Abstracts

Background

Non-communicable diseases (NCDs), the leading cause of mortality globally, could be prevented and controlled by the introduction of public health policies in countries ¹1. World Health Organization. WHO Global Non Communicable Diseases Action Plan 2013-2020. Geneva: World Health Organization; 2013.. In Brazil, there were proposals to restrict marketing of unhealthy foods to children, increase taxation on sugar-sweetened beverages, and implement a nutrition front-of-pack labelling on food products, as a means to limit the increased consumption of ultra-processed foods, a main risk factor for developing NCDs ²2. Monteiro CA, Cannon G. The impact of transnational "big food" companies on the South: a view from Brazil. PLoS Med 2012; 9:e1001252.^,33. Departamento de Análise de Situação de Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde. Strategic action plan to tackle noncommunicable diseases (NCD) in Brazil 2011-2022. Brasília: Ministério da Sáude; 2011. (Série B. Textos Básicos de Saúde).. Brazil is a huge market for such products, with a population of 209 million people ⁴4. World Bank. Country profile. Brazil. https://databank.worldbank.org/views/reports/reportwidget.aspx?Report_Name=CountryProfile&Id=b450fd57&tbar=y&dd=y&inf=n&zm=n (accessed on 05/Mar/2020).
https://databank.worldbank.org/views/rep... , and these policies represent a threat to the sales of the food industry. In the past, food industry actors tried to delay and weaken public health efforts to promote adequate and healthy diets. For example, they lobbied the government against the introduction of restrictions on the marketing of unhealthy products proposed by the Brazilian Health Regulatory Agency (ANVISA) ⁵5. Baird MF. O lobby na regulação da publicidade de alimentos da Agência Nacional de Vigilância Sanitária. Revista de Sociologia e Política 2016; 24:67-91.^,66. Henriques P, Dias PC, Burlandy L. A regulamentação da propaganda de alimentos no Brasil: convergências e conflitos de interesses. Cad Saúde Pública 2014; 30:1219-28.. Instead, food industry actors advocated for the adoption of self-regulation ⁶6. Henriques P, Dias PC, Burlandy L. A regulamentação da propaganda de alimentos no Brasil: convergências e conflitos de interesses. Cad Saúde Pública 2014; 30:1219-28.^,77. Monteiro CA, Gomes FS, Cannon G. The snack attack. Am J Public Health 2010; 100:975-81..

These attempts to influence public health policies are referred to as “corporate political activity” (CPA) in the literature ⁸8. Hillman AJ, Keim GD, Schuler D. Corporate political activity: a review and research agenda. J Manage 2004; 30:837-57.^,99. Ulucanlar S, Fooks GJ, Gilmore AB. The policy dystopia model: an interpretive analysis of tobacco industry political activity. PLoS Med 2016; 13:e1002125. and, for the food industry, they comprise five strategies ¹⁰10. Mialon M, Julia C, Hercberg S. The policy dystopia model adapted to the food industry: the example of the Nutri-Score saga in France. World Nutr 2018; 9:109-20.: coalition management; information management; direct involvement and influence on policy; legal strategies; and discursive strategies (Box 1).

Identifying these strategies is a crucial step for informing government officials, public health professionals, and other stakeholders about the negative influence that the industry could exert within the countries. With no existing comprehensive mapping of the different CPA strategies of the food industry in Brazil, this study aimed to identify these political practices.

Methods

Data collection and analysis were carried between October 2018 and January 2019. Data analysis was revised in January/February 2020. A document analysis, triangulated with interviews, was conducted. It is important to note that, while the document analysis had a specific timeframe for the publication of the material collected, our interviewees discussed information that could have occurred at any time in their careers.

