Public policies addressing unhealthy diets in the South-East Asia region: identifying and countering the arguments that undermine policy implementation

In South-East Asia, government implementation of policies recommended for addressing unhealthy diets has generally been slow and fragmented, largely due to food industry opposition and a lack of effective cross-sectoral policy action. To help government policy-makers and other interest-holders address these issues, this study aimed to identify key arguments that undermine implementation of policies for addressing unhealthy diets in the region, and to propose a set of counter-strategies. We conducted semi-structured interviews with 15 interest-holders based in India, Indonesia, Sri Lanka, and Thailand, and performed a scoping review of diverse literature. Data analysis was guided by the 'Policy Dystopia Model', initially used to study the corporate political activity of the tobacco industry. Identified arguments were categorized into six themes: (i) questioning the policy design and development process; (ii) misrepresenting or distorting the supporting evidence, and/or presenting counter evidence; (iii) exaggerating and/or fabricating unintended consequences for health and equity; (iv) raising concerns about effects on the economy; (v) querying the policy's compatibility with trade and investment agreements and national laws; and (vi) raising concerns about restrictions on personal 'freedom'. To help counter these arguments, along with key material and structural factors that may increase their salience, we proposed the following set of counter-strategies: (i) develop a communication strategy to counter opposing arguments; (ii) implement governance measures to mitigate corporate influence on public health policy, research, and practice; (iii) implement governance measures to enable effective health-promoting intersectoral and interdepartmental coordination; and (iv) strengthen research, advocacy, and capacity-building on the determinants of health. Successful implementation of these counter-strategies will require extensive organization and collaboration among diverse interest-holders in South-East Asia and beyond.