The nutrition status of populations is shaped by actions within and across multiple policy sectors, both health and non-health, from global to local levels. Increasingly, the trade sector is recognised as an important determinant of population nutrition. Trade liberalisation impacts on food systems and nutrition through several pathways: by reducing barriers to cross-border trade in food commodities, final products and food services; by enabling investment by foreign food companies throughout the food system; and by removing state protections and supports for domestic industries(Reference Friel, Gleeson and Thow1, Reference Thow, Snowdon and Labonté2). Because trade agreements contain rules about how governments can regulate markets, both at the border (e.g. tariffs, biosecurity measures) and behind the border (e.g. food regulations), they can also affect domestic ‘policy space’ or the ‘freedom, scope, and mechanisms that governments have to choose, design, and implement public policies to fulfil their aims’(Reference Koivusalo, Schrecker and Labonté3) (p. 105).
Recognising these challenges, high-level international agreements and technical reports acknowledge the objective of building trade and nutrition policy coherence or ‘efforts to design policies that take account of the interests of other policy communities, minimize conflicts, maximize synergies and avoid unintended incoherence’(4) (p. 17). In 2014, the Rome Declaration on Nutrition of the Second International Conference on Nutrition called for ‘trade policies to be conducive to fostering food security and nutrition for all’(5). Such calls also stem from emerging understanding and examples of effective governance at the trade–health policy nexus(Reference Hawkes6). For example, positive outcomes from interactions between trade and health authorities in Thailand suggest that coherence is more likely when there is space for dialogue and information sharing, leadership, formal and informal institutional coordinating mechanisms, meaningful engagement among trade and health actors, and supporting evidence(Reference Blouin7). Thus, understanding how to achieve better coherence between trade and public health nutrition policy goals is a critical topic of investigation globally.
One potentially important and yet understudied driver of policy (in)coherence is the extent to which there is (mis)alignment in the beliefs and underlying worldviews of actors in the respective policy sectors. For example, nutrition and health actors may focus on trade agreements and the rules they contain as a threat to population health, taking a ‘harm minimisation’ approach, with little consideration for trade objectives and potential synergies. Conversely, trade actors may focus on achieving reductions in trade barriers and economic objectives without considering the potential impacts on food systems, nutrition and public health(Reference Baker, Kay and Walls8, Reference Drope and Lencucha9). Some research in low- and middle-income countries (e.g. Thow et al.) indicates that beliefs and paradigms of policy actors can create barriers to achieving policy coherence that benefits nutrition(Reference Thow, Greenberg and Hara10). However, to the best of our knowledge, few empirical studies have investigated these ideational barriers in relation to trade and nutrition policy coherence. Furthermore, few studies in the ‘political economy of nutrition’ literature have examined the role of ideational factors as enablers of or barriers to policy coherence for nutrition more generally(Reference Baker, Hawkes and Wingrove11).
In the present qualitative analysis, we examine the case of Australian trade policy to understand the frames used by actors within the respective trade and nutrition sectors, the factors shaping framing (in)coherence between them and the implications for achieving policy coherence in future. To do so, we adopt a constructivist approach, drawing upon framing theory. We ask: how do the individuals and organisations centrally involved in shaping Australian trade policy consider, understand and frame food and nutrition problems? Furthermore, how do processes and mechanisms of coordination in the trade and nutrition policy sectors shape these interpretations and thus the consideration or exclusion of nutrition objectives in trade policy? More broadly, the present study aims to inform an understanding of barriers to and possibilities for achieving healthy public policy in non-health sectors and adds to the growing literature on the political economy of nutrition and health.
Methods
Because of the dynamic and multi-variable nature of the topic, and the focus on a single jurisdiction, we adopted a theoretically guided, qualitative, single case study research design(Reference Yin12). The analysis proceeded via four steps: (i) we developed a summary review (scope and setting) of the trade, food and nutrition policy landscape in Australia to contextualise the analysis; (ii) drawing upon the political science theory of discursive institutionalism and social science theory on framing, we developed a theoretical framework to guide the analysis; (iii) guided by our contextual understanding and theoretical framework, we collected data from key informant interviews with government and non-governmental stakeholders; and (iv) we analysed the interview data and summarised the results. The Australian National University Human Research Ethics Committee granted approval to conduct the study.
