575446
59. Lacy-Nichols J, Marten R, Crosbie E, Moodie R. The Public Health Playbook: ideas for challenging the corporate playbook. Lancet Global Health. 2022;10(7). 10.1016/s2214-109x(22)00185-1.
60. Logan AC D’Adamo CR Pizzorno JE Prescott SL Food faddists and pseudoscientists! Reflections on the history of resistance to ultra-processed foods Explore 2024 20 4 470 6 10.1016/j.explore.2023.12.014 38176973
Logan AC, D’Adamo CR, Pizzorno JE, Prescott SL. Food faddists and pseudoscientists! Reflections on the history of resistance to ultra-processed foods. Explore. 2024;20(4):470–6. 10.1016/j.explore.2023.12.014.38176973 10.1016/j.explore.2023.12.014
61. Monteiro CA Nutrition and health. The issue is not food, nor nutrients, so much as processing Public Health Nutr 2009 12 5 729 31 10.1017/S1368980009005291 19366466
Monteiro CA. Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr. 2009;12(5):729–31. 10.1017/S1368980009005291.19366466 10.1017/S1368980009005291
62. Touvier M da Costa Louzada ML Mozaffarian D Baker P Juul F Srour B Ultra-processed foods and cardiometabolic health: public health policies to reduce consumption cannot wait BMJ 2023 383 e075294 10.1136/bmj-2023-075294 37813465
Touvier M, da Costa Louzada ML, Mozaffarian D, Baker P, Juul F, Srour B. Ultra-processed foods and cardiometabolic health: public health policies to reduce consumption cannot wait. BMJ. 2023;383:e075294. 10.1136/bmj-2023-075294.37813465 10.1136/bmj-2023-075294
63. Pan-American Health Organization (PAHO). Pan American Health Organization Nutrient Profile Model. Pan American Health Organization. 2016;34. https://iris.paho.org/handle/10665.2/18621. Accessed 24 Jan 2024.
64. Zapata ME Arrieta E Beltramo B Rovirosa A Ultra-processed food consumption in Argentina according to income level and its association with the intake of healthy foods Nutr Bull 2023 48 3 317 28 10.1111/nbu.12624 37424053
Zapata ME, Arrieta E, Beltramo B, Rovirosa A. Ultra-processed food consumption in Argentina according to income level and its association with the intake of healthy foods. Nutr Bull. 2023;48(3):317–28. 10.1111/nbu.12624.37424053 10.1111/nbu.12624
65. Argentine Government. Ley de promoción de la alimentación saludable. Argentina.gob.ar. https://www.argentina.gob.ar/salud/ley-de-promocion-de-la-alimentacion-saludable#:~:text=Promueve%20el%20derecho%20a%20la,envasados%20y%20bebidas%20sin%20alcohol.&text=La%20Ley%20N%C2%B0%2027.642,como%20Ley%20de%20Etiquetado%20Frontal. Accessed 24. Jan 2024.
66. Argentina president signs one of World’s strongest health food policy laws. GHAI. 2021. https://www.advocacyincubator.org/featured-stories/2021-12-10-argentina-president-signs-one-of-worlds-strongest-health-food-policy-laws#:~:text=The%20new%20law%20was%20published,the%20front%20of%20the%20package. Accessed 24 Jan 2024.
67. Pan-American Health Organization (PAHO). Front-of-package labeling as a policy tool for the prevention of noncommunicable diseases in the Americas. 2020. https://iris.paho.org/handle/10665.2/52740. Accessed 24 Jan 2024.
68. Ministry of Health. Etiquetado frontal nutricional de alimentos. 2018. https://bancos.salud.gob.ar/sites/default/files/2020-01/0000001380cnt-2019-06_etiquedato-nutricional-frontal-alimentos.pdf
69. Castronuovo L, Tiscornia MV, Guarnieri L, Martins E, Gomes FS, Allemandi L. Efficacy of different front-of-package labelling systems in changing purchase intention and product healthfulness perception for food products in Argentina. Rev Panam Salud Publica. 2022;46:e137. doi:0.26633/RPSP.2022.137.
