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An exposé of the realpolitik of trade negotiations: implications for population nutrition

  • Sharon Friel (a1), Phillip Baker (a2), Anne-Marie Thow (a3), Deborah Gleeson (a4), Belinda Townsend (a1) and Ashley Schram (a1)...



To explore the formal and informal ways in which different actors involved in shaping trade agreements pursue their interests and understand the interactions with nutrition, in order to improve coherence between trade and nutrition policy goals.


The paper draws on empirical evidence from Australian key informant interviews that explore the underlying political dimensions of trade agreements that act as barriers or facilitators to getting nutrition objectives on trade agendas.


Countries experiencing greater availability and access to diets full of energy-dense and nutrient-poor foods through increased imports, greater foreign direct investment and increasing constraints on national health policy space as a result of trade agreements.


Interviews took place with Australian government officials, industry, public-interest non-government organizations and academics.


The analysis reveals the formal and informal mechanisms and structures that different policy actors use both inside and outside trade negotiations to pursue their interests. The analysis also identifies the discourses used by the different actors, as they attempt to influence trade agreements in ways that support or undermine nutrition-related goals.


Moving forward requires policy makers, researchers and health advocates to use various strategies including: reframing the role of trade agreements to include health outcomes; reforming the process to allow greater access and voice to health arguments and stakeholders; establishing cross-government partners through accountable committees; and building circles of consensus and coalitions of sympathetic public-interest actors.


Corresponding author

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1. Vos, T, Abajobir, AA, Abate, KH et al. (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390, 12111259.
2. World Health Organization & Food and Agriculture Organization of the United Nations (2014) Rome Declaration on Nutrition: Second International Conference on Nutrition, 19–21 November 2014. Rome: WHO and FAO.
3. World Health Organization/Food and Agriculture Organization of the United Nations (2017) United Nation’s Decade of Action on Nutrition 2016–2025 Work Programme. Geneva/Rome: WHO/FAO.
4. Blouin, C (2007) Trade policy and health: from conflicting interests to policy coherence. Bull World Health Organ 85, 169173.
5. Thow, AM, Snowdon, W, Labonte, R et al. (2015) Will the next generation of preferential trade and investment agreements undermine prevention of noncommunicable diseases? A prospective policy analysis of the Trans Pacific Partnership Agreement. Health Policy 119, 8896.
6. Schram, A, Ruckert, A, VanDuzer, JA et al. (2017) A conceptual framework for investigating the impacts of international trade and investment agreements on noncommunicable disease risk factors. Health Policy Plann 33, 123136.
7. Hirono, K, Haigh, F, Gleeson, D et al. (2016) Is health impact assessment useful in the context of trade negotiations? A case study of the Trans Pacific Partnership Agreement. BMJ Open 6, e010339.
8. Schram, A, Labonte, R, Baker, P et al. (2015) The role of trade and investment liberalization in the sugar-sweetened carbonated beverages market: a natural experiment contrasting Vietnam and the Philippines. Global Health 11, 41.
9. Hawkes, C, Chopra, M & Friel, S (2009) Globalization, trade and the nutrition transition. In Globalization and Health: Pathways, Evidence and Policy, pp. 235262 [Labonte, R, Schrecker, T, Packer, C et al., editors]. New York: Routledge.
10. Friel, S & Thow, AM (2012) Trade, Diets and Health – Implications for the TPPA. Melbourne: TPP Stakeholder Forum.
11. Baker, P, Friel, S, Schram, A et al. (2016) Trade and investment liberalization, food systems change and highly processed food consumption: a natural experiment contrasting the soft-drink markets of Peru and Bolivia. Global Health 12, 24.
12. Kickbusch, I (2012) Addressing the interface of the political and commercial determinants of health. Health Promot Int 27, 427428.
13. Drope, J & Lencucha, R (2014) Evolving norms at the intersection of health and trade. J Health Polit Policy Law 39, 591631.
14. Friel, S, Ponnamperuma, S, Schram, A et al. (2016) What has the food industry been lobbying for in the Trans Pacific Partnership trade agreement and what are the implications for dietary health? Crit Public Health 26, 518529.
15. Townsend, B, Schram, A, Baum, F et al. (2018) How does policy framing enable or constrain inclusion of social determinants of health and health equity on trade policy agendas? Crit Public Health. Published online: 20 August 2018. doi: 10.1080/09581596.2018.1509059.
16. Ranald, P (2015) The Trans-Pacific Partnership Agreement: reaching behind the border, challenging democracy. Econ Labour Relat Rev 26, 241260.
17. Battams, S & Townsend, B (2018) Power asymmetries, policy incoherence and noncommunicable disease control – a qualitative study of policy actor views. Crit Public Health. Published online: 4 July 2018. doi: 10.1080/09581596.2018.1492093.
18. Ottersen, O, Dasgupta, J, Blouin, C et al. (2014) The political origins of health inequity: prospects for change. Lancet 383, 630667.
19. Cairney, P (2011) Understanding Public Policy: Theories and Issues. Basingstoke: Palgrave Macmillan.
20. Scott, WR (2013) Institutions and Organizations: Ideas, Interests, and Identities. Thousand Oaks, CA: SAGE Publications, Inc.
21. Clapp, J & Fuchs, DA (2009) Corporate Power in Global Agrifood Governance. Cambridge, MA: MIT Press.
22. Berman, A (2017) Industry, regulatory capture and transnational standard setting. AJIL Unbound 111, 112118.
23. Hall, PA (1993) Policy paradigms, social learning, and the state: the case of economic policymaking in Britain. Comp Polit 25, 275296.
24. Thow, AM, Greenberg, S, Hara, M et al. (2018) Improving policy coherence for food security and nutrition in South Africa: a qualitative policy analysis. Food Sec 10, 11051130.
25. United Nations (2015) Transforming Our World: The 2030 Agenda for Sustainable Development. A/RES/70/1. New York: UN.



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