Article Text

Original research
How commercial actors used different types of power to influence policy on restricting food marketing: a qualitative study with policy actors in Thailand
  1. Sirinya Phulkerd1,
  2. Jeff Collin2,
  3. Yandisa Ngqangashe3,
  4. Anne Marie Thow4,
  5. Ashley Schram3,
  6. Carmen Huckel Schneider4,
  7. Sharon Friel3
  1. 1Institute for Population and Social Research, Mahidol University, Salaya, Thailand
  2. 2Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
  3. 3Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
  4. 4Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Sirinya Phulkerd; sirinya.phu{at}mahidol.ac.th

Abstract

Objectives There is limited research focused explicitly on understanding how commercial actors use different forms of power to influence policy decision making in Thailand. This study aimed to identify how the food industry has used structural, instrumental and discursive power to influence policy on restricting food marketing in Thailand.

Study design Qualitative study using in-depth semistructured interviews

Settings Thailand.

Participants The interviews were conducted with 20 participants (of a total of 29 invited actors) from government, civil society, technical experts, international organisation and the food and advertising industry. Interview data were identified in the transcripts and analysed using abductive methods.

Results Non-commercial actors perceived the commercial actors’ structural power (its economic influence and structurally privileged position) as central to understanding the government having not implemented policy to restrict food marketing. The commercial actors’ instrumental power was observed through sponsorship, campaign and lobbying activities. Discursive power was used by the industry to shift responsibility away from the food companies and onto their customers, by focusing their messaging on freedom of consumer choice and consumer health literacy.

Conclusions This study examined different types of power that commercial actors were perceived to use to influence policy to restrict food marketing in Thailand. The study showed arguments and institutional processes used to enhance commercial actors’ ability to shape the policy decision for nutrition, public opinion and the broader regulatory environment. The findings help governments and other stakeholders to anticipate industry efforts to counter policy. The findings also suggest the need for governance structures that counter industry power, including comprehensive monitoring and enforcement in policy implementation.

  • health policy
  • nutrition
  • public health

Data availability statement

Data are available on reasonable request.

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STRENGTHS AND LIMITATIONS OF THIS STUDY

  • This qualitative research examined different types of power used by commercial actors in Thailand food marketing policy.

  • In-depth interviews were undertaken with policy actors to explore the use of power by the commercial sector in food marketing policy.

  • Qualitative interview data enabled a deep understanding of the different types of power at play in the policy processes.

  • Some participants may be reticent in disclosing their views and information about this politically contentious topic.

  • The study methods were not designed to establish casual relationships between the commercial sector’s power and impact on policy outcomes.

Introduction

The commercial determinants of health contribute to global health problems such as obesity and non-communicable diseases (NCDs).1 In particular, the food industry uses a variety of strategies and practices to promote the availability, affordability and consumption of products high in fat, sugar and salt,1–6 including ultraprocessed foods (UPFs), which are associated with a range of adverse health outcomes including NCDs.7 8 Corporations’ power and influence have contributed to overturning, silencing or weakening public health policies across diverse jurisdictions.3 9–12

According to Fuchs’ private governance framework,13 corporations influence policy and governance processes through exertion of different types of power, specifically structural, instrumental and discursive. Structural power refers to corporations’ ability to set rules, and reward and punish policy choices by governments, using its position in material structural contexts including public-private partnerships and self-regulation. Instrumental power connotes the influence that corporations may have on policy primarily through lobbying, and campaign and financing political activities. Discursive power refers to the influence that the corporations may have on the use and shaping of ideas surrounding political issues. Fuchs observed that such powers need to be exerted with support from governments and other actors in order for industry to gain and retain legitimacy as a political actor.