70. Fernández AA, González García G, Vizzotti C, Costa AS, Abriata MG. Evaluación del desempeño del Etiquetado Frontal de Advertencia frente a otros modelos en Argentina. 2020. https://bancos.salud.gob.ar/recurso/evaluacion-del-desempeno-del-etiquetado-frontal-de-advertencia-frente-otros-modelos-en. Accessed 24 Jan 2024.
71. Tiscornia MV, Castronuovo L, Guarnieri L, Martins E, Allemandi L. Argentina Rev argent salud pública. 2020;12:17–17. http://www.scielo.org.ar/scielo.php?script=sci_arttext. &pid=S1853-810X2020000200017&lng=es. Evaluación de los sistemas de perfiles nutricionales para la definición de una política de etiquetado frontal en.
72. Fernández A, García G, Vizzotti C, Costa A, Abriata M. Análisis del nivel de concordancia de Sistemas de perfil de nutrientes con las Guías Alimentarias para la Población Argentina. 2020. https://bancos.salud.gob.ar/recurso/analisis-del-nivel-de-concordancia-de-sistemas-de-perfil-de-nutrientes-con-las-guias. Accessed 24 Jan 2024.
73. Ministry of Agriculture. The Agri-Food and Agro-Industry Sectors in Argentina. 2011. https://ealem.cancilleria.gob.ar/userfiles/Agronegocios_02_HoracioColombetLicMarianoLaffaye.pdf Accessed 24 Jan 2024.
74. Bobbio S. Jan. Would Argentina benefit from a soda tax? O’Neill Institute for National & Global Health Law. ancos.salud.gob.ar/sites/default/files/2020-01/0000001380cnt-2019-06_etiquedato-nutricional-frontal-alimentos.pdf. Accessed 24 2024.
75. Thow AM Jones A Hawkes C Ali I Labonté R Nutrition labelling is a trade policy issue: lessons from an analysis of specific trade concerns at the World Trade Organization Health Promot Int 2017 10.1093/heapro/daw109
Thow AM, Jones A, Hawkes C, Ali I, Labonté R. Nutrition labelling is a trade policy issue: lessons from an analysis of specific trade concerns at the World Trade Organization. Health Promot Int. 2017. 10.1093/heapro/daw109.10.1093/heapro/daw109
76. Garton K Thow AM Swinburn B International Trade and Investment Agreements as barriers to Food Environment Regulation for Public Health Nutrition: a Realist Review Int J Health Policy Manage 2020 10 12 745 65 10.34172/ijhpm.2020.189
Garton K, Thow AM, Swinburn B. International Trade and Investment Agreements as barriers to Food Environment Regulation for Public Health Nutrition: a Realist Review. Int J Health Policy Manage. 2020;10(12):745–65. 10.34172/ijhpm.2020.189.10.34172/ijhpm.2020.189
77. von Tigerstrom B How do international trade obligations affect policy options for obesity prevention? Lessons from recent developments in trade and tobacco control Can J Diabetes 2013 37 3 182 8 10.1016/j.jcjd.2013.03.402 24070841
von Tigerstrom B. How do international trade obligations affect policy options for obesity prevention? Lessons from recent developments in trade and tobacco control. Can J Diabetes. 2013;37(3):182–8. 10.1016/j.jcjd.2013.03.402.24070841 10.1016/j.jcjd.2013.03.402
78. Milsom P, Smith R, Baker P, Walls H. Corporate power and the international trade regime preventing progressive policy action on non-communicable diseases: a realist review. Health Policy Plann. 2020;36(4). 10.1093/heapol/czaa148.
79. Milsom P, Smith R, Modisenyane SM, Walls H. Do international trade and investment agreements generate regulatory chill in public health policymaking? A case study of nutrition and alcohol policy in South Africa. Globalization Health. 2021;17(104). 10.1186/s12992-021-00757-6.