INFORMAS analysis

We used the research protocol of INFORMAS (International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support. https://www.informas.org/) for identifying the CPA of the food industry in Brazil, using publicly available information (i.e.: step 3 of the private sector module of INFORMAS) ¹¹11. Mialon M, Swinburn B, Sacks G. A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available information. Obes Rev 2015; 16:519-30.. Key actors in the food industry in Brazil were identified by an existing pilot study on the CPA of the food industry in Latin America ¹²12. Mialon M, Gomes FS. Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean. Public Health Nutr 2019; 22:1898-908., and consultation with public health nutrition experts in the country. Members of the International Food and Beverage Alliance, comprising the largest global industry actors in terms of market shares, were included. Trade associations and two groups funded by the food industry were also included. These included: Coca-Cola; Danone; Ferrero; General Mills; Grupo Bimbo; Kellogg’s; Mars; McDonald’s; Mondelez; Nestlé; PepsiCo; Unilever; the Brazilian Association of Soft Drinks and Non-Alcoholic Beverages Industries (ABIR); the Brazilian Association of Food Industries (ABIA); the Brazilian office of the International Life Science Institute (ILSI); and the Brazilian Information Council (BRAFIC).

A list of sources of information consulted for this study is presented in Supplementary Material (S1. http://cadernos.ensp.fiocruz.br/static//arquivo/suppl-e00085220-s1_3637.pdf).

The searches were restricted to the federal level and to information published on these websites between January 1 and December 31, 2018, based on the information obtained by an existing pilot study ¹²12. Mialon M, Gomes FS. Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean. Public Health Nutr 2019; 22:1898-908.. Duplicate information within and across different sources of information were only collected once. Data is available in the Supplementary Material (S2. http://cadernos.ensp.fiocruz.br/static//arquivo/suppl-e00085220-s2_5153.pdf).

Interviews

The first author conducted semi-structured interviews with eighteen individuals, including one group interview with two individuals, and a follow-up interview. A former member of the food industry (n = 1) was interviewed, as well as individuals from: the executive branch of the government (n = 5), the legislative branch of the government (n = 3), civil society (n = 4), academia (n = 4), and the media (n = 1). Sampling was purposive (n = 9), and potential interviewees were identified by their public statements on the role of the political practices of the food industry in Brazil and abroad, and were first contacted by email. The snowball sampling method was also used to recruit participants (n = 9). One individual declined to participate due to time constraints, and two individuals indicated someone else who could be interviewed instead of them. Given the sensitivity of our topic and the existing treats faced by other researchers and civil society organizations who denounce the practices of the food industry in Brazil and Latin America, we decided not to approach industry actors for our study.

On the day of the interview, participants signed a consent form, in which they agreed on the digital recording of the interview, and were offered the option to review their transcript. All interviews were conducted face-to-face, at a place selected by the participants, and lasted one hour on average. Restrictions were not placed on the industry actors for which the CPA strategies were discussed, or on the timeframe during which these CPA strategies were used. The interviews were conducted until data saturation was reached. The digital recordings of the interviews were transcribed verbatim by contracted professionals.

Data analysis

For the analysis of both publicly available information and the interviews, a deductive approach to data analysis was used, where the first author identified relevant information on the websites cited above, and in interviews, using an existing framework for classifying the CPA practices outlined in Box 1. All data were in Portuguese or English and were managed on Microsoft Word and Excel (https://products.office.com/). The second author reviewed 10% of the coding and agreement was reached after discussion between the authors (but not measured). The codebook presented in Box 1 was refined, in an iterative process, during data analysis, as indicated in italic in the box.

Reporting

Illustrative examples were used, comprising text from the analyzed documents and quotations from interview participants, presented in our results section. A code starting with the letter A links to specific examples from the document analysis (Supplementary Material. S2. http://cadernos.ensp.fiocruz.br/static//arquivo/suppl-e00085220-s2_5153.pdf). Interview quotations were translated, when necessary, from Portuguese to English, by the first author. All information that could identify our interviewees was removed from their transcripts and feminine pronouns were used when quoting them. Text within brackets in quotations is our addition, for clarification, when necessary. Reporting on the specific influence of the industry on the front-of-pack labelling policy is the subject of a separate manuscript. This study was approved by the ethics committee of the School of Public Health of the University of São Paulo, Brazil (project number 07944118.7.0000.5421).