There is empirical evidence that food companies do indeed exert their power—directly and indirectly—seeking to influence policy and governance in the food sector. The structural, instrumental and discursive powers of food companies are observed through their lobbying and participating in nutritionally focused public–private partnerships, using economic or market dominance to set policy agenda and rules, and framing issues via public outreach in media and advertising campaign and reporting of corporate social responsibility (CSR).14 In England, food and advertising industry actors were very involved in the policy development process of the London Food Strategy, with regular access to officials through consultation and numerous meetings.15 In the strategy development process, the industry used arguments to oppose the proposal on food advertising restrictions, by emphasising the importance of consumer choice, unanticipated costs to economy and society and denying potential benefits of the restrictions to public health. In Australia, the food and grocery supply industry set its own lower standards for children’s marketing guidelines than those recommended by experts in order to be able to advertise during children’s television viewing times.16

In Thailand, the government has committed to reducing premature NCD deaths by one-third by 2030.17 However, measures to reduce the consumption of unhealthy foods such as UPF have not been fully implemented. For example, a policy to restrict the advertising of unhealthy food and beverage products on radio and television, introduced into legislation in 2008, has not yet been implemented due to institutional reforms brought about by a new government.18 Despite ongoing efforts to support implementation of this policy—the Department of Health has developed a national guideline and a legislative act for food marketing restrictions (currently in the drafting stage)—the government is experiencing significant challenges from the food industry. This policy could have significant impact on the food industry and UPF sales, as food marketing is an important business strategy to reach more people, stimulate demand and increase profits through encouraging consumption of their products.19–21 The broader challenges of Thailand’s political and economic context are reflected in the 20-year National Strategy (2018–2037), which prioritises high-tech food processing and food industry activity and investment22 but does not specify priorities or objectives regarding population nutrition. Since all government agencies are required to comply with the plans that accompany the National Strategy, this may indicate low political priority for nutrition policy.

Food industry strategies and tactics to influence policy in Thailand have been documented finding that constituency building and information and messaging were two most commonly used corporate political activities by food and beverage companies.5 To date, there has been no research that focuses explicitly on understanding the different types of power used by the food industry in Thailand to influence policy decision making and governance to restricting marketing of unhealthy food to children. There remains a need to understand how policy actors perceive corporate influence in policy and governance contexts, especially their access to channels of influence that enable them to exert their power. Such an analysis is required to raise concerns with governments, inform actions to counter corporate power, and to provide a more effective basis for food and nutrition policy and regulation.

In light of the aforementioned gaps, this study aimed to examine perceptions of how commercial actors exert different types to influence nutrition policies intended to restrict marketing of unhealthy foods in Thailand. The results of the study can offer insights into the sources and consequences of commercial actors’ political influence and thereby illuminate opportunities to challenge or diminish this power. This will enable health actors to gain better understanding of the influence of commercial actors, supporting work towards improving food environments and ultimately population health.

Methods

Study design and participants

This study used a qualitative research approach, employing semistructured interviews with key policy actors. The study design is in line with Consolidated criteria for Reporting Qualitative Research guidelines (online supplemental file 1).23 Interviews were conducted with actors involved in Thai policy processes concerning obesity prevention and diet-related NCDs, and with experts with experience and expertise in public health nutrition and food marketing-related areas.

Using a purposive sampling strategy, a list of relevant actors was initially drawn from secondary data sources, including governmental and nongovernmental websites and documents, and internet searches. Snowball sampling via the interviews was used to identify additional relevant actors until the information obtained through the interviews became saturated. Participants were approached via email, mail and telephone. Key individuals (n=29) were invited to participate, and 20 agreed to be interviewed. The face-to-face interviews were performed in a private space in the participants’ place of work or online channel, as preferred by the participants. For the online channel, Zoom was used to collect the interview data due to the following advantages: it is relatively easy to use, it is cost-effective, and it provides data management and security options.24 After confirmation of study participation, each participant received a Zoom invite with a meeting link. A researcher tested video and audio with the participant before an interview to ensure that camera and microphone work properly.

The sample consisted of representatives from governmental organisations-GO (n=7); civil society organisations-CS (n=5); academic/technical experts-TE (n=5); food and advertising industry-FI (n=2) and an international organisation-IO (n=1).

GO: High-level policy-makers such as secretary general, Director, senior expert or equivalent in a department, bureau or division, with direct experience or involvement with policy-making in food, nutrition, food marketing, health or other related field.

CS: Senior-level representatives from CS organisations such as director, president or manager with experience related to food marketing or similar field.

TE: Representatives from university, or affiliated or independent research institutions such as university professors and researchers, who had research experience in food marketing or having been involved actively in policy discussions regarding restrictions on food marketing.

FI: Representatives from food and advertising companies or organisations at the level of director, head or manager in a department, division or group that had been working related to food marketing.

IO: Representatives from intergovernmental organisation such as director or senior advisor who had been involved in working for food marketing advocacy or related work in Thailand.

