Overview of the policy process

Proposals on FOP warning labelling in Argentina began to emerge in 2016 [92], the same year in which Chile officially implemented its law on food labelling and advertising (Ley 20,606) and PAHO published its NPM to define limits for critical nutrients in UPFs. As one advocate emphasized, the latter was particularly impactful for the policy process in Argentina:

“It’s a very small book that was very revolutionary. In the sense that it paved the way, in all countries, to regulate. That is the main precedent.” [Advocate, International Development Agency].

As the topic began to gain momentum in Argentina, two parallel approaches emerged to move forward on FOP labelling: one through the Executive branch and the other through the Legislative branch. The former was developed through the convening of an inter-ministerial working group beginning in 2018, led by the Ministry of Health and in partnership with the Ministry of Agriculture, Livestock and Fisheries and the Ministry of Productive Development. This inter-ministerial initiative emphasized the need to work with stakeholders from different sectors throughout the development of the proposal, including civil society, academia, professional nutrition organizations, and the food and beverage industry [93]. This initiative also sought to advance on labelling through changes agreed upon both within the National Food Commission (CONAL), which oversees the implementation of the Argentine Food Code, and with other members of MERCOSUR [94]. Following several changes to the proposal made between 2018 and 2020, in part due to a change in the government administration in 2019, the Executive branch reached a finalized proposal, which it presented in meetings with both CONAL [95] and MERCOSUR [96] around the same time that the bill began to be debated in the National Congress.

The latter approach, which was ultimately passed into law, was a bill proposed in the Senate in early October 2020. This bill was reached through a negotiation process that unified 15 different bills drafted by legislators from different political parties in the years preceding to address unhealthy food environments [97]. Upon receiving a positive opinion from the internal commissions of Health and of Industry, the bill was swiftly given half sanction by the Senate later the same month, promptly moving to the Chamber of Deputies for consideration by relevant internal commissions. The bill was then assigned to be debated by six commissions, though this was later reduced to four: General Legislation; Social Action and Public Health; Consumer Defense User and Competition; and Industry. Almost a year after the half-sanction in the Senate, and following the positive opinion given by the four commissions in July, the bill was passed into law by the Chamber of Deputies in October 2021.

Contextual enablers

Advocates pointed to several contextual factors that shaped the successful adoption of the law. First, the COVID-19 pandemic opened a window of opportunity by elevating the protection of public health as a priority value both amongst the public and decision-makers, as well as the legitimacy of the public sector as an entity to intervene upon the private sector:

“…the state was recognized, at the moment, as an actor that could guarantee our health; so, it was also related to this bill. If we let the market act independently and autonomously, all factories would be open, all enterprises would be open, and the virus would have spread more and increased the rate of deaths and everything. And people were scared at the time, so the state was seen as a positive influence in society, which has changed now.” [Advocate, Advisor to Legislator].

The COVID-19 pandemic, particularly during the lockdown that characterized the debate of the law in the Senate, was also identified as an important factor that shifted access to discussion spaces with decision-makers throughout the process. For instance, one advocate in civil society noted that the shift to online communication helped their organization, which was newer and characterized by few resources, access discussion spaces where the law was being debated, as well as convene spaces to bring together advocates and legislators to discuss the topic. Another advocate highlighted that the virtual nature of policymaking at this time may have also mitigated lobbying and heightened transparency in the early stages of the legislative process:

“…the legislators were at home, in their provinces. It was not possible for the industry to visit them in their offices. And there are things that are not going to be negotiated via Zoom…Personally, I think the pandemic helped make the committee’s discussion transparent, it’s posted on YouTube. There weren’t any twists, lobbying, or at least it was less common, because people could not travel through the streets here. We had a very strict quarantine.” [Advocate, International Development Agency].

In general, advocates noted that they were readily invited, alongside industry and other stakeholders, to participate in spaces that debated the policy in both the Executive and Legislative branches, enabling them to share data and arguments with decision-makers, with the only notable exception related to discussions undertaken at the level of MERCOSUR.

Advocates also pointed to several political factors that shifted perceptions of the bill in Congress, including shortened ideological distances in Congress following the change in administration in 2019 and the fact that FOP labelling laws passed in other countries in the region were adopted by governments that came from similar ideological perspectives as the two major coalitions in Congress at the time. The latter lent the bill a degree of credibility as an innovative and politically viable measure:

“…the previous experience in other countries was helpful because they leaned more towards the center-right, Chile, for example; and my coalition, [Party A], also center-right, saw them as an inspiration. And if Chile was doing this, then it was a modern dynamic and innovative proposal and not some old-fashioned policy. But we also saw the experience in Uruguay, which is center-left, so [Party B] could learn from them too. So, we had this context.” [Advocate, Advisor to Legislator].