Scope and setting
The Australian trade policy-making ‘sub-system’ was selected as a case study. Although, ideally, we would have adopted a comparative case study design involving several countries, this was not possible given limited investigator resources. Therefore this case was selected for convenience as an illustration(Reference Yin12) of an important topic receiving increasing attention by public health groups in Australia and internationally(Reference Hawkes6). We identified key actors from submissions to policy processes, media and published academic reports. They included Australian Commonwealth Government departments and agencies, businesses and lobby groups, health and consumer interest non-governmental organisations, and academics. Australia has a liberal-democratic federal system of government comprising the Australian Commonwealth Government, state/territory and local governments, and linkages to the international system (e.g. through participation in the multilateral World Trade Organization). The Australian Commonwealth Government includes a bicameral Parliamentary legislature (House of Representatives and Senate) and an Executive led by the Prime Minister and Cabinet elected on a three-year term. Two major political parties dominate Australian politics: (i) the libertarian-conservative Liberal Party of Australia, which usually governs in coalition with the conservative National Party; and (ii) the democratic socialist Australian Labor Party. A third, The Australian Greens, is a minor political party with environmental and social justice values.
The Australian Public Service administers policy with responsibilities for making, monitoring and enforcing policy and regulation(Reference Parkin, Summers and Woodward13). Responsibility for trade policy lies with the Department of Foreign Affairs and Trade (DFAT), including the negotiation of trade agreements, which occurs under conditions of strict confidentiality. DFAT engages other government agencies through intergovernmental processes (e.g. Departments of Agriculture and Health, Food Standards Australia New Zealand (FSANZ)) and with non-governmental (i.e. business, civil society) actors through consultations. The negotiating mandate of DFAT is determined by the Australian Commonwealth Government Executive Branch (Prime Minister and Cabinet), again under conditions of strict confidentiality. The Australian Parliament can approve (i.e. ratify) or reject new trade agreements by passing implementing legislation, but not amend them. With regard to food and nutrition policy, Australia’s food regulatory system is governed by the Australian Food Ministerial Council and responsibility for setting food standards lies with FSANZ. Political priority for strong food regulation to combat dietary excesses and the ‘obesogenicity’ of the food supply and consumer food environments is low(Reference Baker, Gill and Friel14). Australia’s approach to food policy can be characterised as ‘productivist’, with strong emphasis on export-led industry growth and minimal consideration for other objectives. This was evident in Australia’s short-lived 2013 National Food Plan, which focused almost exclusively on sector growth and exports, with little consideration for nutrition, public health and environmental sustainability(Reference Carey, Krumholz and Duignan15).
Theory
To understand the role of ideational factors in shaping trade–nutrition policy coherence we adopted a ‘constructivist’ approach(Reference Sabatier and Weible16). Constructivists emphasise the role of ‘ideas, norms, knowledge, culture and argument in politics, stressing in particular the role of collectively held or “inter-subjective” ideas and understandings’, and that ‘these shared beliefs construct the interests and identities of purposive actors’(Reference Finnemore and Sikkink17) (p. 392). Much constructivist scholarship uses the ‘frame’ as a unit of analysis. In his seminal work Frame Analysis, Goffman defined a frame as an organising principle that ‘governs the subjective meaning we assign to social events’(Reference Goffman18) (pp. 10–11). Hence, a ‘frame’ refers to a central organising idea, or set of ideas, used to assign and communicate meaning. Variations of framing theory have been applied across several relevant disciplines including social and political psychology(Reference Kahneman, Tversky, MacLean and Ziemba19, Reference Tversky and Kahneman20), social movement research(Reference Benford and Snow21, Reference Snow and Benford22), communication and media studies(Reference Entman23, Reference Scheufele and Tewksbury24), and in the political and policy sciences(Reference Béland25–Reference Baumgartner and Jones30).