Results

We found 304 examples of CPA practices used by the food industry in Brazil with the INFORMAS protocol: 194 examples of instrumental strategies and 113 examples of discursive strategies (these categories are not mutually exclusive). Some of these examples were also discussed by our interviewees, and they also shared additional examples. In terms of industry actors, most examples in publicly available information were found for Coca-Cola (n = 58), a company that was also regularly cited by our interviewees, as well as Nestlé and McDonald’s, which may mean that they are the most active actors in terms of CPA, or/and have more resources than other actors to use CPA practices. However, no conclusions should be drawn here because it may also mean that other actors are not transparent in their use of CPA, and not necessarily that they are not using these practices.

Box 2 shows a specific case study of the local branch of the ILSI, using the CPA framework as a guiding thread. ILSI has been recently criticized at the global level because it claimed to be an independent research institute, while serving the interests of its funders - large food transnationals - rather than public health interests ¹³13. Steele S, Ruskin G, Sarcevic L, McKee M, Stuckler D. Are industry-funded charities promoting "advocacy-led studies" or "evidence-based science"?: a case study of the International Life Sciences Institute. Global Health 2019; 15:36.^,1414. Corporate Europe Observatory. The International Life Science Institute, a corporate lobby group. Brussels: Corporate Europe Observatory; 2012.^,1515. Greenhalgh S. Soda industry influence on obesity science and policy in China. J Public Health Policy 2019; 40:5-16.. ILSI Brazil is supported by Coca-Cola (A97), Danone (A162), General Mills (A165), and Kellogg’s (A180), amongst others.

Coalition management

By the coalition management strategy, actors from the food industry try to build relationships with third parties, such as health organizations, communities, and the media. On some occasions, food industry actors also try to intimidate their opponents. We found evidence of these practices in Brazil, as described below.

Interactions with third parties

We found examples of the involvement of food industry actors in different health (and other) initiatives across the country (Box 3).

In Brazil, food industry actors supported artistic events, nutrition education, physical activity initiatives, and the prevention of cancer in children. We found many details of the activities of the Ronald McDonald Institute. A medical doctor, for instance, stated that the Institute “played a key role in the development of pediatric oncology in Brazil and is today the main funding agency for the development of this specialty in the country” (A200). The institute organized several events, on an annual basis, such as a gala with key opinion leaders, and the McHappy Day (McDia Feliz), in which the funds generated by the sales of burgers were raised for community initiatives, in partnership with the José Alencar Gomes da Silva Brazilian National Cancer Institute (INCA). Food manufacturers also donated some of their products. One participant described an instance where food that was not considered good enough (but safe) for consumption was sold to municipalities in Brazil, to be used to feed “those who don’t have anything to eat”, because “it costs more to dispose of them correctly than to give them away” (interview, former staff from the food industry).

Besides these interactions with communities and health organizations, a participant noted that the media is connected to the food industry by the revenues generated with the advertisement of food products in newspapers, for example (interview, member of the government). In addition, a former employee from the food industry explained that the marketing departments of food companies (and other industries) sometimes invite journalists to their headquarters to discuss their personal experience, to build relationships with these third parties: “these are journalists who work for the main media companies in Brazil, so you create these channels of dialogue that you use later, for sure” (interview, former staff from the food industry). Our interviewees noted that it could be difficult for public health professionals to get information about the healthiness of food products published in national newspapers, perhaps because of these relations between the industry and the media (interview, member of the government).

Fragmentation and destabilization of the opposition

We found instances where food industry actors discredited public health professionals, as they were seen as opponents to the food industry and/or its products. Two of our interviewees, working in public health, told us that these threats and intimidations were successful at silencing them.

“I remember the threats [to a high ranking oficial], and they always make [that person understand that] they could get her fired from the Brazilian Ministry of Health” (interview, member of the government).

