World Public Health Nutrition Association, London, UK.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Global Health. 2021 Jan 5;17(1):5. doi: 10.1186/s12992-020-00656-2.
In Latin America, total sales of sugar-sweetened beverages (SSBs) continue to rise at an alarming rate. Consumption of added sugar is a leading cause of diet-related non-communicable diseases (NCDs). Coalitions of stakeholders have formed in several countries in the region to address this public health challenge including participation of civil society organizations and transnational corporations. Little is currently known about these coalitions - what interests they represent, what goals they pursue and how they operate. Ensuring the primacy of public health goals is a particular governance challenge. This paper comparatively analyses governance challenges involved in the adoption of taxation of sugar-sweetened beverages in Mexico, Chile and Colombia. The three countries have similar political and economic systems, institutional arrangements and regulatory instruments but differing policy outcomes.
We analysed the political economy of SSB taxation based on a qualitative synthesis of existing empirical evidence. We identify the key stakeholders involved in the policy process, identified their interests, and assess how they influenced adoption and implementation of the tax.
Coalitions for and against the SSB taxation formed the basis of policy debates in all three countries. Intergovernmental support was critical to framing the SSB tax aims, benefits and implementation; and for countries to adopt it. A major constraint to implementation was the strong influence of transnational corporations (TNCs) in the policy process. A lack of transparency during agenda setting was notably enhanced by the powerful presence of TNCs.
NCDs prevention policies need to be supported across government, alongside grassroots organizations, policy champions and civil society groups to enhance their success. However, governance arrangements involving coalitions between public and private sector actors need to recognize power asymmetries among different actors and mitigate their potentially negative consequences. Such arrangements should include clear mechanisms to ensure transparency and accountability of all partners, and prevent undue influence by industry interests associated with unhealthy products.
在拉丁美洲，含糖饮料（SSB）的总销售额仍以惊人的速度增长。添加糖的消费是导致与饮食相关的非传染性疾病（NCD）的主要原因。该地区的几个国家已经形成了利益相关者联盟，以应对这一公共卫生挑战，其中包括民间社会组织和跨国公司的参与。目前，人们对这些联盟知之甚少——它们代表什么利益，追求什么目标，以及如何运作。确保公共卫生目标的首要地位是一个特殊的治理挑战。本文比较分析了墨西哥、智利和哥伦比亚在采用含糖饮料征税方面所涉及的治理挑战。这三个国家具有相似的政治和经济制度、体制安排和监管工具，但政策结果却不同。
我们根据对现有实证证据的定性综合分析，分析了 SSB 征税的政治经济学。我们确定了政策过程中涉及的主要利益相关者，确定了他们的利益，并评估了他们如何影响税收的采用和实施。
支持和反对 SSB 征税的联盟构成了所有三个国家政策辩论的基础。政府间的支持对于确定 SSB 税的目标、利益和实施至关重要；对于国家来说，采用 SSB 税也至关重要。跨国公司（TNCs）在政策过程中的强大影响力是实施的主要制约因素。议程设置缺乏透明度，特别是由于 TNCs 的强大存在而加剧。
预防非传染性疾病的政策需要得到政府的支持，同时还需要基层组织、政策拥护者和民间社会团体的支持，以提高这些政策的成功率。然而，涉及公私部门行为体联盟的治理安排需要认识到不同行为体之间的权力不对称，并减轻其潜在的负面影响。这些安排应包括确保所有合作伙伴透明度和问责制的明确机制，并防止与不健康产品相关的行业利益的不当影响。
