The policy-making process for trans fat and sodium reduction strategies in Canada: exploring stakeholder influence through a decade of voluntary agreements with the food industry.

Given the high consumption of trans fats and sodium in Canada, and the related impact on noncommunicable diseases, the Government of Canada appointed multi-disciplinary stakeholder expert advisory groups to recommend actions to reduce trans fat and sodium consumption across the country. The advisory groups based their recommendations on the international evidence, which indicates that the most effective ways to reduce trans fats and sodium consumption are via mandatory policy measures. Yet the Government of Canada did not adopt the recommendations but rather implemented voluntary agreements with the food industry. Intakes among Canadians remained higher than the recommended levels. Between the early 2000s and the mid-2010s, public health groups made numerous unsuccessful attempts to influence the government and secure formal regulation of these two harmful ingredients. This is a study of how stakeholder interests, dynamics and contextual factors shaped the trans fat and sodium reduction policy processes in Canada, from 2004 – 2014. The research comprised three complementary sub-studies to investigate how stakeholders operated within the policy subsystem: 1) a lobby registry analysis, 2) a media analysis and 3) interviews with key stakeholders and document review. Using the Advocacy Coalition Framework as the guiding framework for analysis, this research sets out to shed light on how stakeholders influenced both the trans fat and sodium reduction policy processes in Canada. The findings depict a complex policy making process where the food industry and health community vied for influence on government decision making. The lobby analysis demonstrates that the food industry had far greater access (both in terms of frequency of communications with the government and access to higher government officials) compared to the health community. This finding was triangulated by the stakeholder interviews which reaffirmed that the food industry worked ‘behind the scenes’, via lobbying efforts, to block government regulation. The study also highlights the divide within the health community related to scientific evidence on sodium; this contributed to hindering policy progress, fracturing the health stakeholder coalition and also creating confusion within the media, which may have resulted in less public pressure on the government for action on the issue. Understanding the policy processes retrospectively can aid public health advocates in influencing future policy initiatives and be more attuned to the impacts of food industry interference in public policy making.