Information management

The food industry in Brazil also influenced the science and information disseminated about nutrition. In particular, food industry actors amplified information that was beneficial to their products, or that was giving a better image to their companies. Several food industry actors took part in scientific events across the country. The Nestlé Nutrition Institute sponsored pediatric congresses in Brazil (A266-7). McDonald’s, through its institute and in partnership with the Brazilian Ministry of Health, organized a forum on public policies for pediatric oncology (A217). The fast-food restaurant also sponsored, participated, and presented information in other scientific events on that topic, in Brazil and abroad (A217). Mondelez and Nestlé were part of the XXII Brazilian Congress of Nutrition (A236, A268).

Moreover, food industry actors developed education initiatives in Brazil, particularly those targeting children in schools. Nestlé has two nutrition and physical activity programs (A254, A256, A262-4), including one that has been running for more than twenty years in the country (A262). Unilever has another nutrition program, in partnership with Latinmed, a marketing and communication company, and the Heart Institute (A303). Our interviewees also mentioned these programs in schools, in “...partnership with the Secretariat of Education. (...) However, the problem is that they had the [logo of the company] in many places (...). And they had a program of rewards for the teachers” (interview, member of civil society).

Influence on public health policy and use of legal actions

The main objective of any CPA strategy is, ultimately, to secure a favorable policy environment for food companies. In Brazil, food industry actors were indeed directly influencing public health policy. Coca-Cola identified the possible regulation of its products as one of the main risks to its business: “Taxes and changes in regulations in the regions where we operate could affect our business” (A123), since they “can reduce the demand for our products, which could negatively affect our profitability” (A146).

Indirect access

A well-known technique of influence on public policy is lobbying, which occurs frequently in Brazil. It was described by one interviewee as “a daily, day-to-day, performance (...) on technical people, politicians (...) with a unique and exclusive interest in financial profit (...). They also put pressure on the executive branch” (interview, member of the government).

Personal relations between members of the government and representatives of the industry, often from the same social class and from the capital city Brasília, could be a factor that facilitates lobbying in Brazil:

“In Brasília, [lobbying] is so common (...). People know each other since they were young, so the public and private relations are mixed up. (...) Because much of the people that are involved in these debates, these government relations area, or even in the government, they were born in Brasília (...) and they were friends since they were kids” (former staff from the food industry).

It seems that a small group of industry actors, composed of ABIA, ABIR, and Brazilian National Confederation of Industry (CNI), as well as large transnationals such as Nestlé and Coca-Cola, amongst others, is involved in lobbying in Brazil (interviews, member of civil society and member of the government). In 2018, ABIR organized a seminar in Brasília on sugar-sweetened beverages, an event attended by representatives from the Brazilian Ministry of Agriculture, ANVISA, and São Paulo Public Institute of Food Technology (ITAL) (A61). In addition, that same year, the Ministry of Health met with representatives of different companies and trade associations, including ABIA, ABIR, and Coca-Cola, on at least four occasions (A6-8, A52-4). That same year, ABIA and Coca-Cola, in separate and joint meetings, met with the Government Secretariat of the Presidency of the Republic (A12, A122) and with the director of ANVISA (A11-2, A116, A118). Towards the end of the year, ILSI also visited the director of ANVISA to present the activities of the institute and discuss a “report of the technical and operational cooperation agreement with ANVISA” (A169).

Furthermore, the philanthropic activities of corporations in Brazil were directly used to interact with government officials. Two representatives from the Ronald McDonald Institute, for example, visited the Vice-Secretary of Health “in order to align the Institute’s strategies with the national cancer prevention and control policy” (A206).

Another form of indirect influence on policy is the co-option of policy makers, in which members of the government represent the interests of the industry. This was the case, for instance, during the development of the Bill on the restrictions of marketing to children, where “one of the rapporteur (...) was an owner of a Coca-Cola distributor in Brasília” (interview, civil society). In 2018, the government proposed to reduce the tax credits to producers of sugar-sweetened beverages in the economic free-zone of the Manaus region, in the Amazon State. In this case, members of the government had personal ties with the industry, and they defended its position, which was to avoid any cut in the tax credits. In particular, a Senator and owner of a sugar-sweetened beverages distribution company used his position to influence the decisions of the government. They coordinated a meeting between the “Minister of Economy and the president of Coca-Cola Latin America” in 2008, when “the government was discussing a change on the tax model”, and then, in 2018, by working “to revoke the decree [on the reduction of tax credits]. The Senators that presented the project to revoke the decree were all from the Amazon (...). All of them have financial ties with Coca-Cola and Pepsi. All of them” (interview, journalist).

