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Scholarly Works (2 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2022)

Non-communicable diseases (NCDs) are a global public health problem, causing 74% of all deaths worldwide. High systolic blood pressure and an unhealthy diet are the first and second most important contributors to the burden of cardiovascular diseases.

In this dissertation, I analyze policies implemented in micro-and macro-environments aiming to modify the food environment to address the burden of diet-related non-communicable diseases (DR-NCDs). I follow Hawke's framework that highlights the food environment as a mediator between preference learning and actual food consumption. Thus, policies that address the food environment are more likely to succeed because they address the main barriers to healthy eating.

The first paper provides evidence of the food industry's tactics in weakening and preventing the national and international diffusion of the sugar-sweetened beverages (SSB) tax's policy effectiveness, implemented in Mexico in 2014. The food industry paid scientists to produce evidence aligned with their interests, showing that the tax was ineffective in improving health and harming the economy. The second paper examines how a workplace SSB sales ban at the University of California, San Francisco (UCSF) reduced SSB consumption at work and outside work. Heavy SSB drinkers reduced their consumption by half at work and outside workplaces. Finally, the third paper evaluates the impact of a Food Pharmacy Program (FPP) at clinics in the San Francisco Health Network. The FPP is associated with significant systolic and diastolic blood pressure reduction in low-income adults with hypertension, with greater effects among those with poor blood pressure control, and those that attended the FPP at least five times.

I conclude that to reduce the burden of DR-NCDs, a package of interventions and policies at different levels that modify the food environment may be effective in reducing the access to health-harming products and increase the availability and access to healthy food. In addition, governments and policymakers should be free of conflict of interest and implement policies based on independent peer-reviewed evidence.

    Cover page: Evaluating how innovative nutrition policies promote healthy diets to reduce the burden of non-communicable diseases
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2021)
    Mexico is the largest soft drink market in the world, with high rates of obesity and type 2 diabetes. Due to strains on the nation's productivity and healthcare spending, Mexican lawmakers implemented one of the world's first public health taxes on sugar-sweetened beverages (SSBs) in 2014. Because Mexico's tax was designed to reduce SSB consumption, it faced strong opposition from transnational food and beverage corporations. We analysed previously secret internal industry documents from major corporations in the University of California San Francisco's Food Industry Documents Archive that shed light on the industry response to the Mexican soda tax. We also reviewed all available studies of the Mexican soda tax's effectiveness, contrasting the results of industry-funded and non-industry-funded studies. We found that food and beverage industry trade organisations and front groups paid scientists to produce research suggesting that the tax failed to achieve health benefits while harming the economy. These results were disseminated before non-industry-funded studies could be finalized in peer review. Mexico still provided a real-world context for the first independent peer-reviewed studies documenting the effectiveness of soda taxation-studies that were ultimately promoted by the global health community. We conclude that the case of the Mexican soda tax shows that industry resistance can persist well after new policies have become law as vested interests seek to roll back legislation, and to stall or prevent policy diffusion. It also underscores the decisive role that conflict-of-interest-free, peer-reviewed research can play in implementing health policy innovations.
      Cover page: Food and beverage industry interference in science and policy: efforts to block soda tax implementation in Mexico and prevent international diffusion
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