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A realist review of voluntary actions by the food and beverage industry and implications for public health and policy in low- and middle-income countries

Nature Food volume 3, pages 650–663 (2022)Cite this article

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Abstract

The increasing availability of unhealthy processed food products is linked to rising rates of non-communicable diseases and obesity in low- and middle-income countries. Voluntary actions (VAs) are often adopted in lieu of regulating the composition, production, marketing and sale of unhealthy commodities, but their effectiveness is unclear. This realist review examines VAs adopted by the food and beverage industry in low- and middle-income countries. We developed a conceptual framework and followed a three-stage search to identify literature and VAs and, adhering to the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines, we produced a synthesized analysis of VAs. VAs, often initiated in response to governments’ efforts to introduce regulations, were difficult to evaluate due to vague language and a lack of enforcement mechanisms. The review found no evidence indicating that VAs are effective in safeguarding public health. Yet their implementation has resulted in weaker responses and policy substitution, and so we suggest that VAs have the potential to negatively influence public health and policy. The United Nations should rescind their endorsement of industry involvement and mandatory measures should be favoured over VAs.

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Fig. 1: Conceptual framework to examine the effect of VAs.
Fig. 2: Realist review searching processes.

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Data availability

The full search strategy and citations of studies eligible in this review are available in alternative formats from the corresponding author upon reasonable request.

Code availability

The coding strategy used for data extraction and analysis of studies included in our review is outlined in Supplementary Table 1.

References

  1. Bigna, J. J. & Noubiap, J. J. The rising burden of non-communicable diseases in sub-Saharan Africa. Lancet Glob. Health 7, e1295–e1296 (2019).

    Article  PubMed  Google Scholar 

  2. Popkin, B. M., Adair, L. S. & Ng, S. W. Now and then: the global nutrition transition: the pandemic of obesity in developing countries. Nutr. Rev. 70, 3–21 (2012).

    Article  PubMed  Google Scholar 

  3. Lencucha, R. & Thow, A. M. How neoliberalism is shaping the supply of unhealthy commodities and what this means for NCD prevention. Int. J. Health Policy Manag. 8, 514–520 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tackling NCDs: ‘Best Buys’ and Other Recommended Interventions for the Prevention and Control of Noncommunicable Diseases (WHO, 2017); https://apps.who.int/iris/handle/10665/259232

  5. 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. 14, 159–168 (2013).

    Article  PubMed  Google Scholar 

  6. Hawkes, C. & Lobstein, T. Regulating the commercial promotion of food to children: a survey of actions worldwide. Int. J. Pediatr. Obes. 6, 83–94 (2011).

    Article  CAS  PubMed  Google Scholar 

  7. Global Database on the Implementation of Nutrition Action (GINA) (WHO, accessed 27 January 2022); https://extranet.who.int/nutrition/gina/en

  8. Juma, P. A. et al. Non-communicable disease prevention policy process in five African countries. BMC Public Health 18, 961 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Allen, L. N., Wigley, S. & Holmer, H. Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries. Lancet Glob. Health 9, e1528–e1538 (2021).

    Article  PubMed  Google Scholar 

  10. Thow, A. M. et al. The political economy of sugar-sweetened beverage taxation: an analysis from seven countries in sub-Saharan Africa. Glob. Health Action 14, 1909267 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mialon, M. & da Silva 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. 22, 1898–1908 (2019).

    Article  PubMed  Google Scholar 

  12. Global Strategy on Diet, Physical Activity and Health (WHO, 2004); https://www.afro.who.int/sites/default/files/2017-06/NCD-Global_Strategy_Diet_Physical-Activity_health_2004.pdf

  13. First Meeting of UN Funds, Programmes and Agencies on the Implementation of the Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of NCDs (WHO, 2011); https://apps.who.int/gb/ebwha/pdf_files/EB148/B148_7-en.pdf

  14. Global Action Plan for the Prevention and Control of NCDs 2013-2020 (WHO, 2013); https://apps.who.int/iris/handle/10665/94384

  15. Political Declaration of the 3rd High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases (UN General Assembly, 2018); https://digitallibrary.un.org/record/1648984

  16. Ronit, K. & Jensen, J. D. Obesity and industry self-regulation of food and beverage marketing: a literature review. Eur. J. Clin. Nutr. 68, 753–759 (2014).