80. Milsom P, Smith R, Modisenyane SM, Walls H. Does International Trade and investment liberalization facilitate corporate power in nutrition and alcohol policymaking? Applying an integrated political economy and Power Analysis Approach to a case study of South Africa. Globalization Health. 2022;18(1). 10.1186/s12992-022-00814-8.
81. Fuchs D Lederer MML The power of business Bus Power Global Gov 2007 9 3 1 10
Fuchs D, Lederer MML. The power of business. Bus Power Global Gov. 2007;9(3):1–10. https://ideas.repec.org/a/bpj/buspol/v9y2008i3n1.html.
82. Lukes S, Power. A radical view. London: McMillan. https://voidnetwork.gr/wp-content/uploads/2016/09/Power-A-Radical-View-Steven-Lukes.pdf
83. Hall A Lichbach I Zuckerman AS The role of interests, institutions, and ideas in the comparative political economy of the industrialized nations Comparative politics: rationality, culture, and structure 1997 Cambridge Cambridge University Press 174 98
Hall A. The role of interests, institutions, and ideas in the comparative political economy of the industrialized nations. In: Lichbach I, Zuckerman AS, editors. Comparative politics: rationality, culture, and structure. Cambridge: Cambridge University Press; 1997. pp. 174–98.
84. Lavis JN Ross SE Hurley J Examining the role of health services research in public policymaking Milbank Q 2022 80 125 54 10.1111/1468-0009.00005
Lavis JN, Ross SE, Hurley J, et al. Examining the role of health services research in public policymaking. Milbank Q. 2022;80:125–54. 10.1111/1468-0009.00005.10.1111/1468-0009.00005
85. Gauvin FP Understanding policy developments and choices through the 3-i framework: interests, ideas and institutions. Briefing note 2014 Montréal, Québec National Collaborating Centre for Healthy Public Policy
Gauvin FP. Understanding policy developments and choices through the 3-i framework: interests, ideas and institutions. Briefing note. Montréal, Québec: National Collaborating Centre for Healthy Public Policy; 2014.
86. Shearer JC Abelson J Kouyate B Lavis JN Walt G Why do policies change? Institutions, interests, ideas and networks in three cases of policy reform Health Policy Plann 2016 31 1200 11 10.1093/heapol/czw052
Shearer JC, Abelson J, Kouyate B, Lavis JN, Walt G. Why do policies change? Institutions, interests, ideas and networks in three cases of policy reform. Health Policy Plann. 2016;31:1200–11. 10.1093/heapol/czw052.10.1093/heapol/czw052
87. Gaventa J Finding the spaces for change: a power analysis IDS Bull 2006 37 23 33 10.1111/j.1759-5436.2006.tb00320.x
Gaventa J. Finding the spaces for change: a power analysis. IDS Bull. 2006;37:23–33.10.1111/j.1759-5436.2006.tb00320.x
88. Argentina media guide. BBC. 2023. https://www.bbc.com/news/world-latin-america-18707517. Accessed 24 Jan 2024.
89. Hennink M Kaiser BN Sample sizes for saturation in qualitative research: a systematic review of empirical tests Soc Sci Med 2022 292 114523 10.1016/j.socscimed.2021.114523 34785096
Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Soc Sci Med. 2022;292:114523. 10.1016/j.socscimed.2021.114523.34785096 10.1016/j.socscimed.2021.114523
90. Fereday J Muir-Cochrane E Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development Int J Qualitative Methods 2006 5 1 80 92 10.1177/160940690600500107
Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qualitative Methods. 2006;5(1):80–92. 10.1177/160940690600500107.10.1177/160940690600500107
91. Proudfoot K Inductive/deductive hybrid thematic analysis in mixed methods research J Mixed Methods Res 2022 17 3 308 26 10.1177/15586898221126816
Proudfoot K. Inductive/deductive hybrid thematic analysis in mixed methods research. J Mixed Methods Res. 2022;17(3):308–26. 10.1177/15586898221126816.10.1177/15586898221126816
92. Pan-American Health Organization (PAHO). OPS pide avanzar en regulación de alimentos ultraprocesados en jornada en el Senado de la Nación. Organización Panamericana de la Salud. 2016. https://www.paho.org/es/noticias/24-10-2016-ops-pide-avanzar-regulacion-alimentos-ultraprocesados-jornada-senado-nacion. Accessed 23 Jan 2024.
