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

Milsom, Penelope, Smith, Richard, Baker, Phillip and Walls, Helen 2020, Corporate power and the international trade regime preventing progressive policy action on non-communicable diseases: a realist review, Health policy and planning, pp. 1-16, doi: 10.1093/heapol/czaa148.

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Title Corporate power and the international trade regime preventing progressive policy action on non-communicable diseases: a realist review
Author(s) Milsom, Penelope
Smith, Richard
Baker, PhillipORCID iD for Baker, Phillip orcid.org/0000-0002-0802-2349
Walls, Helen
Journal name Health policy and planning
Start page 1
End page 16
Total pages 16
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2020-12-04
ISSN 0268-1080
1460-2237
Keyword(s) Trade agreements
trade liberalization
public health policy
political economy
power analysis
Summary Transnational tobacco, alcohol and ultra-processed food corporations use the international trade regime to prevent policy action on non-communicable diseases (NCDs); i.e. to promote policy ‘non-decisions’. Understanding policy non-decisions can be assisted by identifying power operating in relevant decision-making spaces, but trade and health research rarely explicitly engages with theories of power. This realist review aimed to synthesize evidence of different forms and mechanisms of power active in trade and health decision-making spaces to understand better why NCD policy non-decisions persist and the implications for future transformative action. We iteratively developed power-based theories explaining how transnational health-harmful commodity corporations (THCCs) utilize the international trade regime to encourage NCD policy non-decisions. To support theory development, we also developed a conceptual framework for analysing power in public health policymaking. We searched six databases and relevant grey literature and extracted, synthesized and mapped the evidence against the proposed theories. One hundred and four studies were included. Findings were presented for three key forms of power. Evidence indicates THCCs attempt to exercise instrumental power by extensive lobbying often via privileged access to trade and health decision-making spaces. When their legitimacy declines, THCCs have attempted to shift decision-making to more favourable international trade legal venues. THCCs benefit from structural power through the institutionalization of their involvement in health and trade agenda-setting processes. In terms of discursive power, THCCs effectively frame trade and health issues in ways that echo and amplify dominant neoliberal ideas. These processes may further entrench the individualization of NCDs, restrict conceivable policy solutions and perpetuate policymaking norms that privilege economic/trade interests over health. This review identifies different forms and mechanisms of power active in trade and health policy spaces that enable THCCs to prevent progressive action on NCDs. It also points to potential strategies for challenging these power dynamics and relations.
Language eng
DOI 10.1093/heapol/czaa148
Indigenous content off
Field of Research 1117 Public Health and Health Services
1605 Policy and Administration
1606 Political Science
HERDC Research category C1 Refereed article in a scholarly journal
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30146181

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.