    Article  CAS  PubMed  Google Scholar 

  17. Nixon, L. et al. ‘We’re part of the solution’: evolution of the food and beverage industry’s framing of obesity concerns between 2000 and 2012. Am. J. Public Health 105, 2228–2236 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Abdool Karim, S., Kruger, P. & Hofman, K. Industry strategies in the parliamentary process of adopting a sugar-sweetened beverage tax in South Africa: a systematic mapping. Glob. Health 16, 116 (2020).

    Article  Google Scholar 

  19. Brownell, K. D. & Warner, K. E. The perils of ignoring history: big tobacco played dirty and millions died. How similar is big food? Milbank Q. 87, 259–294 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Petticrew, M. et al. Provision of information to consumers about the calorie content of alcoholic drinks: did the Responsibility Deal pledge by alcohol retailers and producers increase the availability of calorie information? Public Health 149, 159–166 (2017).

    Article  CAS  PubMed  Google Scholar 

  21. Barennes, H., Aaron, P., Goyet, S. & Srour, L. Regulation and the food industry. Lancet 381, 1901–1902 (2013).

    Article  PubMed  Google Scholar 

  22. Buse, K., Tanaka, S. & Hawkes, S. Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Global Health 13, 34 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  23. Moodie, R. 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 Manag. 10, 968–982 (2021).

  24. Moodie, R. et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet 381, 670–679 (2013).

    Article  PubMed  Google Scholar 

  25. Romero-Fernández, M. M., Royo-Bordonada, M. Á. & Rodríguez-Artalejo, F. Compliance with self-regulation of television food and beverage advertising aimed at children in Spain. Public Health Nutr. 13, 1013–1021 (2010).

    Article  PubMed  Google Scholar 

  26. Schwartz, M. B. et al. Breakfast cereal industry pledges to self-regulate advertising to youth: will they improve the marketing landscape? J. Public Health Policy 31, 59–73 (2010).

    Article  PubMed  Google Scholar 

  27. Hebden, L. A., King, L., Grunseit, A., Kelly, B. & Chapman, K. Advertising of fast food to children on Australian television: the impact of industry self-regulation. Med. J. Aust. 195, 20–24 (2011).

    Article  PubMed  Google Scholar 

  28. Mulligan, C., Labonté, M. È., Vergeer, L. & L’Abbé, M. R. Assessment of the Canadian Children’s Food and Beverage Advertising Initiative’s uniform nutrition criteria for restricting children’s food and beverage marketing in Canada. Nutrients. 10, E803 (2018).

    Article  PubMed  CAS  Google Scholar 

  29. Hawkes, C. & Harris, J. L. An analysis of the content of food industry pledges on marketing to children. Public Health Nutr. 14, 1403–1414 (2011).

    Article  PubMed  Google Scholar 

  30. King, L. et al. Industry self regulation of television food advertising: responsible or responsive? Int. J. Pediatr. Obes. 6, e390–e398 (2011).

    Article  PubMed  Google Scholar 

  31. Craig, P. et al. Developing and Evaluating Complex Interventions: New Guidance (Medical Research Council, 2021); https://webarchive.nationalarchives.gov.uk/ukgwa/20220207162925/http://mrc.ukri.org/documents/pdf/complex-interventions-guidance/

  32. Pawson, R., Greenhalgh, T., Harvey, G. & Walshe, K. Realist review - a new method of systematic review designed for complex policy interventions. J. Health Serv. Res. Policy 10, 21–34 (2005).

    Article  PubMed  Google Scholar 

  33. WHO Consultation on Obesity & WHO Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation (WHO, 2000); https://apps.who.int/iris/handle/10665/42330

  34. Beaglehole, R. et al. UN High-Level Meeting on Non-Communicable Diseases: addressing four questions. Lancet 378, 449–455 (2011).

    Article  PubMed  Google Scholar 

  35. Signé L. Africa’s Consumer Market Potential: Trends, Drivers, Opportunities, and Strategies (Brookings Institution, 2018); http://www.mbuyucapital.com/uploads/3/8/3/9/38397351/brookings_2018_africas-consumer-market-potential.pdf

  36. Hawkes, C., Chopra, M. & Friel, S. in Globalization and Health: Pathways, Evidence and Policy (eds Labonté, R. et al.) 235–262 (Routledge, 2009).