Data collection

The interviews were undertaken by the research team from May to September 2020, conducted in either Thai or English depending on the preference of the interviewee. The exploratory study allows investigation for research questions in depth; open and closed questions were asked in order to capture each actor’s perception of commercial sector influence on introducing policy to restrict food marketing in Thailand.

Guiding questions (online supplemental file 2) were informed by Fuchs’ framework that offers insights into the influence of corporations through the exertion of different types of power: structural, instrumental and discursive. This framework has been widely used to examine commercial actors’ power in various policy domains including agrifood,25 sustainable consumption26 and food retail,27 and provides a helpful guide for a comprehensive empirical analysis of how different types of power are used by commercial actors, and others in the policy system, to influence food marketing policy in Thailand.

The interview guide questions were pretested to assess instrumentation rigour and address any limitation regarding bias and interview procedures before carrying out the actual interviews. Data saturation was reached with 20 participants.28

The interviews lasted between 45 min and 1.5 hours and were transcribed verbatim. Each interview was conducted with an audiorecording to collect the data with participant’s consent. The transcripts of those interviews conducted in Thai language were translated to English by a professional translator, and double checked by SP. To ensure the privacy of participants, the study anonymised the individual participants in the reporting of the results. Attribution is therefore made by type of organisation and participant number only.

Data analysis

A thematic analysis was performed by SP. A coder reliability checking process was carried out with two independent coders (JC and YN) to analyse and compare the results, and to discuss and resolve any discrepancies.

Data were coded to categories derived from both the theoretical framework and emerging from the data, using Nvivo V.12 software. This was an iterative process of abstraction where words, sentences and paragraphs from the interview transcripts relating to the broad topic of perceptions of commercial sector were identified. The coding allowed for the development of additional codes and themes beyond Fuchs’ framework. The coded data were analysed with reference to the theoretical framework, to identify the use of different types of power. Participant quotations were presented to illustrate the themes and findings, and each quotation was identified with participant sector and number.

Patient and public involvement

Neither patients nor the public were involved in the design, conduct, reporting or dissemination plans for our research.

Results

The three major categories of perceived commercial actors’ power—structural, instrumental and discursive—were identified as being significant.

Structural power

Policy actors perceived that commercial actors were able to convince policy decision-makers not to advance with policy to restrict food marketing through leveraging their economic influence and structurally privileged position. This structural power provided commercial actors with institutional access to raise their concerns with governments and predisposed government actors to be sympathetic to industry perspectives. As one civil actor commented, for example:

I suspect that there are too many vested interests in the government which are linked to the food advertising companies. So, it’s a big challenge. We have hit a wall. It’s not just a matter of corruption or collusion between government and the advertising sector. It’s that there are ingrained vested interests in the way the money moves and how that money also stimulates the economy (CS4).

One TE noted that the structural power of the commercial actors was enhanced by implementation of Thailand’s 20-year National Strategy, which aims to promote technology and innovation to support Thailand’s transformation to a value-based and innovation-driven economy. This also includes gearing up Thailand to become a global food innovation hub and a renowned kitchen of the world which entails the food industry shifting towards higher value-added segments, such as digitalised food services and advanced processed food manufacturing.

One actor from an IO further elaborated the difficulties for food marketing advocacy arising from the industry’s economic dominance, noting the strong relationships and shared interests between commercial actors and government that inhibited prospects for regulation.

when I went to speak to the new director [of the food regulatory agency], I was told, you know, “oh, we have been told that the economy is low, so don't be too strict.” You know, with the, sort of, the rules with the industries. So, I think there may be some, you know, I think the motive is not as clear […] That is, it [regulatory agency] has a little bit of a mixed relationship with the industry although I think they are very powerful, you know, and they should really use the regulatory power (IO1).

Rules or obligations in the international trade system also emerged as important in understanding the structural power of commercial actors. Several government actors and TEs expressed concerns about international trade disputes, in which they had observed prioritising of commercial sector interests. They saw such international commitments as providing a venue for industry to align nutrition-related policies with their interests. Interviewees highlighted how the commercial sector has used the threat of trade disputes to protect its interests, highlighting the need for high levels of access and expertise in engaging with trade issues.