Across most of these disciplines ‘framing’ elaborates on the processes by which ‘issues’ are interpreted and communicated (i.e. ‘framed’) through social interaction and discourse. Framing in the media, by social movements and by interest groups, can play an important role in determining the rise and fall of certain ideas in public discourse(Reference Benford and Snow21, Reference Entman23, Reference Shiffman29, Reference Baumgartner and Jones30). In this regard, only some of the multitude of ‘issues’ that exist out there in material reality will become salient as ‘problems’ worthy of consideration in government policy agendas and for policy enactment. Frames can be deployed as ‘weapons of advocacy’ in policy settings(Reference Weiss31). Policy actors come to define problems in terms of causality, responsibility, tractability and benefit in ways that mobilise their supporters and counter opposition(Reference Benford and Snow21, Reference Entman23, Reference Edelman28, Reference Shiffman29). Policy ideas are often constructed collectively through the ‘coordinative discourses’ of actors involved in the policy arena, including networks of experts, interest groups, bureaucrats and elected politicians who share certain ideas, interests and causal beliefs. ‘Communicative discourses’ are employed to portray those ideas to the wider public and other stakeholders for deliberation and legitimation(Reference Schmidt26). The political economy of nutrition literature describes how these discourses are often fragmented in nutrition, given the wide diversity of actors and interests involved in developing nutrition-specific policies, as well as those in nutrition-sensitive sectors(Reference Baker, Hawkes and Wingrove11).
Policy ideas can be ‘doubly embedded’(Reference Béland25). First, within deeper ‘policy paradigms’ or coherent sets of guiding principles and causal beliefs, both technical and ideological in content, that function as ‘road maps’ for experts, bureaucrats and elected politicians. According to Hall (as quoted in Béland(Reference Béland25), p. 5), a paradigm serves as ‘a framework of ideas and standards that specifies not only the goals of policy and kind of instruments that can be used to attain them, but also the very nature of the problems they are meant to be addressing’(Reference Hall32) (p. 279). Second, ideas are embedded within ‘ideological repertoires’ as relatively stable sets of cultural symbols, values and deep-seated beliefs present within the wider political system and in society at large. By mobilising and drawing upon cultural symbols and ideological representations, actors can frame issues in ways that appeal to the wider polity(Reference Béland25). Ideas are both shaped by and come to define and constitute institutions. Political and administrative institutions (e.g. political parties, government agencies), formal rules (e.g. international and national laws, processes and regulations) and informal norms (e.g. acceptable beliefs and practices within policy-making organisations) represent ideas that have become ‘institutionally embedded’ just as they set parameters for ongoing ideation and discourse. Institutions, in turn, act as ‘ideational filters’ by shaping which ideas are considered acceptable, which are ignored, or outright rejected from consideration(Reference Smith33). As described earlier, Australia has a ‘productivist’ orientation to food policy, which demonstrates features of a policy paradigm(Reference Carey, Krumholz and Duignan15). Others have described the importance of a ‘neoliberal’ ideology as a hindrance to progressing food and nutrition policy in Australia, especially in relation to a normative emphasis on individual responsibility, a minimal role for government intervention and market deregulation(Reference Baker, Gill and Friel14, Reference Henderson, Coveney and Ward34).
Data sources and collection
Semi-structured interviews were conducted by the lead author with nineteen key informants spanning a diversity of sectors, between March and May 2016 (Table 1). Participants were recruited using a purposive snowball sampling strategy(Reference Goodman35). There were eleven non-respondents, of which half were federal public servants. Interviews were recorded and transcribed verbatim. Given the sensitive nature of the topic, informants were identified by their sector only. The analysis was informed by documents sourced from government websites including media releases, speeches and Hansard transcripts of the House of Representatives, Senate and Committees available from the ParlInfo database. Other grey literature was sourced from the websites of relevant non-government organisations.