    Google Scholar 

  37. Igumbor, E. U. et al. ‘Big Food,’ the consumer food environment, health, and the policy response in South Africa. PLoS Med. 9, e1001253 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  38. Juma, P. A. et al. Multi-sectoral action in non-communicable disease prevention policy development in five African countries. BMC Public Health 18, 953 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mexico Marketing to Children Pledge (Rudd Center for Food Policy & Obesity, 2010); http://pledges.uconnruddcenter.org/pledge.aspx?id=17

  40. We Know How to Evolve (ANPRAC-Mexican Beverage Association, 2018); http://anprac.org.mx/sabemos-evolucionar/

  41. Grupo Bimbo and the Health Department of Mexico Comply With the Mandate of the WHO to Reduce Salt Content in Bread (Group Bimbo, 2012); https://www.grupobimbo.com/en/press/releases/ethics/grupo-bimbo-and-health-department-mexico-comply-mandate-who-reduce-salt

  42. Public Health and the Food and Drinks Industry: The Governance and Ethics of Interaction: Lessons from Research, Policy and Practice (UK Health Forum, 2018); https://www.idrc.ca/sites/default/files/sp/Documents%20EN/ukhf-casebook-jan18.pdf

  43. The EU Pledge at a Glance (EU Pledge, accessed 12 November 2021); https://eu-pledge.eu/the-eu-pledge-at-a-glance/

  44. Baum, F. E. et al. Assessing the health impact of transnational corporations: its importance and a framework. Glob. Health 12, 27 (2016).

    Article  Google Scholar 

  45. Lowery, C. M., Mora-Plazas, M., Gómez, L. F., Popkin, B. & Taillie, L. S. Reformulation of packaged foods and beverages in the Colombian food supply. Nutrients 12, 3260 (2020).

    Article  CAS  PubMed Central  Google Scholar 

  46. Brazil Public Commitment on Food and Beverage Advertising to Children (Rudd Center for Food Policy & Obesity, 2009); http://pledges.uconnruddcenter.org/pledge.aspx?id=5

  47. Erzse, A. et al. Availability and advertising of sugar sweetened beverages in South African public primary schools following a voluntary pledge by a major beverage company: a mixed methods study. Glob. Health Action 14, 1898130 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Implementation Guide for Marketing Communications to Children Commitment (The World Federation of Advertisers & The Consumer Goods Forum, 2016); https://www.theconsumergoodsforum.com/wp-content/uploads/2017/11/CGFImplementation_Guide_for_CGF_Marketing_Communications_to_Children_Commitment.pdf

  49. Non-binding Agreement (ABIR-Brazilian Beverage Association, 2018); https://icba-bigtree.s3.amazonaws.com/files/resources/termo-de-compromisso-reducao-acucar-eng.pdf

  50. Discontinuation of Sales of Sugar Sweetened Beverages to Primary School Outlets (Coca-Cola Beverages South Africa, 2017).

  51. The South African Marketing to Children Pledge (Consumer Goods Council of South Africa, 2008); https://ifballiance.org/wp-content/uploads/2020/10/South_african_marketing_to_children_pledge.pdf

  52. Thailand Children’s Food and Beverage Advertising Initiative (Rudd Center for Food Policy & Obesity, 2008); http://pledges.uconnruddcenter.org/pledge.aspx?id=9

  53. Latnovic, L. & Rodriguez Cabrera, L. Public health strategy against overweight and obesity in Mexico’s National Agreement for Nutritional Health. Int. J. Obes. Suppl. 3, S12–S14 (2013).

  54. White, M. & Barquera, S. Mexico adopts food warning labels. Why now? Health Syst. Reform 6, e1752063 (2020).

    Article  PubMed  Google Scholar 

  55. South African Pledge on Marketing to Children (Rudd Center for Food Policy & Obesity, 2009); http://pledges.uconnruddcenter.org/pledge.aspx?id=8

  56. Mialon, M., Swinburn, B., Wate, J., Tukana, I. & Sacks, G. Analysis of the corporate political activity of major food industry actors in Fiji. Glob. Health 12, 18 (2016).