93. Ministry of Health. Etiquetado frontal: González García recibió a integrantes de la COPAL. Argentina.gob.ar. 2020. https://www.argentina.gob.ar/noticias/etiquetado-frontal-gonzalez-garcia-recibio-integrantes-de-la-copal. Accessed 23 Jan 2024.
94. Hacker D. Ministro de Salud Rubinstein con infobae: El Etiquetado frontal de los alimentos es una advertencia sanitaria. Infobae; 2018. https://www.infobae.com/salud/2018/06/06/ministro-de-salud-adolfo-rubinstein-con-infobae-el-etiquetado-frontal-de-los-alimentos-es-una-advertencia-sanitaria-a-los-consumidores-para-saber-que-tienen-en-la-mano/. Accessed 24 Jan 2024.
95. National Food Commission (CONAL). Reunión Ordinaria De Los días 15, 16 y 17 de septiembre de 2020. 2020. http://www.conal.gob.ar/sitio/_pdf/20200917184700.pdf
96. Ministry of Health. Ministerio de Salud presentó a la COPAL los ejes centrales del proyecto de etiquetado frontal de alimentos. Argentina.gob.ar. 2020. https://www.argentina.gob.ar/noticias/ministerio-de-salud-presento-la-copal-los-ejes-centrales-del-proyecto-de-etiquetado-frontal. Accessed 23 Jan 2024.
97. Argentine Senate. Órdenes Del Día. https://www.senado.gob.ar/parlamentario/parlamentaria/ordenDelDiaResultadoLink/2020/375. Accessed 24 Jan 2024.
98. Pan-American Health Organization (PAHO). Piden nuevas leyes que ayuden a prevenir la obesidad y proteger a los consumidores - OPS/OMS. 2017. https://www.paho.org/es/noticias/31-5-2017-piden-nuevas-leyes-que-ayuden-prevenir-obesidad-proteger-consumidores. Accessed 23 Jan 2024.
99. Argentine Government. Rubinstein inauguró jornada sobre etiquetado frontal de alimentos y salud en Diputados. 2018. https://www.argentina.gob.ar/noticias/rubinstein-inauguro-jornada-sobre-etiquetado-frontal-de-alimentos-y-salud-en-diputados. Accessed 23 Jan 2024.
100. Argentine Government. Autoridades de Salud y OPS inauguraron encuentro sobre etiquetado frontal en el marco del MERCOSUR. 2019. https://www.argentina.gob.ar/noticias/autoridades-de-salud-y-ops-inauguraron-encuentro-sobre-etiquetado-frontal-en-el-marco-del. Accessed 23 Jan 2024.
101. United Nations Children’s Fund (UNICEF). La Coordinación de ONU en Argentina, la OPS/OMS, UNICEF y FAO presentan una Jornada sobre la Ley de Alimentación Saludable. 2021. https://www.unicef.org/argentina/comunicados-prensa/jornada-alimentacion-saludable. Accessed 23 Jan 2024.
102. Network of Lawyers for Food Sovereignty (REDASA). https://www.redasa.org/. Accessed 24 Jan 2024.
103. Network of Free Chairs of Food Sovereignty and Related Groups (RED CALISAS). Informe anual de la situación de la soberanía alimentaria en argentina. 2022. https://redcalisas.org/. Accessed 24 Jan 2024.
104. United Nations Children’s Fund (UNICEF). Narda Lepes se sumó al pedido por la urgente sanción de la ley de etiquetado frontal de alimentos. 2021. https://www.unicef.org/argentina/comunicados-prensa/Narda-Lepes-se-sumo-al-pedido-ley-etiquetado-frontal-alimentosl. Accessed 24 Jan 2024.