Description of informants recruited to participate in interviews on trade and nutrition policy coherence, Australia, March–May 2016
Data analysis
Interview transcripts were coded using Atlas.ti software by the lead author. An initial coding schema was developed from framing theories outlined earlier and additional codes (i.e. those not captured by the initial theory) were added using open coding to ensure capture of emergent themes. The coding schema was refined using constant comparative analysis over successive stages of data analysis(Reference Fram36). As is typical with interpretive research, this was not a linear, stepwise process, but more iterative, involving reflection and refinement of key thematic categories through ongoing engagement with both theory and the coded data(Reference Schwartz-Shea and Yanow37). Applying to this to the interview data, constant comparisons were made between codes used within each respective interview transcript, then between transcripts of those participants in the same group, and then between transcripts from participants of different groups(Reference Fram36). To immerse all team members in the interview data and as an internal robustness check, all authors were further assigned a sample of transcripts to code. The results from this additional exercise were contrasted with the coding of the lead author and inter-coder differences were considered. The final interpretation of themes identified in the coded data, and overall findings, were clarified through discussion among all authors.
Results
We made several key observations relating to the role of ideational factors in shaping the coherence of trade and nutrition policy. These included: (i) the low salience of nutrition as a trade policy issue and on government agendas in Australia and among its trading partners; (ii) the primacy of a ‘productivist’ ideational paradigm emphasising the ideas of market freedom (i.e. limited regulation and constraints on business), market access and economic growth to the exclusion of non-productivist ideas and, in this context, the importance of using economic arguments to raise priority for nutrition in trade policy; (iii) that existing institutional spaces and trade policy-making processes limit the development of ‘coordinative discourses’ for trade and health policy coherence, and are therefore likely to exclude nutrition from consideration in trade policy; and (iv) the complexity of trade–nutrition linkages impedes the development of effective ‘communicative discourse’ for engaging the wider public and, through the public, politicians.
Nutrition has low salience as a trade policy issue
Health and consumer advocates, academics and some policy makers acknowledged that trade has important implications for nutrition. Key substantive issues identified by informants as ‘within scope’ included food labelling (front-of-pack nutrition, country-of-origin, GM food and palm oil labelling), infant formula regulation, folate and iodine fortification of imported foods, intellectual property and trademark protection, and the cross-cutting issues of investor state dispute settlement, regulatory chill and protecting regulatory space for nutrition.
The work of FSANZ (the statutory authority responsible for developing food standards for Australia and New Zealand) in relation to trade was seen as a ‘high priority’, particularly given the expanding globalisation of food supply chains, increased food imports and the implications for food safety and public health. This work mostly concerned Australia’s compliance with and contributions to Codex Alimentarius processes (i.e. the UN food standards setting body) and other international food standards (including the avoidance of technical barriers to trade), ensuring food safety and, in a small number of cases, public health (e.g. the fortification of imported bread with folate).
Despite these acknowledgements, almost all informants considered public health nutrition to have low salience as a substantive trade policy issue. For example, as one federal public servant commented:
‘[I]t’s quite interesting, there have been other measures that we’ve looked at from a public health perspective. But not nutrition; I haven’t come across that one.’
One academic described ‘food security and nutrition and hunger and obesity at best as a shadow’ in trade policy debates.
One rationale proposed by some informants for why nutrition has low salience in trade policy was its low priority in government policy agendas in Australia and among the governments of its major trading partners in general. Some informants reflected on this point in comparison with tobacco control, which had (as a high priority political issue) received considerable attention in trade policy. For example:
‘In terms of tobacco versus nutrition, there is still quite a wide gap in terms of [their respective] stages … Yes, we know certain foods are harmful. Yes, there are certain marketing practices that are quite similar … But in terms of international support and consensus on how those issues should be addressed, it’s much more limited.’ (Federal public servant)
Another rationale was that civil society groups with interests in public health nutrition had, to date, been largely absent from trade policy debates. This was contrasted with the more visible advocacy on tobacco control, medicines and GM foods in trade policy. As one academic informant commented, for example:
‘Those concerned about nutrition have been missing in action. Even if you fixed up the processes you would need the advocates in that area to develop much greater expertise.’