    Article  Google Scholar 

  57. Mialon, M. et al. ‘The architecture of the state was transformed in favour of the interests of companies’: corporate political activity of the food industry in Colombia. Glob. Health 16, 97 (2020).

    Article  Google Scholar 

  58. Turkey Pledge (Rudd Center for Food Policy & Obesity, 2011); http://pledges.uconnruddcenter.org/pledge.aspx?id=18

  59. Peru Pledge (Rudd Center for Food Policy & Obesity, 2011); http://pledges.uconnruddcenter.org/pledge.aspx?id=22

  60. Kunkel, D., Castonguay, J., Wright, P. J. & McKinley, C. J. Solution or smokescreen? Evaluating industry self-regulation of televised food marketing to children. Commun. Law Policy 19, 263–292 (2014).

    Article  Google Scholar 

  61. Philippines Pledge (Rudd Center for Food Policy & Obesity, 2010); http://pledges.uconnruddcenter.org/pledge.aspx?id=20

  62. Théodore, F. L. et al. Pitfalls of the self-regulation of advertisements directed at children on Mexican television. Pediatr. Obes. 12, 312–319 (2017).

    Article  PubMed  Google Scholar 

  63. Code of Ethics (Outdoor Advertising Association of the Philippines, 2006); https://www.oaap.org.ph/

  64. India Pledge (Rudd Center for Food Policy & Obesity, 2011); http://pledges.uconnruddcenter.org/pledge.aspx?id=16

  65. Industria de Bebidas no Alcohólicas Firma Compromisos de Autorregulación Responsable (Camara de la Industria de Bebidas de la ANDI, 2016); https://www.postobon.com/sites/default/files/boletin_prensa_compromisos_vf_0.pdf

  66. Malaysia Responsible Advertising to Children Pledge (Rudd Center for Food Policy & Obesity, 2013); http://pledges.uconnruddcenter.org/pledge.aspx?id=24

  67. India Pepsico Pledge 2016 (Rudd Center for Food Policy & Obesity, 2016); http://pledges.uconnruddcenter.org/company.aspx?id=63&pledge_id=16

  68. Grupo Bimbo Reaffirms its Commitment with the Health of Our Population (Group Bimbo, 2006); https://www.grupobimbo.com/en/press/releases/wellness/grupo-bimbo-reaffirms-its-commitment-health-our-population

  69. Memorandum of Understanding: Supporting Healthy Active Lives for People in Fiji (Fiji Beverage Group, 2013); http://fijibeveragegroup.com.fj/wp-content/uploads/2014/04/FBG-MOU-2013.pdf

  70. Performance With Purpose (PepsiCo, 2006); https://www.thinkunthink.org/perch/resources/documents/thnking-the-unthinkablecopyright-nik-gowing-chris-langdonchapter-18pepsicopdf-002.pdf

  71. Kelly, B. et al. Density of outdoor food and beverage advertising around schools in Ulaanbaatar (Mongolia) and Manila (the Philippines) and implications for policy. Crit. Public Health 25, 280–290 (2015).

  72. Guideline: Sugars Intake for Adults and Children (WHO, 2015); https://www.who.int/publications/i/item/9789241549028

  73. WHO Global Sodium Benchmarks for Different Food Categories (WHO, 2021).

  74. Lacy-Nichols, J., Scrinis, G. & Carey, R. The politics of voluntary self-regulation: insights from the development and promotion of the Australian Beverages Council’s Commitment. Public Health Nutr. 23, 564–575 (2020).

    Article  PubMed  Google Scholar 

  75. Pledges on Food Marketing to Children (Rudd Center for Food Policy & Obesity, 2015); http://pledges.uconnruddcenter.org/search.aspx

  76. Sacks, G. et al. Comparison of food industry policies and commitments on marketing to children and product (re)formulation in Australia, New Zealand and Fiji. Crit. Public Health 25, 299–319 (2015).

    Google Scholar 

  77. Cetthakrikul, N., Phulkerd, S., Jaichuen, N., Sacks, G. & Tangcharoensathien, V. Assessment of the stated policies of prominent food companies related to obesity and non-communicable disease (NCD) prevention in Thailand. Glob. Health 15, 12 (2019).