105. National Coalition to Prevent Childhood Obesity. https://www.prevenirobesidadinfantil.org/materiales/. Accessed 24 Jan 2024.
106. United Nations Children’s Fund. Informe Annual de Actividades Argentina 2017. 2017. https://www.unicef.org/argentina/media/1351/file/Informe%20anual%202017.pdf. Accessed 24 Jan 2024.
107. Argentina FIC. Informe de investigación: Publicidad de alimentos dirigida a niños y niñas en la TV Argentina. FIC Argentina; 2015. https://www.ficargentina.org/investigaciones/informe-de-investigacion-publicidad-de-alimentos-dirigida-a-ninos-y-ninas-en-la-tv-argentina/. Accessed 23 Jan 2024.
108. Argentina FIC. Reporte de investigación: Técnicas de marketing dirigidas a niños y niñas en envases de alimentos procesados de Argentina (2017). FIC Argentina; 2017. https://www.ficargentina.org/investigaciones/reporte-de-investigacion-tecnicas-de-marketing-dirigidas-a-ninos-y-ninas-en-envases-de-alimentos-procesados-de-argentina-2017/. Accessed 23 Jan 2024.
109. Allemandi L Castronuovo L Tiscornia MV Ponce M Schoj V Food Advertising on Argentinean television: are ultra-processed foods in the lead? Public Health Nutr 2017 21 1 238 46 10.1017/s1368980017001446 28745262
Allemandi L, Castronuovo L, Tiscornia MV, Ponce M, Schoj V. Food Advertising on Argentinean television: are ultra-processed foods in the lead? Public Health Nutr. 2017;21(1):238–46. 10.1017/s1368980017001446.28745262 10.1017/s1368980017001446
110. Ministry of Health, National Institute of Statistics and Censuses (INDEC). 4° Encuesta Nacional de Factores de Riesgo. Resultados definitivos. – 1a ed. 2019. https://bancos.salud.gob.ar/recurso/4ta-encuesta-nacional-de-factores-de-riesgo-2019-informe-definitivo
111. Ministry of Health. 2° Encuesta Nacional de Nutrición y Salud ENNYS 2. Resumen ejecutivo. 2019. https://bancos.salud.gob.ar/recurso/2deg-encuesta-nacional-de-nutricion-y-salud-indicadores-priorizados
112. Coordinator of Food Product Industries (COPAL). Propuesta de Etiquetado Frontal. 2017https://copal.org.ar/2017/10/01/propuesta-de-etiquetado-frontal/. Accessed 24 Jan 2024.
113. Etiquetado frontal: qué piensan y qué cuestionan las entidades de la industria alimenticia. Perfil. 2021. https://www.perfil.com/noticias/economia/etiquetado-frontal-la-industria-de-alimentos-advierte-sobre-conflictos-en-el-mercosur.phtml. Accessed 24 Jan 2024.
114. Brazilian Institute for Consumer’s Defense (IDEC), Inter-American Heart Foundation (FIC). An analysis of regulatory scenarios on food labeling in Brazil and Argentina within the overall context of MERCOSUR. 2020. https://idl-bnc-idrc.dspacedirect.org/server/api/core/bitstreams/f7a164fe-ac28-45c8-b4fb-167963f33a52/content. Accessed 24 Jan 2024.
115. Rios B, Cerra B, Cury Chaddad C. Etiquetado frontal de alimentos en Argentina y Brasil: barreras y facilitadores jurídicos, Microjuris Argentina al Día. AL DÍA | ARGENTINA. 2020. https://aldiaargentina.microjuris.com/2020/04/21/etiquetado-frontal-de-alimentos-en-argentina-y-brasil-barreras-y-facilitadores-juridicos/. Accessed 23 Jan 2024.
116. FIC Argentina. Lessons learned from tobacco control: court decisions that ratify public health policies. FIC Argentina. 2020. https://www.ficargentina.org/wpcontent/uploads/2019/12/2001_argumentos_juridicos_ingles.pdf. Accessed 23 Jan 2024.