In contrast to the limited consideration of nutrition in trade policy, it was recognised by informants from all sectors that Australia’s obligations under international trade rules frequently impacted directly or indirectly on food and nutrition standards setting. Issues ‘within scope’ included the anticipated impacts of any new regulation on export opportunities and the international competitiveness of Australian producers, the potential for so-called ‘retaliatory measures’ taken in major export country markets and the potential for new regulations to act as technical barriers to trade. As one federal public servant reflected, for example:
‘Any sort of regulation on the Australian food producers around standards, there will always be a trade argument, either positive or negative.’
Another important rationale for why nutrition had low salience in trade policy is the perceived lack of international consensus and limited evidence base demonstrating the linkages between poor diet and health, and between trade and nutrition. This was emphasised in comparison with tobacco. As one federal public servant commented, for example:
‘One of the key things … in tobacco control is that evidentiary underpinning [which] you need to form the basis for public policy making and then to successfully defend against any attack in the WTO [World Trade Organization] … It needs to stand up to international scrutiny, so all of the evidence is peer reviewed, and has also been endorsed by the WHO as well as a number of very authoritative bodies … so an international scientific consensus.’
The dominance of a ‘productivist’ policy paradigm
Informants from all sectors acknowledged that a ‘productivist’ policy paradigm dominates within both the Australian food and trade sectors, one that emphasises market growth, food production for export and market deregulation; that free trade is unquestionably a ‘good’ and that promoting market access for Australian exporters is the primary objective. For example, one food advocate commented:
‘It’s a kind of a bit of a constant in Federal Government policy. It’s almost like a given that free trade is a good. It’s an ideology, and the only real question is how can we expand and how can we have more of it.’
One consumer advocate elaborated further:
‘With trade policy makers, it’s really hard to get their interest with anything other than an argument about the export benefits for Australian businesses … that seems to be the only thing that will capture their attention.’
Some informants saw this paradigm as largely reflecting and as reinforcing the interests and power of ‘Big Food’ companies and as an ideological feature of capitalism in its present ‘neoliberal’ form. For example, one food advocate commented:
‘Market fundamentalism is not a bad description of it. Neoliberalism, yes … More fundamentally, it’s part of the workings out of capitalism in its current … stage of development, which has a constant need for expansion and quantitative growth … It’s a clear example of how national governments participating in … free trade processes are very much working closely with corporate lobbies to support their expansion.’
The implications for coherence between trade and social objectives, including public health, were apparent to several informants. Some consumer and health advocates, for example, viewed the ‘productivist’ paradigm as a barrier to the consideration of social and environmental objectives in food and trade policy. For example, one consumer advocated commented:
‘We want [trade] to pay attention to issues like human rights … and environmental sustainability. However, that is still a relatively novel idea, because the classic approach has been … about reducing trade barriers and that is it.’
Some viewed the ‘productivist’ paradigm’s emphasis on market freedom and deregulation as a barrier to achieving new food regulations. This is because the paradigm tends to reinforce the ideas that regulation imposes a cost of doing business and that this further reduces the competitiveness of Australian businesses in international markets. For example, one federal public servant reflected:
‘A key issue, and this came up in [recent food regulation dialogues], is the cost implications of any food and nutrition regulation that we do for the Australian public health benefit and whether that disadvantages Australian producers.’
In the context of this dominant ‘productivist’ paradigm, economic arguments for the consideration of social objectives in trade policy, particularly quantitative evidence demonstrating economic costs and benefits, were seen as having the most influence with Australian decision makers. For example, as one federal public servant described it:
‘[I]f you want to promote any policy position, the strongest argument that you can present to support that is to actually demonstrate the economic benefits and the economic detriment of not doing it.’