    Article  Google Scholar 

  78. Kelly, B. et al. Global benchmarking of children’s exposure to television advertising of unhealthy foods and beverages across 22 countries. Obes. Rev. 20, 116–128 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  79. Busse, P. & Bernabé-Ortiz, A. Self-regulation of the Peruvian food industry: health message cues in the context of food and beverage advertisements. Public Health 159, 1–3 (2018).

    Article  CAS  PubMed  Google Scholar 

  80. da Silva, D. A. C., da Cunha, A. C. R., da Cunha, T. R. & Rosaneli, C. F. Food marketing targeting children: unveiling the ethical perspectives in the discourse on self-regulation. Ciênc. Saúde Colet. 22, 2187–2196 (2017).

    Google Scholar 

  81. Jaichuen, N., Vongmongkol, V., Suphanchaimat, R., Sasiwatpaisit, N. & Tangcharoensathien, V. Food marketing in Facebook to Thai children and youth: an assessment of the efficacy of Thai regulations. Int. J. Environ. Res. Public Health 16, 1204 (2019).

    Article  PubMed Central  Google Scholar 

  82. Kassahara, A. & Sarti, F. M. Marketing of food and beverage in Brazil: scientific literature review on regulation and self-regulation of advertisements. Interface 22, 589–602 (2017).

    Article  Google Scholar 

  83. Mallarino, C., Gómez, L. F., González-Zapata, L., Cadena, Y. & Parra, D. C. Advertising of ultra-processed foods and beverages: children as a vulnerable population. Rev. Saúde Pública 47, 1006–1010 (2013).

    Article  PubMed  Google Scholar 

  84. Monteiro, C. A., Gomes, F. S. & Cannon, G. The snack attack. Am. J. Public Health 100, 975–981 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  85. Myers, A. et al. Sugar and health in South Africa: potential challenges to leveraging policy change. Glob. Public Health 12, 98–115 (2017).

    Article  PubMed  Google Scholar 

  86. Yamoah, D. A., De Man, J. & Onagbiye S. O. & Mchiza, Z. J. Exposure of children to unhealthy food and beverage advertisements in South Africa. Int. J. Environ. Res. Public Health 18, 3856 (2021).

  87. Lowery, C. M., Mora-Plazas, M., Gómez, L. F., Popkin, B. & Taillie, L. S. Reformulation of packaged foods and beverages in the Colombian food supply. Nutrients. 12, 3260 (2020).

    Article  CAS  PubMed Central  Google Scholar 

  88. Instituto Nacional de Salud Pública de México Review of Current Labelling Regulations and Practices for Food and Beverage Targeting Children and Adolescents in Latin America Countries (Mexico, Chile, Costa Rica and Argentina) and Recommendations for Facilitating Consumer Information (UNICEF, 2016); https://www.unicef.org/lac/media/1876/file/PDF%20An%C3%A1lisis%20de%20regulaciones%20y%20pr%C3%A1cticas%20para%20el%20etiquetado%20de%20alimentos%20y%20bebidas%20ING.pdf

  89. Milsom, P., Smith, R., Baker, P. & Walls, H. Corporate power and the international trade regime as drivers of NCD policy non-decisions: a realist review. Health Policy Plan. 36, 820 (2021).

  90. Garton, K., Thow, A. M. & Swinburn, B. International trade and investment agreements as barriers to food environment regulation for public health nutrition: a realist review. Int. J. Health Policy Manag. 10, 745–765 (2021).

  91. Bowers, S., Signal, L. & Jenkin, G. Does Current Industry Self-Regulation of Food Marketing in New Zealand Protect Children from Exposure to Unhealthy Food Advertising? (Report prepared for the Cancer Society of New Zealand by the Health Promotion and Policy Research Unit, University of Otago, 2012); https://www.otago.ac.nz/wellington/otago036971.pdf

  92. Crosbie, E. & Florence, D. Expanding our understanding of industry opposition to help implement sugar-sweetened beverage taxation. Public Health Nutr. 25, 180–182 (2021).

  93. Sacks, G., Swinburn, B. A., Cameron, A. J. & Ruskin, G. How food companies influence evidence and opinion–straight from the horse’s mouth. Crit. Public Health 28, 253–256 (2018).

