III. Framing the solution of the policy problem
How to tackle obesity has been an ongoing debate worldwide for more than two decades (Cecchini & Sassi, 2012; WHO, 1990, 2003, 2007a, 2013b). Different
approaches to tackle obesity have been debated, such as improving diets, improving access and availability of foods and improved public spaces for increasing activity, as explained in Chapter 2. The solution for the ‘obesity problem’ was framed as being either a personal matter or a collective one. However, the solution for the
‘soda consumption’ problem was additionally framed as being a ‘difficult’ or ‘unfair’
one, since it intervened only in respect of one product. This debate mirrors public health literature where polls and suggestions include dietary interventions (Sassi et al., 2012), nutrition education (Beeken & Wardle, 2013), interference of media in health habits (Boyce, 2007) and change in prices of single products (Powell &
Chaloupka, 2009) as the solutions. Each of these frames is explained below.
Regardless of the solution being a personal or political matter, the solution to the obesity problem was framed as being ‘difficult’ (Rivera-Dommarco et al., 2013, p.
11). The ‘difficulty’ frame was identified as a barrier to public actions, and actors regardless of their backgrounds repeatedly mentioned it. For example, the ANM mentioned:
It is very difficult for people to modify their eating patterns, especially with respect to products such as sugar, where there is a tendency of humans to like it. This is especially true in Mexico where we spoil our children. From a very young age, they consume sugary drinks, and they no longer like simple water. (ACA)
The perception of the problem being ‘difficult’ to solve is related to other assumptions about the problem, namely, the multi-causality of the disease, as discussed in Section II. This ‘multi-causality’ framing has been one of the driving arguments to oppose the soda tax as a solution. These findings concur with research dating from 2000 and before (Nestle & Jacobson, 2000) in which solutions kept focusing on changing the behaviour of individuals, an approach that, as the authors describe it, ‘has proven woefully inadequate, as indicated by the rising rates of both conditions’ (Nestle & Jacobson, 2000). The argumentation follows that it is better than doing nothing about it because it is ‘difficult’ or to start making some changes to the environment (Stuckler & Nestle, 2012), as discussed in the following section.
Individual versus collective solutions
Arguments about changing personal choices and lifestyles as a solution (CONMEXICO, 2013; EPC, 2011b; Radio Forumla, 2013) contrast with views on obesity as a structural problem concerning the State and in need of policies for changing the environment and for using legal interventions (Charvel S, 2012;
Encarnación, 2015; EPC, 2011b). Actors interviewed, such as advertisers, activists and think tank members, framed solutions as a matter for the individual, particularly for those suffering from obesity or diabetes. As a member of the media pointed out:
Each individual is responsible for their own behaviour and attitudes, and therefore, I think that the people have to take some actions and consume a healthier diet. (MIM)
Framing the obesity solution as being the responsibility of individuals is mainly an argument given by actors whose main interests are to promote food and drinks for commercial gain. They tend to influence debates when regulations are up for consideration, when such regulations might damage their primary interests (Hawkins & Holden, 2013b), as in the case of alcohol (Hawkins & McCambridge, 2014) or tobacco (Cairney et al., 2012) regulations. As described in Chapter 2, Mexico is a major consumer of snacks and sodas, and therefore any intervention strongly affecting demand is perceived as a threat to the soda industry (US SEC, 2013). Therefore, resistance to the policy was expected from the F&BI, and framing the problem as a personal matter was a means to resist policy change, as has been described in the literature (Brownell & Warner, 2009; Nestle & Jacobson, 2000).
In contrast, actors familiar with the evidence on obesity as a health problem framed the solution as a matter of public concern. For example, the ANM’s academic publication considered the problem to be a matter of protecting human rights. It stated that public policies for ‘improving health’ were a part of attending to human rights and ‘are much needed in the country’ (Rivera-Dommarco et al., 2013, p. 10);
they were supported by CSO organisations when promoting their ‘Manifiesto por la Salud Alimentaria’ (Alianza por la Salud Alimentaria, 2012b).
Attributing obesity to a single product: soda
A discrepancy in the frames around the causes of obesity was mainly the contrast between singling out one commodity versus the overall energy consumption of food.
For example, while academics and civil society groups insisted on pointing out the negative effects of soda and sugary drinks on health, others dismissed it. An actor from the industry mentioned ‘demonizing one thing [soda] is not good for anything’.
He was supported by a civil society member who said ‘everything you eat or drink excessively will affect negatively your health. […] soda, water, anything’.