Other informants also offered some nuance on this point. For example, another public servant suggested:
‘[Economic evidence] is most compelling … Can we show that positive nutrition policies mean more employment than poor ones? That’s very powerful. If positive nutrition policies are more economically advantageous than negative ones.’
Process barriers to achieving a coordinative discourse for policy coherence
There were strongly contrasting views among informants regarding the opportunities, structures and processes for developing a ‘coordinative discourse’ on the social (and other) implications of trade policy. On the one hand, trade policy makers and some industry representatives were of the view that existing consultation processes – both internal consultations between government departments and external consultations with interest groups – allowed for the consideration of diverse views and inputs prior to and during any negotiating process. For example, as one public servant outlined:
‘Usually there will be interdepartmental committee meetings where issues are put on the table. DFAT will then produce [a] Cabinet submission and circulate among departments … That will then go to Cabinet [who] will produce a negotiating mandate. Then [there are] stakeholder consultations. So certainly, yes … a very high level of consultation.’
On the other hand, civil society representatives, academics and some other industry informants reported a different experience, describing limited opportunities for consultation and then only prior to the negotiation of individual trade agreements rather than on Australia’s overarching approach to trade policy. For example, one consumer advocate voiced their concern on this point:
‘There’s very little transparency … about what might be the issues that are under discussion in a particular agreement. The [only] sources you have are ministerial statements and media releases which are very, very high level … or there are leaks, and that’s about it.’
Another reflected:
‘We’ve been asked to raise concerns about the specific wording of sections while not having access to those documents in any way. So effectively they’re asking us to imagine what might be in the text.’
Some also reported on the limited opportunity for Parliament to consider the social implications of new trade agreements and the inclusion of non-trade objectives in trade negotiations. In this regard, Parliament essentially functioned as a ‘rubber stamp’ for ratifying trade agreements once negotiated, rather than as a platform for public scrutiny and debate. As one public servant articulated, for example:
‘On some issues there’ll be Select Committee inquiries and of course the Joint Standing Committee on Treaties … but that’s essentially rubber-stamping what’s already been done rather than setting policy per se; it’s after the event.’
At a more paradigmatic level, some commented that existing consultation processes related only to the negotiation of specific agreements, and not to Australia’s overall trade policy. Thus, there was no overarching process for civil society groups to provide input into trade policy, nor for wider public deliberation and debate about synergies and trade-offs between trade and social objectives. For example, as one consumer advocate highlighted:
‘There’s this gap around what Australia’s overall trade policy is because what you actually get is Australia’s trade policy being established through a series of agreements … I’m not aware of any process through which there’s a dialogue led by DFAT or the Minister about Australia’s [overall approach]. This is part of the problem … we’ve only ever had the opportunity to have a dialogue about something like the TPP [Trans-Pacific Partnership].’
Issue complexity impedes a strong communicative discourse
Several informants also commented on the significant challenges involved with developing a ‘communicative discourse’ on trade, nutrition and health in relation to the complexity of the issue (i.e. the ease with which the issue could be communicated to wider public and political audiences). This was contrasted with communicative discourses on the implications of trade policy for ‘simpler’ health issues like pharmaceuticals, the impact of which consumers experienced directly (and financially). For example, a consumer advocate reflected:
‘It was harder to motivate consumers based on [food labelling] arguments because … it required a few steps of thinking. Whereas if you compare that to pharmaceuticals it felt much more immediate. Consumers could see very quickly how medicine prices might go up.’
Acknowledging this complexity, some commented on the power of using simplified ‘economic cost’ arguments in communicative discourses. For example, one consumer advocate informant reflected on the power of this argument for communicating the implications for the cost of medicines:
‘When it comes to engaging the broader public and via public sentiment, politicians, I think that the most powerful arguments are those that affect day-to-day expenses or behaviours of consumers. Of all the arguments we’ve raised … the most powerful was … on the price and availability of medicines.’