Incentives

We also found evidence of the provision of incentives by food industry actors to policy makers. While corruption was beyond the scope of our study, the infamous 2014 Lava Jato Operation (Operation Car Wash) in Brazil, in which members of the government were found to be involved in cases of corruption, was mentioned by our interviewees as a critical event in the political history of Brazil ¹⁶16. Procuradoria Geral da República. Caso Lava Jato. http://www.mpf.mp.br/grandes-casos/lava-jato (accessed on 05/Mar/2020).
http://www.mpf.mp.br/grandes-casos/lava-... . One interviewee explained that some food industry actors were involved in these cases and that some companies “have a fund to defend former executives that eventually could have problems with the justice because they sent unofficial incentives to [third parties]” (interview, former staff from the food industry).

The Car Wash episode led to some reforms in Brazil, such as restrictions to political donations (interview, member of civil society). However, food industry actors sometimes offer incentives of a smaller value to policy makers, such as travels abroad, wine, and smartphones (interviews, members of the government and former policy makers). Nevertheless, there are existing restrictions in place for government officials to receive gifts from companies (interview, member of the government). Our interviewees explained that lobbying often takes place outside the Congress, through events paid by the industry, such as dinners in restaurants or private cocktails (interview, member of the government). One interviewee described an event organized by the Chamber of Commerce, with the participation of the director of ANVISA, and noted that such events could interfere with the democratic process, when discussions are not recorded and not made transparent, contrary to what happens in formal meetings of ANVISA (interview, former staff from the food industry).

Actors in government decision-making

Food industry actors were directly involved in government decision-making in Brazil. They advocated for co-regulation (through, for example, public-private partnerships) and self-regulation. In Brazil, several food companies had voluntary agreements to restrict their marketing to children (A142, A157, A165, A185, A208, A244, A252, A298). Food industry actors also promoted their voluntary efforts in reformulating food products (A30, A142, A247, A252, A281-2, A299-301). Since 2008, ABIA has a partnership with the Brazilian Ministry of Health to reduce trans fats in food products (A37). The industry claimed the reductions of trans fats were successful, thus the Ministry signed another partnership to reduce sodium (interview, member of the government). During data collection, in 2018, a new agreement to reduce added sugar was signed. During the development of the agreement, over a period of eighteen months, food industry actors met with the Brazilian Ministry of Health on six occasions (A36). The launch of the agreement was promoted online by both the food industry (A36) and the Brazilian Ministry of Health (A16, A34, A64, A84-5). Some of our participants were critical of these agreements, because they could serve as a “damage control agenda” rather than really improving the food environment (interview, member of the government). In addition, one interviewee suggested that the Brazilian Ministry of Health, in the case of reformulation, depends on the good will of the industry and “will never tell that it is not working, because they are part of that (...) - because it would just be saying that the Brazilian Ministry of Health failed if it doesn’t work” (interview, member of the government). Self-regulation was explicitly cited by the food industry as an argument against mandatory legislation, for example, in the case of taxation of unhealthy foods or restrictions of marketing to children (interview, civil society).

“We formed an unprecedented partnership between the food and beverage industry and the Brazlian Ministry of Health to reduce sugar in products by 2022. We invested in sport, in innovation, in responsible marketing to children guidelines. Tax does not create health” (ABIR, A63).

Legal actions

Another strategy of the food industry in Brazil was the use of legal actions to challenge public health policies, termed “judicial activism” (interview, member of the government). This was used, for example, to prevent the introduction of a policy on marketing to children (interviews, member of the government and academia).