They have to be the people who communicate with multiple factions, even from the industrial side, both at the national and the international level because there are legal issues concerning food trade. They have to be, by role, the people who communicate on this matter. There also needs to be an agreement so that there will not be conflicts in terms of food trade policies or legal issues concerning free trade and such (TE3).

Instrumental power

Strategies perceived as being used by commercial actors to influence nutrition-related policy agendas involve direct and indirect interactions with key policy decision makers. Interviewees identified mechanisms via which commercial actors were seen as retaining control over the policy agenda, including via sponsorship such that a ‘school accepts money from a company (CS3),’ political campaigns whereby ‘they [food retailer] had supported the campaigns of certain politicians who were running for election (CS4),’ and also by lobbying; for example ‘if the government was considering a special tax on functional drinks, we would help lobby the government on that (FI1).’

Interviewees from GO, IOs and CS observed that commercial actors engaged in lobbying activities to pursue their policy goals through formal and informal interactions with bureaucrats.

you know, the health [government] side, they started saying, “oh, this is so difficult for industry to do, and this is difficult for them to” or something like that, you know, like, “we have to give them more time” or “this is more” “this is difficult for the industry to do.” So, something I feel that I heard consistently. The same couple of people who, sort of, uh, you know, make those points in a meeting, and then, the industry gets very, you know, gets its support of someone sitting within [name of food regulatory agency] (IO1).

One commercial actor also confirmed that lobbying is a strategy used to bring pressure to bear on government to influence its policy decision.

If it is an issue that would affect all the producers equally, then we would take up that issue. For example, if the government was considering a special tax on functional drinks, we would help lobby the government on that (FI1).

The following quote from an interview with a government official outlines the value afforded to building working relationships with industry actors to facilitate the linkage of modern food production and processing with consumption to support nutrition policy.

there is an acceptable cooperation in working with the [name of food regulatory agency] or food manufacturers in the private sector because we are not working only on the governmental side. We listen to all stakeholders and come to a consensus that determines what we will do. If it is accomplished only by the governmental sector, had the government aspires to take care of the people to the extreme, the business sector, which is a mechanism to bring in manufacturing and cooking technologies, the facilitators for the consumers in contemporary society, will have problems and obstacles (GO4).

The industry also reportedly engaged with government through participation in formal processes. Several interviewees noted that industry actors participated ‘by invitation’ to discuss and provide input on policy design through ‘committees or task force,’ which are mainly organised by the relevant government authority.

just taxing sugar doesn’t mean people will go sugar-free in their diets. There has to be a comprehensive approach if the goal is reduced sugar consumption. There should be non-tax measures as well. We sat on a task force [for non-tax measures] with the Department of Health of the Ministry of Public Health (FI1).

An interviewee from an IO observed that the industry used such formal participation, enabled by its relationships with government, to advance their interests in the policy process. Strategic use of formal participation supported an emphasis on consensus in policy decision making between industry and government, as well as providing opportunities to enhance alignment with other stakeholders, and thereby shape government’s decision-making.

There are very good turnouts because it [meeting] was led by [name of food regulatory agency] so they do that well I think they have a relationship already combined. So they are able to convene and they are also able to some extent bring about consensus, you know, on a voluntary basis […] the industry, of course, the goals are completely not aligned, you know, because we feel the industry on the table; we've given them a space on the table, and they are, instead of looking at the evidence or the logical evidence that is presented, they come up with their own lies and they try to deviate the process, and they're using the same tactics that the tobacco industry uses and any other industry uses (IO1).

Some academic and CS actors felt that governments created platforms for industry to influence decision-making without broader consultation or involvement of other stakeholders. They observed that the industry builds relationships with senior government officials, and made a personal discussion with the government agency.

But the problem arises with the policy makers, and I wondered if some in the private sector go behind our backs to influence those policy makers or not. […] I do not have any direct evidence of that kind of pressure be applied to the [names of regulatory agencies on food and communication] […] with the [name of communication regulatory agency] (TE1).

An interviewee from the commercial sector described a strategy used to collaborate in order to coordinate and amplify their instrumental influence and thus shape the policy agenda.

A recent example is the news about recycling. Some of our members wanted Thailand to allow use of recycled polypropylene. So, we approached the [food regulatory agency] on this matter. A task force was set up with a representative from the Association participating (FI1).