117. Ley de etiquetado frontal: la Copal busca modificar el proyecto para que. atienda al sector productivo. BAE Negocios; 2021. https://www.baenegocios.com/economia/Ley-de-etiquetado-frontal-la-Copal-busca-modificar-el-proyecto-para-que-atienda-al-sector-productivo-20210707-0118.html. Accessed 24 Jan 2024.
118. Que no te tapen los ojos: la campaña que exige el etiquetado de advertencias en alimentos y bebidas. Infobae. 2021. https://www.infobae.com/salud/2021/07/04/que-no-te-tapen-los-ojos-la-campana-que-exige-el-etiquetado-de-advertencias-en-alimentos-y-bebidas/. Accessed 24 January.
119. Activa el Congreso. https://activaelcongreso.ar/. Accessed 24 January 2024.
120. Octógonos negros. de qué se trata el proyecto de ley de etiquetado frontal de alimentos que hoy se trata en comisiones en Diputados. La Nacion; 2021. https://www.lanacion.com.ar/sociedad/octogonos-negros-de-que-se-trata-el-proyecto-de-ley-de-etiquetado-frontal-de-alimentos-que-hoy-se-nid13072021/. Accessed 24 Jan 2024.
121. FIC Argentina. No hubo quórum en la Cámara de Diputados para tratar el proyecto de etiquetado de alimentos. FIC Argentina. 2021. https://www.ficargentina.org/que-no-te-tapen-los-ojos-la-campana-para-exigir-un-etiquetadoclaroya/. Accessed 23 Jan 2024.
122. FIC Argentina. Etiquetado frontal de advertencias: guía para identificar y responder a los argumentos de la industria alimenticia y sus aliados. 2020. https://www.ficargentina.org/wp-content/uploads/2020/11/2011_guia.pdf. Accessed 24 Jan 2024.
123. National Coalition to Prevent Childhood Obesity. Mitos y realidades del etiquetado frontal de advertencia. 2020. https://fagran.org.ar/wp-content/uploads/2020/10/2010_Mitos_Realidades_Etiquetado.pdf. Accessed 24 Jan 2024.
124. Draft Law FUNDEPS. Promotion of Healthy Eating: refutation of arguments of the food industry. 2021. https://fundeps.org/en/healthy-eating-refutation-arguments-food-industry/. Accessed 24 Jan 2024.
125. Paraje G Colchero A Wlasiuk JM Sota AM Popkin BM The effects of the Chilean food policy package on aggregate employment and real wages Food Policy 2021 100 102016 10.1016/j.foodpol.2020.102016
Paraje G, Colchero A, Wlasiuk JM, Sota AM, Popkin BM. The effects of the Chilean food policy package on aggregate employment and real wages. Food Policy. 2021;100:102016. 10.1016/j.foodpol.2020.102016.10.1016/j.foodpol.2020.102016
126. Paraje G Montes de Oca D Wlasiuk JM Canales M Popkin BM Front-of-pack labeling in Chile: effects on employment, real wages, and firms’ profits after three years of its implementation Nutrients 2022 14 2 295 10.3390/nu14020295 35057474
Paraje G, Montes de Oca D, Wlasiuk JM, Canales M, Popkin BM. Front-of-pack labeling in Chile: effects on employment, real wages, and firms’ profits after three years of its implementation. Nutrients. 2022;14(2):295. 10.3390/nu14020295.35057474 10.3390/nu14020295
127. Barahona N, Otero C, Otero S. Equilibrium effects on food labeling policies. Available at SSRN: doi.10.2139/ssrn.3698473.