“The food industry used a legal action to prevent the government from introducing the legislation. Yes, the legislation was formulated, was published, but not implemented, because they went to the Justice and they got the legislation suspended” (interview, academic).

Food industry actors also used the threat of legal action as a means to silence their public health opponents in Brazil (interview, member of civil society), a practice directly related to the opposition fragmentation and destabilization strategy described earlier.

“Anything that you do that can criticize [their brand], they [threat to sue you] (...). And if you do not stop [your criticismo], they will sue you, and litigations are costly in Brazil, and they tend to take some time to proceed. So, usually, [critics] prefer to stop criticizing” (interview, former member from the food industry).

Discursive strategies

Impacts on the economy and society

In Brazil, food industry actors used economic arguments to present themselves as important stakeholders in the country. ABIA claimed that the food industry generates 10% of the gross domestic product (GDP) and 1.6 million jobs (A22-3). ABIR explained that its members paid BRL 10 million per year in taxes in Brazil (A70-1). ABIR used similar arguments to show its important contribution to the economic-free zone of the Amazon (A68) and claimed that the economic-free zone “has become largely responsible for protecting the Amazon Forest” (A68). Our interviewees noted that these economic arguments are often used by the food industry:

“They are always highlighting this issue. All the PowerPoint presentations they make here in the National Congress are saying ‘our sector generates so many jobs (...), the economy lives around that, if there is a change in the legislation, the city will turn into a ghost town and such’” (interview, member of the government).

Food industry actors claimed that public health policies would lead to losses of profits and jobs in the industry, and to direct negative impacts on the economy of the country. This was the case made against a proposal to reduce the tax credits to producers of sugar-sweetened beverages in the economic-free zone of the Amazon, which would “deeply impact the sector” of beverages (ABIR, A66) and “impact the economic development of the Amazon region (...) and directly affect populations that depend on the production of native inputs, such as guaraná and açaí. It also affects the fight against deforestation and regional tourism” (ABIR, A68). These arguments were also used in discussions regarding the restrictions of marketing to children (interview, civil society).

Framing the debate

Food industry actors in Brazil presented themselves as part of the solution in the prevention and control of obesity (ABIR, A75). Coca-Cola, Nestlé, and Unilever, among others, were part of the Brazilian branch of the World Business Council for Sustainable Development, and used the United Nations Sustainable Development Goals (UN SDG), including SDG 17, which focuses on partnership, to justify their interactions with third parties (A131, A246).

In their discourse regarding nutrition, food industry actors in Brazil mostly focused on obesity, while the question of a healthy and adequate diet was virtually ignored. Instead, the industry focused on personal and parental responsibility, the need for more physical activity, and the importance of moderation, education, and balanced diets (A79, A115, A145). Here again, these arguments were used when trying to influence public policy in the country.

“You see the same arguments in public hearings, in their presentations, in documents that they leave for the assessors and assistants of Deputies and Senators. And at the end they always suggest solutions such as education, balanced diet, self-regulation. It is incredible. (...) I didn't realize that they would use the same expressions [in other countries]” (interview, civil society).

As discussed earlier, we found evidence that the food industry preferred way of delivering these solutions was co-regulation and self-regulation rather than mandatory policies.