Opportunities for enhancing discourses involving trade and non-trade actors
Several informants offered suggestions for modifying trade negotiations and policy-making processes to enhance coherence between trade and non-trade sectors. These related primarily to: (i) making trade agreement negotiation processes more transparent and participatory (e.g. having stakeholder consultation processes throughout negotiations rather than only prior to them); (ii) empowering Parliament, including parliamentary committees, to better engage with the potential content of trade agreements (rather than acting simply as a ‘rubber stamp’); and (iii) developing an overarching Australian trade policy through a participatory process (in contrast to the existing ‘piecemeal’ approach of considering singular trade agreements in isolation).
Discussion
The present research identifies a number of significant ‘ideational’ challenges and opportunities for increasing coherence between trade and public health nutrition policy objectives.
First, ideas about public health nutrition are not salient within the trade policy arena in large part because it is not a domestic political priority in Australia nor among its trading partners. This stands in contrast to the issues of tobacco control and access to medicines. The absence of ideas concerning nutrition in trade policy at least partially stems from the limited presence of interest groups advocating for public health nutrition in the trade sector specifically, but also in Australia’s domestic policy context more generally. Mobilising advocacy groups to frame nutrition as a trade policy issue, and ensuring those groups participate in trade policy-making processes, presents an opportunity for raising awareness about nutrition in trade policy going forward. Such actions can be guided by the emerging evidence base on the determinants of political commitment for nutrition and advocacy strategies for influencing government policies(Reference Baker, Hawkes and Wingrove11, Reference Cullerton, Donnet and Lee38). Another important reason why nutrition is of low salience (especially in comparison with tobacco) is the perception of limited international consensus on the strength of evidence linking dietary change with health outcomes, and trade liberalisation with nutrition. Robust evidence of this nature is imperative to withstanding challenges existing under the World Trade Organization, and other trade policy dispute settlement mechanisms, and is therefore essential to making nutrition salient in trade policy. This suggests that more effort is required to generate an evidence base, develop an international consensus on the strength of that evidence, and communicate it effectively.
Second, a ‘productivist’ orientation to food and trade policy strongly emphasises the objectives of achieving market access for Australian food exporters, agricultural market growth, and preventing the adoption of new regulations that impose costs on business or that act as technical barriers to trade. This paradigm – which appears to be strongly institutionalised in Australia and embedded within a deeper ‘neoliberal’ orientation to policy – may be an important barrier to achieving the consideration of social objectives in trade policy. Prior studies on the development of agricultural and nutrition policies reveal similar findings that productivist and neoliberal ideologies strongly orientate responses in Australia(Reference Baker, Gill and Friel14, Reference Carey, Krumholz and Duignan15) and are impediments to achieving political priority for nutrition in several other countries(Reference Baker, Hawkes and Wingrove11). As demonstrated in another study, this paradigm is also reflected in the food industry’s framing of the benefits of trade liberalisation: that it is always a ‘good’ that results in more exports and investment, which in turn raises living standards and benefits the economy and country as a whole(Reference Friel, Ponnamperuma and Schram39). In this context, economic evidence demonstrating the ‘dollars and cents’ impacts of nutrition, and of the economic cost implications of trade liberalisation for nutrition, is likely to resonate most strongly with policy makers. This is consistent with a former Australian study finding that health ministers and other policy makers are most likely to listen when they are ‘given the numbers’(Reference Baum, Laris and Fisher40).
Third, there appears to be a significant lack of agreement – between the views of traditional trade policy actors (i.e. DFAT and large agribusinesses) and of civil society groups and academics concerned about the social impacts of trade policy – regarding the efficacy of existing stakeholder consultation processes during trade negotiations and policy-making processes. The majority of informants from all sectors believed that greater transparency in trade negotiation processes, and more stakeholder consultation during them (rather than only at the beginning), is urgently needed to enhance civil society input into trade negotiations. Many also reflected on the need for a wider and more participatory approach to trade policy making in Australia that goes well beyond the existing one of negotiating individual agreements with Parliament providing a ‘final approval’ once negotiated. This suggests that there are currently procedural and institutional impediments to achieving a ‘coordinative discourse’ among the different actor groups in trade policy. Public health nutrition objectives may, therefore, remain peripheral to trade policy until this changes. Reforms might include the empowerment of Parliament to scrutinise agreements during negotiation, as well as the development of an overarching Australian ‘trade policy’ through a participatory process with meaningful engagement of all interested stakeholders.