One CS actor commented that when such instrumental power is used, the public can sometimes be made aware of and respond to the industry’s influence on policy.

when people found out that they [name of food retailer] had supported the campaigns of certain politicians who were running for election. Thai youth were worried about the potential for corruption, and sounded the alarm through social media. Some even started a mass boycott of convenience stores under their management (CS4).

Discursive power

Respondents from all actor groups, except CS, acknowledged that discursive power serves as a strategic pillar of the commercial sector to retain control over the policy agenda. The food industry was perceived as having sought to shift responsibility away from the food companies and onto their customers, by focusing its message about freedom of consumer choice and consumer health literacy.

If the consumer demands a product with less sugar, Industry will certainly respond to meet that demand. […] the population needed to acquire more health literacy so they could make healthy choices themselves (FI1).

Discursive strategies were perceived as being used by the industry, often in formal meetings, to fend off criticism which charges that unhealthy food products are harmful and should be more stringently regulated. One actor from an IO felt that the industry tried to delegitimise, devalue or delay proposed government policies, to dispel concerns about the societal impacts of their products.

They [food industry] have really done everything possible to disrupt and delay and defer. Their tactics are, you know, just have been very very-. They have played more of a disruptive role so far. They have been lip-serviced to the promise they make which were all voluntary. […] The industry just buys the time. They pay lip service, and they don't really do it (IO1).

Such perceived discursive strategies were broadly consistent with the responses of the commercial interviewees. These included advancing an argument that there is no such thing as harmful foods, emphasised the appropriateness of participation in the policy process, focused on the importance of consumer’s food choice and education, and claimed alignment with national policy priorities. One industry representative stated:

Industry is already providing options for consumers to choose the regular formula, one with reduced sugar, and sugar-free beverage. So the choice is there. Now the task is to persuade consumers to make the healthy choice for their own good (FI1).

Another perceived discursive strategy used by the industry to deflect policy change includes criticising the use of policy actions that target specific products, in particular manufactured product categories. The premise of this criticism is often that such policy actions are discriminatory. For example, in relation to the adoption of an excise tax on sugar sweetened beverages:

during the sugar tax debate, we made the argument I described earlier—that just taxing sugar doesn’t mean people will go sugar-free in their diets. […] If we used a supply-side approach and just flooded the market with sugarless drinks that no one wanted to buy, then that wouldn’t help the situation and everyone would lose. […] The government still wants to pressure the supply side instead of focusing on demand (FI1).

The industry was also noted to use discourse in CSR to increase their brand credibility and reputation to public, as well as to enable government to endorse industry as good partners. This was acknowledged by one government actor:

The companies will do CSR. Now, for most of the CSR, they will approach us rather than us approaching them. The CSR unit will work with 3, 4, 5 companies to launch a cooperative CSR. […] They will come to talk with us about what we want, or what we would like to promote, or, what is it called, a win-win situation on both sides. […] There are all kinds, all forms. Sometimes, the provision of resources, in this sense, is not offering money, not money offering, but they just financially invest on schools, such as buying computers and such, for school development (GO6).

Some TEs perceived the industry as having invested in various media platforms to communicate their products to influence consumer choice including “online games” and “lucky draw [buy green tea beverages for a chance to win a prize at a draw]” (TE1). This is consistent with an interview of the commercial actor mentioning that social media brings them opportunity to connect with consumers.

The Internet has huge potential for industry, good and bad. Social media does open up the opportunity for interaction between the consumer and the producer that is fast and efficient, and can occur 24/7 [24 hours a day, 7 days a week] (FI1).

Actors from all groups except commercial actors cited the commercial sector’s research and development or marketing prowess that exerts influence over consumers, the government and governance. Their expertise, notably in marketing techniques, was perceived as having progressed “far beyond” traditional marketing, which makes them ‘a few steps ahead’ of the food marketing policy advocates. One government actor depicted government as lagging behind the commercial sector to the extent that ‘We are still analog, while business is going digital (GO5).’

Another government actor elaborated further how the industry builds its discursive power to influence consumers’ decision making while government actions cannot keep pace with marketing advances in the industry.

When we know they know what we need, what kinds of channels we need, how they approach us, they have been laying traps [upon us]. […] we [government] do not have a marketing genius who can keep up with them that far (GO7).

