Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study

Highlights

• Obesity prevention requires food marketing, labelling, pricing & content regulation.

• We identify factors enabling & constraining political priority for such regulation.

• Enablers: rising obesity prevalence, state government attention, issue framing.

• Constraints: non-cohesive advocates, industry power, institutional norms, evidence.

• Overcoming these challenges will be important to future obesity prevention efforts.

Abstract

Effective obesity prevention requires a synergistic mix of population-level interventions including a strong role for government and the regulation of the marketing, labelling, content and pricing of energy-dense foods and beverages. In this paper we adopt the agenda of the Australian Federal Government (AFG) as a case study to understand the factors generating or hindering political priority for such ‘regulatory interventions’ between 1990 and 2011. Using a theoretically-guided process tracing method we undertook documentary analysis and conducted 27 interviews with a diversity of actors involved in obesity politics. The analysis was structured by a theoretical framework comprising four dimensions: the power of actors involved; the ideas the actors deploy to interpret and portray the issue; the institutional and political context; and issue characteristics. Despite two periods of sustained political attention, political priority for regulatory interventions did not emerge and was hindered by factors from all four dimensions. Within the public health community, limited cohesion among experts and advocacy groups hampered technical responses and collective action efforts. An initial focus on children (child obesity), framing the determinants of obesity as ‘obesogenic environments’, and the deployment of ‘protecting kids’, ‘industry demonization’ and ‘economic costs’ frames generated political attention. Institutional norms within government effectively selected out regulatory interventions from consideration. The ‘productive power’ and activities of the food and advertising industries presented formidable barriers, buttressed by a libertarian/neolibertarian rhetoric emphasizing individual responsibility, a negative view of freedom (as free from ‘nanny-state’ intervention) and the idea that regulation imposes an unacceptable cost on business. Issue complexity, the absence of a supportive evidence base and a strict ‘evidence-based’ policy-making approach were used as rationales to defer political priority. Overcoming these challenges may be important to future collective action efforts attempting to generate and sustain political priority for regulatory interventions targeting obesity.

Introduction

Since the turn of the century obesity has emerged onto the agendas of multiple governments (Kurzer and Cooper, 2011, Oliver, 2006), in parallel with a surge of attention from researchers, the media and business (Saguy and Riley, 2005). It is now common to hear of the ‘obesity epidemic’ with broad recognition that tackling the problem should be a political priority. Obesity is, however, a formidable political challenge. It has been referred to as ‘a test case for 21st century health policy’ and as a ‘wicked policy problem’ with many interconnected determinants, and coordinated action required ‘at all levels of government and in many sectors of society’ (Kickbusch and Buckett, 2010, p13).

A cost-effective and equitable approach to obesity prevention requires a mix of population-level interventions, including a strong role for government and the use of law and regulation (Gortmaker et al., 2011, Swinburn et al., 2011). This includes inter alia the regulation of the marketing, labelling, content, and pricing of energy-dense foods and beverages (referred to hereon as ‘regulatory interventions’). Experts argue that without addressing these determinants of ‘obesogenic environments’ policy responses are likely to be ineffective (Sassi et al., 2012, Swinburn et al., 2011).

Despite widespread attention to the issue, however, political priority for action to tackle obesogenic environments is low in many countries. Responses have favoured programme and education-based interventions (Lachat et al., 2013), despite evidence that such interventions in isolation have limited efficacy and cost-effectiveness (Lemmens et al., 2008, Summerbell et al., 2005). Indeed, obesity experts assert that ‘[t]he degree of political difficulty for implementation of…regulatory interventions is typically much higher than that for program-based and education-based interventions’ (Swinburn et al., 2011, p810).

Recognizing such challenges, a small number of studies elaborate on the political dimensions of obesity in Australia (Crammond et al., 2013, Shill et al., 2012). Crammond et al., for example, investigated the barriers to the adoption of regulatory interventions by the Executive Branch of the Australian Government. Yet, in focusing only on government actors these studies do not account for the broader network of non-state actors, including civil society, experts, and business groups, that also shape political responses to obesity. Thus, we conceptualise obesity as ‘governed’ by a plurality of actors in society rather than through the machinations of ‘government’ alone (Baldwin et al., 2012).

In this paper we bring key questions into play: Why are regulatory interventions politically difficult to achieve? Under what conditions do regulatory interventions receive political priority? Such questions concern the ‘agenda-setting’ phase of the policy cycle, when some problems rise to the attention of policy-makers while others receive minimal attention, or none at all (Kingdon, 2003). Political attention is a necessary but insufficient condition for political action. Hence, we view this concept as related to but distinct from ‘political priority’, the extent to which political leaders respond to the issue by mobilising official institutions and wider political systems into providing resources and enacting interventions commensurable with the severity of the issue (Shiffman and Smith, 2007).

Although obesity and poor diet are the leading causes of death and disability in Australia (Australian Institute of Health and Welfare, 2014), political priority for regulatory interventions has been notably absent. This paper adopts the agenda of the Australian Federal Government (AFG) as a case study and determines the factors generating or hindering political priority for regulatory interventions targeting obesity prevention, thereby helping to understand how future political priority might come about.