    Article  Google Scholar 

  94. Reeve, B. & Gostin, L. O. ‘Big’ food, tobacco, and alcohol: reducing industry influence on noncommunicable disease prevention laws and policies. Int. J. Health Policy Manag. 8, 450–454 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  95. Delobelle, P., Sanders, D., Puoane, T. & Freudenberg, N. Reducing the role of the food, tobacco, and alcohol industries in noncommunicable disease risk in South Africa. Health Educ. Behav. 43, 70S–81S (2016).

    Article  PubMed  Google Scholar 

  96. Lachat, C. et al. Diet and physical activity for the prevention of noncommunicable diseases in low- and middle-income countries: a systematic policy review. PLoS Med. 10, e1001465 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  97. Lauber, K., Rutter, H. & Gilmore, A. B. Big food and the World Health Organization: a qualitative study of industry attempts to influence global-level non-communicable disease policy. BMJ Glob. Health 6, e005216 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  98. Lauber, K., Ralston, R., Mialon, M., Carriedo, A. & Gilmore, A. B. Non-communicable disease governance in the era of the sustainable development goals: a qualitative analysis of food industry framing in WHO consultations. Glob. Health 16, 76 (2020).

    Article  Google Scholar 

  99. Sharma, L. L., Teret, S. P. & Brownell, K. D. The food industry and self-regulation: standards to promote success and to avoid public health failures. Am. J. Public Health 100, 240–246 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  100. Petticrew, M. et al. The Public Health Responsibility Deal: how should such a complex public health policy be evaluated? J. Public Health 35, 495–501 (2013).

    Article  Google Scholar 

  101. Ray, P. Evidence-Based Policy: A Realist Perspective (SAGE, 2006).

  102. Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J. & Pawson, R. RAMESES publication standards: realist syntheses. BMC Med. 11, 21 (2013).

    CAS  Google Scholar 

  103. 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. 16, 519–530 (2015).

    Article  CAS  PubMed  Google Scholar 

  104. Delobelle, P., Sanders, D., Puoane, T. & Freudenberg, N. Reducing the role of the food, tobacco, and alcohol industries in noncommunicable disease risk in South Africa. Health Educ. Behav. 43, 70S–81S (2016).

    Article  PubMed  Google Scholar 

  105. Jahiel, R. I. & Babor, T. F. Industrial epidemics, public health advocacy and the alcohol industry: lessons from other fields. Addiction 102, 1335–1339 (2007).

    Article  PubMed  Google Scholar 

  106. World Bank Country and Lending Groups (World Bank, accessed 12 November 2021); https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups

  107. Industry Self-Regulation: Empty Pledges (Global Food Research Programmes, 2020); https://www.globalfoodresearchprogram.org/wp-content/uploads/2020/08/Industry_Self-Regulation_Empty_Pledges_July_2020.pdf

  108. Sugar Reduction Pledges (International Council of Beverages Associations, accessed 12 November 2021); https://www.icba-net.org/industry-commitments/sugar-reduction-pledges-2/

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Acknowledgements

The authors acknowledge K. Lebard and N. Mazonde for providing assistance and support to this study. This research was funded by the National Institute for Health Research (NIHR; GHR: 16/137/34) using UK aid from the UK government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care. A.E., S.A.K. and K.J.H. are supported by the SAMRC/Wits Centre for Health Economics and Decision Science – PRICELESS SA (grant number 23108).

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  1. SAMRC/Wits Centre for Health Economics and Decision Science – PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa

    Agnes Erzse, Safura Abdool Karim & Karen Joanne Hofman

  2. MRC Epidemiology Unit, University of Cambridge, Cambridge, UK

    Louise Foley

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K.J.H. and A.E. conceptualized the study, S.A.K. and A.E. designed the study. A.E. collected data, A.E. and S.A.K. analysed the data. A.E. led the writing of the manuscript. All authors reviewed, commented on and approved the final manuscript.

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Correspondence to Agnes Erzse.

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Erzse, A., Karim, S.A., Foley, L. et al. A realist review of voluntary actions by the food and beverage industry and implications for public health and policy in low- and middle-income countries. Nat Food 3, 650–663 (2022). https://doi.org/10.1038/s43016-022-00552-5

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