Alongside the recognition of the commercial actors’ power and points of contention, strategies to develop agreement on a nutrition agenda with industry were discussed. One government actor emphasised the importance of consensus or compromise with industry, including in encouraging change in commercial actors. This included an emphasis on the potential bridging role of evidence in promoting change: ‘If we have the evidence, then industry will cooperate (GO3).’

One CS actor indicated support for UPF as a basis for regulation sitting alongside desire for consensus, by persuading industry to develop healthier products rather than adversarial approach or radical expansion of regulation. Consistent with this, one TE outlined a strong commitment to consensus, and a desire to avoid alienating commercial actors.

If we portray a product as evil, then we will never be able to get cooperation from industry to improve food marketing policy and practices. Thus, in my view—which may seem strange—is that we need to take a holistic approach, and one that uses a positive strategy, for example, which showcases appropriate advertising of food and beverage for children (TE1).

Discussion and conclusions

This paper set out to examine the major types of power that commercial actors were perceived as using to influence the development and implementation of policy to restrict food marketing in Thailand. The foundations for the study correspond to the recommendation of the WHO’s framework for implementing restrictions on the marketing of foods and non-alcoholic beverages stating that governments should “protect the public interest and avoid any conflict of interest.29

There are three key findings from the study. The first concerns key types of power that are perceived to be used by the food industry—structural, instrumental and discursive. The commercial actors in Thailand used structural power, through their economic prowess and use of trade rules and disputes, to control the government policy agenda. This was not surprising as the private sector commonly serves as an engine for growth, especially providing jobs and income.30 The push for economic development in Thailand, in particular via the 20-year National Strategy and international trade liberalisation, was seen by many respondents to have advanced industry’s structural position and power. This gives industry legitimacy as political actors and authority that they can exercise vis-à-vis governments and public, allowing them to determine development of economic-driven governance institutions, as well as the focus and content of policy issues.31 This finding in the Thai context corresponds with the international literature which has shown that food industry structural power has restricted the power of governments to shape food system activities within and outside the country.32 This is similar to that observed in Australia, where food policy placed strong emphasis on export-led industry growth and minimal consideration for nutrition and public health objectives; this lends legitimacy to commercial actors to engage in rule-setting activities, and results in nutrition having limited salience in Australian trade policy.33

The industry was also perceived to use their instrumental power, through sponsorship, campaign and lobbying, to shape the food marketing policy agenda through formal (by invitation) and informal (personal communication) interactions with bureaucrats. This study extends the previous finding that such strategies and practices were employed by the food industry in Thailand to increase influence over government policies.5 Industry’s instrumental power is intertwined with their relationships with important decision-makers in government. Such relationships are often cultivated via public–private partnerships via which industry actors provide technical advice to government while simultaneously emphasising the need to avoid mandatory government regulation, focusing on consumer education and industry self-regulation. While public private partnerships are often criticised for providing more benefits for businesses than public health,34 they are becoming more common in the food sector as documented in previous studies.35 36 In England, the UPF industry endeavoured to gain access to a policy process seeking to prohibiting advertising of products high in fat, sugar and/or salt across Transport for London, involving various strategies such as direct lobbying of policymakers, requesting and attending meetings, and attempts to engage with the Greater London Authority and the associated Child Obesity Taskforce.15

The industry also employed discursive power to present themselves as guardians of consumer interests, serving consumer preference. In their communications, they used language to legitimise their food and beverage products especially UPF as non-harmful commodities even though a positive association between UPF consumption and risk of several health is clearly evident.37 38 Such discursive strategies are amplified by the economic ability of companies to buy media space and time as they are a key source of information for much of the general public.39 For example, industry uses CSR discourse to promote company engagement with societal goals. This finding was not surprising, given that CSR is commonly used as a means for food industry to prevent regulation,40 or to place responsibility for selecting healthy foods onto consumers.41 CSR can be considered as an exercise in discursive power, although rooted in structural power and advanced by instrumental strategies. The industry seeks to use CSR to define a policy agenda centred on voluntarism and consensus approaches, setting limits on the range of choices available to other actors such as government and delineating rules.42 This discursive strategy aligns with evidence in England where food industry invoked ‘responsible advertising’ initiatives to favourably impact their image,15 and evidence from other unhealthy commodity industries such as tobacco and alcohol showing that these industries used CSR to convey the efficiency and effectiveness of their institutions and standards for benefit of public good.43