128. Baker P Brown AD Wingrove K Allender S Walls H Cullerton K Generating political commitment for ending malnutrition in all its forms: a system dynamics approach for strengthening nutrition actor networks Obes Rev 2019 20 S2 30 44 10.1111/obr.12871 31245905
Baker P, Brown AD, Wingrove K, Allender S, Walls H, Cullerton K, et al. Generating political commitment for ending malnutrition in all its forms: a system dynamics approach for strengthening nutrition actor networks. Obes Rev. 2019;20(S2):30–44. 10.1111/obr.12871.31245905 10.1111/obr.12871
129. Freudenberg N Lee K Buse K Collin J Crosbie E Friel S Defining priorities for action and research on the commercial determinants of Health: a conceptual review Am J Public Health 2021 111 12 2202 11 10.2105/ajph.2021.306491 34878875
Freudenberg N, Lee K, Buse K, Collin J, Crosbie E, Friel S, et al. Defining priorities for action and research on the commercial determinants of Health: a conceptual review. Am J Public Health. 2021;111(12):2202–11. 10.2105/ajph.2021.306491.34878875 10.2105/ajph.2021.306491
130. Paarlberg R Mozaffarian D Micha R Viewpoint Can U.S. local soda taxes continue to spread? Food Policy 2017 71 1 7 10.1016/j.foodpol.2017.05.007 34531634
Paarlberg R, Mozaffarian D, Micha R, Viewpoint. Can U.S. local soda taxes continue to spread? Food Policy. 2017;71:1–7. 10.1016/j.foodpol.2017.05.007.34531634 10.1016/j.foodpol.2017.05.007
131. Baker P Gill T Friel S Carey G Kay A Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study Soc Sci Med 2017 177 141 9 10.1016/j.socscimed.2017.01.047 28161671
Baker P, Gill T, Friel S, Carey G, Kay A. Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study. Soc Sci Med. 2017;177:141–9. 10.1016/j.socscimed.2017.01.047.28161671 10.1016/j.socscimed.2017.01.047
132. Crosbie E Sosa P Glantz SA Defending strong tobacco packaging and labelling regulations in Uruguay: Transnational Tobacco Control Network versus Philip Morris International Tob Control 2017 27 2 185 94 10.1136/tobaccocontrol-2017-053690 28336521
Crosbie E, Sosa P, Glantz SA. Defending strong tobacco packaging and labelling regulations in Uruguay: Transnational Tobacco Control Network versus Philip Morris International. Tob Control. 2017;27(2):185–94. 10.1136/tobaccocontrol-2017-053690.28336521 10.1136/tobaccocontrol-2017-053690
133. Phulkerd S Collin J Ngqangashe Y Thow AM Schram A Schneider CH Frield S How commercial actors used different types of power to influence policy on restricting food marketing: a qualitative study with policy actors in Thailand BMJ Open 2022 12 e063539 10.1136/bmjopen-2022-063539 36229148
Phulkerd S, Collin J, Ngqangashe Y, Thow AM, Schram A, Schneider CH, Frield S. How commercial actors used different types of power to influence policy on restricting food marketing: a qualitative study with policy actors in Thailand. BMJ Open. 2022;12:e063539. 10.1136/bmjopen-2022-063539.36229148 10.1136/bmjopen-2022-063539
134. Popkin BM Barquera S Corvalan C Hofman KJ Monteiro C Ng SW Swart EC Taillie LS Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating Lancet Diabetes Endocrinol 2021 9 7 462 70 10.1016/S2213-8587(21)00078-4 33865500
Popkin BM, Barquera S, Corvalan C, Hofman KJ, Monteiro C, Ng SW, Swart EC, Taillie LS. Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating. Lancet Diabetes Endocrinol. 2021;9(7):462–70. 10.1016/S2213-8587(21)00078-4.33865500 10.1016/S2213-8587(21)00078-4
135. Pahle M Burtraw D Flachsland C Kelsey N Biber E Meckling J Sequencing to ratchet up climate policy stringency Nat Clim Change 2018 8 10 861 7 10.1038/s41558-018-0287-6