Opposing arguments against an intervention in a single product (soda) emerged in the data. For industry and media actors, the soda tax was overvalued as a solution to the obesity problem. The CONCAMIN industry consortium press release mentioned:
Besides not having a real impact on reducing obesity, it [the soda tax]
has negative effects to society: taxes on foods and beverages result in increased revenue but do not improve the habits and behaviour of consumers. (CONCAMIN, 2015)
This frame was largely contested by academics and civil society members. They repeatedly highlighted the relevance of soda and sugary drinks as being part of the problem, and they emphasized that doing something about it was the key to solving the obesity problem. This was expressed by civil society groups (see Chapter 8) and highlighted in the academics’ ANM report:
Soda is not healthy, and its consumption is very well accepted and rooted in Mexican society. However, its consumption is linked to an increased risk of overweight, obesity, diabetes and CVD. This is why, amongst other recommendations to reduce its intake, a soda tax is recommended. (Juan Rivera et al., 2012, p. 3)
Consequently, these arguments opened an opportunity to frame the soda tax as a solution to overcome the obesity and diabetes problems, as discussed in literature (Dorfman, Wallack, & Woodruff, 2005; Smith et al., 2016). The cornerstone
arguments used to push for the soda tax were considered to be (a) the current epidemiology data on obesity, (b) data on sugary drinks’ consumption and its relation to obesity; and (c) the public health advocacy arguments about the need for solutions. As a member of a think tank mentioned:
We had the perfect excuse: we are the country which consumes the most soda in the world, we have the data [on the obesity epidemic], [we had] the moment of [a fiscal reform coming], and […] we have the IEPS [special taxes on products and services] applied to products having negative externalities. (TTM)
Therefore, having recognised obesity as a problem and having a political solution to it, the next step was to frame it as a collective effort. An important frame adding strength to the solution was how the new government promoted itself as an inclusive government, where all actors should participate. The following section discusses the positive and negative beliefs and frames about this approach.
Multi-stakeholder approach
One of the main frames about polices to tackle obesity was to have a multi-stakeholder approach. In this thesis, a multi-multi-stakeholder approach is defined as ‘a governance structure that seeks to bring stakeholders [actors] together to participate in the dialogue, decision-making and implementation of solutions to common problems or goals’ (Council of Europe, 2016; Fuchs, Kalfagianni, & Havinga, 2011). However, no clear views were expressed, neither by informants nor in the documents, to suggest how such recommendations are to be implemented or operationalised (Pratt, Charvel Orozco, Hernandez-Avila, Reis, & Sarmiento, 2014;
Rivera-Dommarco et al., 2013; SSA, 2011).
The multi-stakeholder approach to tackle the obesity epidemic was framed both as a positive and negative approach. Viewed positively, actors mentioned that the multi-stakeholder arrangement provides a space to influence and improve collaboration of non-state actors with policy-makers, regardless of the power imbalances among them. For example, a legal document explaining how to operationalise the policy of obesity mentions:
[Considering] that the Health Sector Program 2013-2018 has as one of its objectives to consolidate actions for disease prevention and health promotion [in order] to promote healthy attitudes and behaviours, it is necessary to promote participation of the public, social and private sectors to have an impact on the social determinants of health. (DOF, 2014, p. 1)
In contrast, academic members framed multi-stakeholder arrangements as potentially negative, if they were not established under clear principles and rules to outweigh the competing interests of actors. As one academic mentioned:
The political weight that the industry has in policy decisions is high.
The Ministry of Health leading the process allowed the [F&BI]
influence to be high […]. I believe that when the industry is part of the process, it loses credibility. Obviously I believe that communication with the industry is necessary, and their opinion has to be heard, but it is very different [when instead, you only] hear their opinion and then a group of experts make the decisions. (ACA)
Multi-stakeholder arrangements were also framed as arrangements that ‘have been shown to serve the private sector interests’ (CSO), as they tend to have the most power and close relationships with policy makers amongst all non-state actors (Farnsworth & Holden, 2006; Fuchs et al., 2011; Ken, 2014). As noted by an interviewee from an international organisation:
It seems like a joke having more representatives of the industry at the discussions than you have experts on nutrition and from the civil society groups at these workshops [workshops to set nutritional criteria for the ENCSOP]. They are deciding the rules. (IAM)
Furthermore, while multi-stakeholder arrangements were highlighted as a platform that may or may not have potentially positive outcomes, the role of non-state actors or independent entities under such arrangements were also portrayed differently
depending on the informant. Civil society members saw themselves as suddenly having a powerful position in food policy-making (Nestle & Rosenberg, 2015). But they also framed the F&BI’s discursive power throughout the process (EPC, 2015), as has been the case in the policy sphere worldwide through the years (Clapp &
Fuchs, 2009, pp. 93-95).
It is important to consider the power of the F&BI, and how the outcome of the policy, as a fiscal measure, was what the F&BI wanted least. However, as covered in Chapter 8, remediation actions were taken to avoid the full impact of the soda tax, and therefore the F&BI showed that they were able to maintain a powerful position throughout the policy process. For instance, they had a place in the monitoring strategy (OMENT), as described in Chapter 7, and they initiated several PPPs that benefited their own interests, as noted in Chapter 8. Also, framing the F&BI’s power was an important factor in the soda tax debate since it helped to engage the opposition to build a network, and also encouraged the government to avoid being perceived as complying with the F&BI demands.
The government’s framing of the multi-stakeholder approach was highlighted in official state documents. It did not consider potential sources of conflict but assumed a natural, positive and inclusive arrangement; an imbalance of power among the participants was not considered. This is relevant to understanding the process described in Chapter 7.
In addition to the multi-stakeholder approach frame, the use of evidence for policy design and implementation is a common argument used among actors. The next section provides details about how actors framed evidence to either support or oppose the fiscal measure.