Fourth, the complexity of the linkages between nutrition and trade makes it difficult for advocates to develop a ‘communicative discourse’ that appeals to the wider public and, through the public, political leaders. Advocates have been more likely to advocate (i.e. frame and promote) simpler issues that people ‘get’ and that have clear tangible impacts on people’s everyday lives. This is clearly the case for medicines, as highlighting the implications of trade agreements for medicine prices through Australia’s Pharmaceutical Benefits scheme has resonated with public and political audiences. This suggests that public health advocates may be more effective in generating priority for nutrition in trade policy by developing simple frames easily understood by public audiences and that bring into focus the immediate impacts of trade agreements for the food choices of everyday consumers. These results are consistent with the emphasis given to ‘strategic communication’, in the political economy of nutrition literature, as an important determinant of political priority for nutrition(Reference Baker, Hawkes and Wingrove11). This literature further emphasises the importance of tailoring messages to target audiences, investing in relationship building or using ‘policy champions’ with direct access to decision makers to convey messages, and advocating for realistic policy changes in line with policy makers’ preferences(Reference Baker, Hawkes and Wingrove11, Reference Cullerton, Donnet and Lee38).
The current analysis has several limitations. The single case study design makes generalisations from the research difficult and what applies in Australia may not apply elsewhere. The ideational factors that most affect policy coherence are also underdetermined. These are general limitations of the single case study design and the current analysis should be interpreted with this in mind. Comparative case study designs, ideally contrasting multiple jurisdictions and/or issues (e.g. alcohol, tobacco), may address such limitations in future.
Conclusion
The present research demonstrates that ideational factors – including the frames used by policy actors and a deeper productivist policy paradigm and neoliberal ideology in which these frames are embedded – are important to consider in relation to improving policy coherence for trade, nutrition and public health. It reveals a number of key ideational challenges and opportunities for achieving this coherence. Moving towards coherence will likely involve ‘norm promotion’ by nutrition advocates through active engagement in trade policy-making processes, building a stronger evidence base linking trade with nutrition, and wider efforts to raise the salience of nutrition in public discourse and to make it a domestic policy priority. In the context of a dominant ‘productivist’ policy paradigm and ‘neoliberal’ ideology, drawing upon economic evidence to demonstrate the ‘dollars and cents’ impacts of trade on nutrition, health and the economy may likely be most influential in promoting the consideration of nutrition in trade policy. Framing the inter-linkages between trade and nutrition in simplistic, easy-to-understand messages may be imperative to raising the profile of the issue with public and political audiences. Finally, existing trade negotiation and policy-making processes, which lack transparency and meaningful engagement with non-trade stakeholders, may act as an impediment to achieving this. Reforming these processes may create new opportunities for advancing trade and nutrition coherence in future.
Acknowledgements
Acknowledgements: The reviewers are kindly thanked for their helpful comments. Financial support: P.B. was supported by an Alfred Deakin Post-Doctoral Research Fellowship from Deakin University. This project was supported by funding from an Australian Research Council Discovery Project, ‘Trade policy: Maximising benefits for nutrition, food security, human health, and the economy’ (DP130101478). The funders had no role in the design, analysis or writing of this article. Conflict of interest:None. Authorship: All authors conceived the study and provided input into the study design. P.B. conducted key informant interviews, analysed the data and prepared the initial manuscript draft. All authors provided input into ongoing iterations of the manuscript and approved the final version. Ethics of human subject participation: This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the Australian National University Human Research Ethics Committee. Written or verbal informed consent was obtained from all participants. Verbal consent was witnessed and formally recorded.