Pahle M, Burtraw D, Flachsland C, Kelsey N, Biber E, Meckling J, et al. Sequencing to ratchet up climate policy stringency. Nat Clim Change. 2018;8(10):861–7. 10.1038/s41558-018-0287-6.10.1038/s41558-018-0287-6
136. Leipprand A Flachsland C Pahle M Starting low, reaching high? Sequencing in EU Climate and Energy policies Environ Innov Societal Transitions 2020 37 140 55 10.1016/j.eist.2020.08.006
Leipprand A, Flachsland C, Pahle M. Starting low, reaching high? Sequencing in EU Climate and Energy policies. Environ Innov Societal Transitions. 2020;37:140–55. 10.1016/j.eist.2020.08.006.10.1016/j.eist.2020.08.006
137. Fesenfeld LP Maier M Brazzola N Stolz N Sun Y Kachi A How information, social norms, and experience with novel meat substitutes can create positive political feedback and demand-side policy change Food Policy 2023 117 102445 10.1016/j.foodpol.2023.102445
Fesenfeld LP, Maier M, Brazzola N, Stolz N, Sun Y, Kachi A. How information, social norms, and experience with novel meat substitutes can create positive political feedback and demand-side policy change. Food Policy. 2023;117:102445. 10.1016/j.foodpol.2023.102445.10.1016/j.foodpol.2023.102445
138. Barlow P Thow AM Neoliberal discourse, actor power, and the politics of nutrition policy: a qualitative analysis of informal challenges to nutrition labelling regulations at the World Trade Organization, 2007–2019 Soc Sci Med 2021 273 113761 10.1016/j.socscimed.2021.113761 33621752
Barlow P, Thow AM. Neoliberal discourse, actor power, and the politics of nutrition policy: a qualitative analysis of informal challenges to nutrition labelling regulations at the World Trade Organization, 2007–2019. Soc Sci Med. 2021;273:113761. 10.1016/j.socscimed.2021.113761.33621752 10.1016/j.socscimed.2021.113761
139. Mais LA Mialon M Hassan BK Marcos J Peres D dos Santos MG Martins APB Coutinho JG Carvalho CMP Do they really support your freedom of choice? FoPNL and the food industry in Brazil Front Nutr 2023 9 921498 10.3389/fnut.2022.921498 36741995
Mais LA, Mialon M, Hassan BK, Marcos J, Peres D, dos Santos MG, Martins APB, Coutinho JG, Carvalho CMP. Do they really support your freedom of choice? FoPNL and the food industry in Brazil. Front Nutr. 2023;9:921498. 10.3389/fnut.2022.921498.36741995 10.3389/fnut.2022.921498
140. Fisher DR, Nasrin S. Climate activism and its effects. WIREs Clim Change. 2020;12(1). 10.1002/wcc.683.
141. Seferedi P, Scrinis G, Huybrechts I, Woods J, Vineis P, Millett C. The neglected environmental impacts of ultra-processed foods. Lancet Planet Health. 2020;4(10):–437. 10.1016/S2542-5196(20)30177-7.
142. Alderete M, Gutkowski P, Shammah C. Health is Not Negotiable: Civil Society against the Tobacco Industry’s Strategies in Latin America. 2012. https://theunion.org/sites/default/files/2020-11/reportes_de_casos_lsns_ingles.pdf
143. Ramos S Keefe-Oates B Romero M Ramon Michel A Krause M Gerdts C Yamin AE Step by step in Argentina: putting Abortion rights into Practice Int J Women’s Health 2023 15 1003 15 10.2147/IJWH.S41297 37455681
Ramos S, Keefe-Oates B, Romero M, Ramon Michel A, Krause M, Gerdts C, Yamin AE. Step by step in Argentina: putting Abortion rights into Practice. Int J Women’s Health. 2023;15:1003–15. 10.2147/IJWH.S41297.37455681 10.2147/IJWH.S41297
144. McHardy J The WHO FCTC’s lessons for addressing the commercial determinants of health Health Promot Int 2021 36 1 39 52 10.1093/heapro/daab143
McHardy J. The WHO FCTC’s lessons for addressing the commercial determinants of health. Health Promot Int. 2021;36(1):39–52. 10.1093/heapro/daab143.10.1093/heapro/daab143
