The soaring prevalence of obesity, and the non-communicable diseases (NCDs) associated with it, is increasingly becoming one of the main public health threats in the world. Once considered an ailment of the rich, overweight and obesity are no longer a health concern only in wealthy countries. Their prevalence continues to grow in low- and lower-middle-income countries (LMICs), and is pervasive even in countries where undernutrition persists. To face this challenge, many countries have designed and implemented comprehensive strategies and standalone policies to curb the epidemic. However, most documentation around the process to design and implement these policies come from high-income countries, and only recently have there been some efforts aimed at understanding the process and experiences in middle-income countries. This work aims to help fill this knowledge gap. This case study is part of a series of country case studies commissioned to better understand the process of designing and implementing policies to prevent and control obesity. The series provides an overview of the contextual factors and political processes in which these policies were introduced and the roles of the stakeholders in moving the policies forward from design to implementation.
This case study examines policies implemented by the government of Chile that aim to offset the challenge of rising obesity under the aegis of the national “Food Law.” The policies analyzed in this case study specifically tackle the challenge related to caloric intake by giving consumers better tools to make informed food choices, providing them with easy-to-understand nutritional information and modifying food environments, particularly for children.
Three stages can be identified in the process followed by the policies addressed in this case study: development, implementation, and enforcement. The development process refers to the law-making procedure in Congress and its motivations, led by a group of parliamentarians, advised by the Ministry of Health, who presented the Food Law. The implementation process, led by the Ministry of Health, took place once the law was approved by Congress and consisted of developing the regulation that would define how to apply the Food Law. The enforcement stage, also led by the Ministry of Health, is ongoing at the time this case study was written. It consists of monitoring compliance to all aspects of the law.
By understanding this particular policy development and implementation in Chile, this case study examines the main challenges faced by these processes, offering lessons about the value of creating strong alliances between academia and politics in order to convince policymakers about the relevance of creating policies to regulate the food industry, the importance of making evidence-based decisions, and the usefulness of creating adequate incentives for self-regulation and creating agreements with existing institutions to ensure compliance with the Law.
The Development Challenge
Overweight and obesity have significant economic and health consequences. Chile specifically loses around 0.81 percent of its GDP due to medical treatments, associated diseases, disability pensions, absenteeism, and early deaths. Additionally, 10 percent of total deaths in Chile may be attributed to obesity
The delivery challenges were the obstacles that hindered the approval and implementation of the Food Law in all possible phases—institutional obstacles due to the design of state institutions responsible for implementing or designing specific policies as well as difficulties due to lack of resources.
Opposition and Lack of Consensus
Opposition to the original project from specific stakeholders and interest groups, and lack of consensus among parliamentarians led to an inability to find a solution acceptable to all major stakeholders. This challenge was not overcome once the law was approved, though. Even then, major differences between the body responsible for creating the regulatory framework—the Ministry of Health—and the food industry lobbyists further delayed the implementation of the Food Law.
Three governments were in power during the Law’s development, implementation and enforcement. One ruled between 2006 and 2010, another one in the period 2010-2014, and the last one in 2014 until 2018. The first government in power when the bill was originally presented in Parliament in 2007 had a substantially different position about the policies involved in the Food Law than the government in power throughout most of the discussion process in parliament, which also had differences from their successor government’s position.
Skilled Manpower/Organizational Capacity
During the implementation process, a delivery challenge emerged regarding technical capacities within the Ministry of Health. The Parliament gave the Ministry of Health the task of developing a regulation seeking to implement the Food Law that was approved in Congress. One of the major challenges was to define “unhealthy food.” Corvalán et al. (2013) assert that this task found the Ministry’s Nutrition and Foods Department in the midst of a restructuring process due to the change of administration, leaving the Ministry of Health facing a skilled manpower related challenge. Because of this change, new working teams in the Ministry were not familiar with the on-going process.
Most of the discussion in parliament involved politicians, public health experts, government authorities, and food industry’s representatives. Civil society, nevertheless, was seldom taken into account as a relevant actor in the law-making process. This challenge carried over to the implementation process (Corvalán et al. 2013), particularly during the development of the first regulation. Although the Ministry of Health heavily relied on groups of experts and took into account the interests of the food industry, it did not fully utilize mechanisms for incorporating citizens’ perspectives, who, together with the food industry, would be directly affected by the implementation of the law.
Create Strong Alliances Between Academia and Policy- and Law-Makers, and Convince with Evidence
Solid and close political-academic cooperation was the most important factor for the success of the Food Law.
The Food Law was a pioneer, worldwide, in terms of its regulations, particularly for the front-of-package labeling policy, and the restrictions for child-oriented advertising. The Ministry of Health needed to define the thresholds to determine if a certain product needed a warning message, and then develop the warning message to be put on packages of all processed foods. Few, if any, countries in the world had implemented such a policy. In this sense, it was very important that the Ministry of Health collected data in order to make evidence-based decisions. Once again, the role of academia in supporting the technical teams in the Ministry of Health was crucial.
Enforcement: Incentives for Self-Regulations and Agreements with Existing Institutions
The scale of the regulations forced the Ministry to invest an enormous amount of resources in fulfillment of regulation efforts. Therefore, in order to make and efficient use of resources, the Ministry of Health signed agreements with several existing organizations, which contributed to better implementation and enforcement processes, and reinforcing intersectoral work in order to achieve a common goal. Recent agreements with the National Television Council, the National Consumer Service, and the Ministry of Education have been vital for the correct enforcement of the Law.