The second key finding is that the different types of industry power were interrelated and played out in various spaces, lending additional strength to the power of the industry. Gaventa’s powercube helps understand the interaction between types and spaces of power.44 In this study, different types of power were being used in both formal decision-making spaces (government meetings, appointed committee member) and informal spaces (eg, face-to-face meeting). This could lead to the absence of visible contestation over time, and thus may contribute to unconscious acceptance of the status quo. This can ultimately bring challenges to public health advocates to respond to the industry’s strategic or tactical moves. This finding is consistent with previous literature which has shown that transnational UPF corporations exert power through formal and informal spaces to promote policy ‘non-decisions’ on NCDs through international trade regimen.45

The third finding relates to unequal power. Some actors with a health or nutrition focus perceived that they had a lack of power to obtain commitment for a health/nutrition agenda, while non-health government and commercial actors were perceived as exerting a large influence over government policy. Food marketing is characterised by intersectoral working beyond health sector and thus non-health sector governance is crucial for interventions in food marketing to work. Addressing the significant power inequities between different actors requires ‘political empowerment’ whereby individuals and organisations can have greater influence on the decisions that interest or affect them.46

Policy implications

First, nutrition governance must be informed by greater awareness of power processes underlying or mediating actor interdependencies, especially between governments and industry. Second, the government needs good governance structures in place to counter industry power while, at the same time, nurturing equity and inclusivity in food marketing policy. This can lay the groundwork for mitigating power imbalances between different actors, and can ease partners’ acceptance of collaboration decisions that may not align with their interests (especially between health/nutrition actors and economic actors). The promotion of good governance requires comprehensive monitoring and enforcement in policy implementation, entailing the establishment of an independent transparent monitoring system and availability of a complaints handling systems.47 Third, empowering people and organisations by building their capacity to mobilise a wide variety of persuasive strategies for advancing the nutrition agenda is necessary. Key capacity should include socially attuned leadership and negotiation, conflict management skills and strategic communications with varied audiences. Fourth, a multisectoral approach to governance is required. Despite complex processes of the multisectoral approach, this can initially start with multistakeholder knowledge-gathering and knowledge-sharing by inviting experts and key actors to identify major trends, factors or motivations for change and to identify possible solutions in a collaborative approach. Creation of a dialogue with Thai citizens on food marketing issues using new information and communication technologies may also be useful. Lastly, this study only aimed for better understanding on how the commercial actors used their power to influence policy on restricting food marketing in Thailand, yet impact of this power to the policy outcomes. This suggests a need for further research on the impacts of corporate power on implementation of the food marketing restriction, and changes in marketing strategies, food products sold and consumer behaviours.

Limitation

This study has some limitations. There were limited number of commercial actors in this study, reflecting refusal of some invitees to be involved. This may limit viewpoints of those actors and information on corporate actions and strategies used. The findings of the study were also based solely on in-depth interviews with key actors. Use of triangulation could be useful for providing more in-depth understanding of the corporate power, particularly by combining interviews with document review, which is often used in other qualitative studies. This approach can reduce the impact of potential biases that can exist in this single study.48 In addition, this study was unable to establish if the commercial sector’s power had any substantive impacts on policy outcomes. Therefore, further research on analysis of other information sources for the commercial sector’s power and assessment of its impacts on policy outcomes is needed.

Data availability statement

Data are available on reasonable request.

Ethics statements

Patient consent for publication

Ethics approval

The study was reviewed and approved by the Institutional Review Board of the Institute for Population and Social Research of Mahidol University (COA. No. 2019/10-378). Participants gave informed consent to participate in the study before taking part.

Acknowledgments

The authors would like to thank participants for giving their time for interviews, and Mr. Weerapak Samsiripon and Ms. Rungrat Palakai who assisted in the completion of the project’s data collection.

References

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Footnotes

  • Contributors SP was a guarantor who has the full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. JC, YN, AMT, AS, CHS and SF advised on the study design and methods, contributed to developing the analytical framework, supported the analysis and provided significant guidance and editing. SF was a chief investigator responsible for the overall conduct of this research study. All authors read and approved the final manuscript.

  • Funding This work was funded by the Australian Research Council (DP190100576). The ARC had no role in the conduct of this research.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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