Discussion

Food industry actors in Brazil used a diverse range of CPA strategies, which, individually and collectively, have the potential to negatively influence public policy, but also research and practice, in the country. They built relationships with communities, health organizations, and the media, and tried to shape the evidence base in nutrition by their participation in scientific events, or interactions with professionals in nutrition. This was discussed by Canella et al. ¹⁷17. Canella DS, Martins APB, Silva HFR, Passanha A, Lourenço BH. Food and beverage industries' participation in health scientific events: considerations on conflicts of interest. Rev Panam Salud Pública 2015; 38:339-43. in an article published in 2015. Pereira et al. ¹⁸18. Pereira TN, Nascimento FA, Bandoni DH. Conflito de interesses na formação e prática do nutricionista: regulamentar é preciso. Ciênc Saúde Colet 2016; 21:3833-44. also reported the influence of the food industry in the training of nutrition professionals. Some of our participants noted the promotion of specific brands of parental products during training events, where these interactions with communities and professionals could become marketing opportunities ⁷7. Monteiro CA, Gomes FS, Cannon G. The snack attack. Am J Public Health 2010; 100:975-81.^,1919. Freedhoff Y, Hebert PC. Partnerships between health organizations and the food industry risk derailing public health nutrition. Can Med Assoc J 2011; 183:291-2.. These interactions with third parties and efforts to influence science risk compromising the integrity and credibility of public institutions and health professionals, by their association with food manufacturers, particularly those producing ultra-processed products ²⁰20. Marks JH. The perils of partnership: Industry influence, institutional integrity, and public health. New York: Oxford University Press; 2019.. These interactions also risk promoting the agenda of the industry, while compromising the public health agenda ²¹21. Panjwani C, Caraher M. The public health responsibility deal: brokering a deal for public health, but on whose terms? Health Policy 2014; 114:163-73.. There is a need for more scrutiny of these initiatives, particularly when they are targeted at children and other vulnerable populations.

Moreover, food industry actors had indirect access to policy makers and were providing financial incentives to government officials. The industry, when faced with potential regulation of its products and activities, advocated for co- and self-regulation rather than mandatory policies. The many shortcomings of co- and self-regulation, in the case of the food industry, particularly their ineffectiveness in improving population health, have been discussed elsewhere ²²22. Clark H, Coll-Seck AM, Banerjee A, Peterson S, Dalglish SL, Ameratunga S, et al. A future for the world's children? A WHO-UNICEF-Lancet Commission. Lancet 2020; 395:605-58.^,2323. Ronit K, Jensen JD. Obesity and industry self-regulation of food and beverage marketing: a literature review. Eur J Clin Nutr 2014; 68:753-9.^,2424. Kunkel D, Castonguay J, Wright PJ, McKinley CJ. Solution or smokescreen? Evaluating industry self-regulation of televised food marketing to children. Communication Law and Policy 2014; 19:263-92.. Besides their efforts in trying to influence policy, food industry actors threatened to silence public health professionals who advocated for restrictions on the sale of unhealthy products, or who were vocal against the practices of corporations.

Finally, food industry actors used discursive strategies, focusing on their economic importance in the country and on the positive role they can play in society. These arguments could serve to shift the blame away from the role of unhealthy products in the NCDs epidemic, while securing a seat for the food industry at the policy table ²⁵25. Nestle M. Soda politics: taking on big soda (and winning). New York: Oxford University Press; 2015.^,2626. Nixon L, Mejia P, Cheyne A, Wilking C, Dorfman L, Daynard R. "We're part of the solution': evolution of the food and beverage industry's framing of obesity concerns between 2000 and 2012. Am J Public Health 2015; 105:2228-36..

Our results are similar to existing evidence of the CPA of the food industry in other countries, where all CPA practices have also been observed ¹²12. Mialon M, Gomes FS. Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean. Public Health Nutr 2019; 22:1898-908.^,2727. Mialon M, Mialon J. Analysis of corporate political activity strategies of the food industry: evidence from France. Public Health Nutr 2018; 21:3407-21.^,2828. Jaichuen N, Phulkerd S, Certthkrikul N, Sacks G, Tangcharoensathien V. Corporate political activity of major food companies in Thailand: an assessment and policy recommendations. Global Health 2018; 14:115.. For example, in Costa Rica, Ecuador, Guatemala, and Uruguay, food industry actors lobbied government officials ¹²12. Mialon M, Gomes FS. Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean. Public Health Nutr 2019; 22:1898-908.. In Ecuador, Nestlé also has education programs for schools ¹²12. Mialon M, Gomes FS. Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean. Public Health Nutr 2019; 22:1898-908.. In France, the Ronald McDonald Foundation built relationships with health professionals and was regarded as a credible health partner by medical doctors ²⁷27. Mialon M, Mialon J. Analysis of corporate political activity strategies of the food industry: evidence from France. Public Health Nutr 2018; 21:3407-21.. This could be explained by the fact that several of the actors included in our study are transnationals, or pertain to international organizations, such as ILSI and International Food Information Council (IFIC). There are three notable differences in Brazil compared to other countries where the CPA of the food industry has been analyzed to date. First, the personal relationships between policy makers and industry representatives - since they belong to the same social class and many of them are from Brasília - may explain the political influence exerted in the Congress and on the executive branch of the government. Second, food industry actors explicitly cited the SDG, particularly SDG 17, as an argument for collaborations with other stakeholders in nutrition. Thus, international standards have a direct impact in shaping the discourse of the industry at the national level. Third, in Brazil, this discourse, where the industry presents itself as part of the solution, is in direct contradiction with its threats to public health advocates and its attempts to influence public health policy in the country.

