The emergence of political attention to obesity and factors generating support for policy intervention : an international and national case study analysis

Abstract

At the turn of the 21st century obesity began to receive significant political attention at both international and nation levels. Yet political support for obesity prevention policies has been hampered by multiple challenges. The issue is both technically complex and politically cacophonous with interventions required across multiple policy sectors, involving powerful actors. Recognizing these challenges, this thesis explores why and how political attention emerged. It seeks answers to the following questions: What has generated political attention to obesity? What factors have generated political support for, or opposition to, obesity prevention policies? It offers suggestions as to how political support can be maintained and extended. It also aims to contribute answers to the broader question - how do health issues come to receive political attention? A case-study design and causal process tracing method were employed. A first case explores the ascendance of obesity onto the agenda of an intergovernmental organization - the World Health Organization (WHO). A second onto the agenda of a national government - the Commonwealth Government of Australia (CGA). This involved a two-step analytical process. First, a detailed historical account of each case was developed. Second, a thematic analysis identified and elaborated on the causal factors and mechanisms determining political support and opposition. A theoretical framework was adapted to organize the analysis. This was comprised of four dimensions - the power of actors, the power of the ideas they deployed, the political context, and issue characteristics. Several factors have generated political support at the international level - the emergence of an expert community; the injustice of childhood obesity as a powerful idea deployed by advocates; the WHO as a supportive institutional platform; the issues emergence onto multiple member-state agendas; and, the emergence of a broader non-communicable disease and tobacco control agenda. Several factors have inhibited political support - the power of the transnational sugar, food and beverage industries; a lack of cohesion within the policy community; and, contests over evidence. Several factors have generated political support at the national level - a concern with childhood obesity by state governments was the initial trigger for ascendance onto the CGA agenda; the injustice of childhood obesity and marketing to children, a 'food is like tobacco' metaphor and an economic rationale were important ideas deployed by advocates. Several factors have generated opposition - the power of the food, beverage and advertising industries; an unsupportive institutional platform within Government; the deferment of decision-making on politically risky issues; and, contests over evidence. In both cases, the significant complexity of the issue has made evidence-based policy-making problematic. The implications of the findings are discussed, with reference to relevant political science and public health scholarship. Suggestions are made as to how political support for obesity prevention may be maintained and extended in coming years. Overall, this study is the first to document the ascendance of obesity onto the agenda of the WHO and CGA. It adds to a growing literature on the factors that explain political support and opposition for obesity prevention policies and public health issues more broadly.