Our study has limitations. First, this was not an exhaustive mapping of all industry political practices. Future studies could focus on other periods in time and other actors, including those influencing policies at the State level. Our interviewees noted that the question of an adequate and healthy diet in Brazil is very much aligned with the question of land, indigenous communities, and families, and they discussed the political practices of the agribusiness industry, particularly large farmers and the pesticide industry. These sectors were beyond the scope of our project, as were the factors that contributed to the use of one or another CPA practice, and the effectiveness of these practices in influencing public policy.

In Brazil, there is an existing coalition of individuals in the government, civil society, and academia ²2. Monteiro CA, Cannon G. The impact of transnational "big food" companies on the South: a view from Brazil. PLoS Med 2012; 9:e1001252., pioneers for their efforts in protecting and promoting adequate and healthy diets of Brazil and addressing undue influence from corporations. Academics from Brazil started denouncing the negative influence that corporations in the food industry have on low- and middle-income countries a decade ago ²2. Monteiro CA, Cannon G. The impact of transnational "big food" companies on the South: a view from Brazil. PLoS Med 2012; 9:e1001252.^,77. Monteiro CA, Gomes FS, Cannon G. The snack attack. Am J Public Health 2010; 100:975-81.. However, our interviewees noted that these efforts have been under threats in recent years. They felt that, more than ever, these public spaces need to be protected (interview, academic). This study contributes to that objective, by providing knowledge of the political practices of the food industry. These practices interfere with the implementation of the Brazilian National Food and Nutrition Policy (PNAN) ²⁹29. Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Política Nacional de Alimentação e Nutrição. Brasília: Ministério da Saúde; 2013., particularly the efforts to: promote adequate and healthy diets, build a workforce of independent nutrition professionals, regulate unhealthy food products, and conduct independent food and nutrition research. Identifying and monitoring the political practices of corporations is a crucial step to protect public health policy, but, ultimately, mechanisms should be put in place to address and manage these practices. In Brazil, some of these mechanisms already exist, with the publication of the agenda of policy makers and limitations on political donations, as explained in this article. Moreover, more efforts are needed to prevent undue influence from the food industry during the development stage of public health policies.

Conclusion

In Brazil, food industry actors used a broad range of instrumental strategies, such as interactions with third parties, the dissemination of information on nutrition and physical activity, and lobbying high ranking officials. They also intimidated public health professionals, including threats of litigation, which had the effect of silencing them. All of these instrumental practices were supported and facilitated by the use of arguments, such as the crucial role that the food industry plays in the economy, and its support to the UN SDG. Personal responsibility, moderation, and education were cited as solutions to the obesity epidemic, and there was little discussion on the broader issue of inadequate and unhealthy diets. It is crucial that public health professionals, policy makers, and the public learn about these practices and, in response, develop and implement robust mechanisms to address undue influence from corporations.

Acknowledgments

The authors thank their interviewees for their involvement in this study. They also acknowledge Dr. Marita Hennessy for having proofread a revised version of this manuscript and São Paulo State Research Foundation (FAPESP; grant number 2017/24744-0) for the financial support.

References

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