Another political factor that enabled the law’s successful passage was its bi-partisan support in Congress. This support was due in part to the fact that the bill that was ultimately debated in Congress was reached through the negotiation process that unified previous bills drafted by legislators from different political parties in the years preceding. This political neutrality was also further reinforced by the fact that the unified bill was proposed by two Senators who came from the same province but each from a different political party that constituted the two main coalitions at the time.

“The fact that we managed to present a bill that was not affiliated to any political party is very important because it allowed us to receive support from both parties without any political divide.” [Advocate, Civil Society].

Structural powerConvening spaces and knowledge exchange

As early momentum began to build on UPF regulation in Argentina, advocates were able to capitalize on growing attention to the topic to elevate it on the legislative agenda by organizing a series of conferences, beginning in 2016 and continuing through the legislative debate of the law [92, 98,99,100,101], which convened stakeholders across civil society, the Executive branch (e.g., national ministries), the Legislative branch, academia, and professional nutrition organizations, amongst others. These spaces were convened via a partnership of international agencies, led by PAHO. A key activity facilitated by advocates throughout these meetings was to invite champions of UPF regulations passed in other countries in the region, beginning with representatives from Chile, and proceeding with those from Uruguay, Mexico, Peru, and Colombia. Inviting stakeholders to learn from regional precedents was not only advantageous for building political momentum, but for learning from previous experiences to foresee challenges, such as CPA, that would ensue as the proposal for regulation began to gain ground:

“It was like a regional training, not only were we debating this, but other countries as well; so, before Argentina, also other countries went along, Perú went along, Uruguay went along, then Mexico went along, and each country benefiting from the previous experience of other countries. So, when we learned from the experience in Chile, we knew how the food industry would react, what their strategies would be…” [Advocate, Academia].

Revolving doors

The ability to convene these spaces with decision-makers was enabled in part by existing relationships advocates held, some of which were cultivated through prior health policy processes, including tobacco control and regulation on sodium content in foods. Several participants pointed to the importance of ‘revolving doors’ in this respect, referring to the importance of seasoned advocates who either held multiple roles at one time or changed roles across sectors during the policy process, bringing their knowledge, expertise, and networks with them to new positions:

“We have the same people in different organizations, for instance, I mentioned three that I belong to, and you take this to the agenda of the organization.” [Advocate, Academia].

The most commonly noted shifts between sectors that advocates highlighted were between civil society, international development agencies, and the Ministry of Health; however, specific reference to these shifts is omitted here for anonymity purposes.

Informal alliances

Informal alliances were identified as key to overcoming roadblocks faced by any one organization or sector. This emerged, for instance, in the context of the tension between the Executive and Legislative proposals that were developing simultaneously in the years leading up to the official proposal of the bill in Congress. Both proponents and opponents sought to leverage these two institutional approaches to UPF regulation to their respective advantage to either promote or hinder the law from advancing. For example, the Coordinator of Food Product Industries (COPAL), an umbrella entity representing the interests of the food and beverage industry, supported the proposal furthered by the Executive branch rather than the bill. Advocates identified this as CPA, as the Executive proposal was inferior to the Legislative approach for several reasons, including higher susceptibility to shifts in political climate, lower alignment with best practice in both scope and stringency of proposed regulation, and the fact that pursuing a regional agreement with other members of MERCOSUR would significantly delay the process, as well as place the debate in an arena in which industry and trade interests were paramount. Indeed, stakeholders representing industry interests often used their resources to disseminate the argument that Argentina was not allowed to regulate without agreement at the level of MERCOSUR to stifle support for the bill in Congress:

“…they started to say that we could not move forward with the law because it went against our integration within the MERCOSUR, even though legally it was not the case. But they still claimed this, which confused legislators.” [Advocate, Advisor to Legislator].

Advocates leveraged structural power in the face of this challenge through informal alliances with advocates across different positions. Particularly for those advocates facing institutional constraints, such as those positioned within the Executive branch, the importance of informal alliances was key:

“…the best option was always the bill, and even then, we knew that a bill would not involve the Executive Branch we worked at. So, it was our priority to ally with the organizations that would work closely with deputies and senators to try and convince them to be in favor of this policy.” [Advocate, Ministry of Health].

Within civil society, informal alliances also allowed advocates to collectively permeate spaces where misinformation was spread to decision-makers to undermine the bill. This was the case, for instance, for some conferences held by professional nutrition organizations with known conflicts of interest. As one advocate explained:

“…thankfully we were able to work together with other civil society organizations. Whenever one was not able to participate, the others would be there to support them. So, in certain meetings they would say: “Let’s invite [Organization A] because they aren’t as antagonistic as [Organization B]”. But, thanks to our alliance with other organizations, we were always able to speak for each other, to empower each other.” [Advocate, Professional Nutrition Organization].

Coalition building

Formal alliances, in the form of coalitions [102,103,104] also helped advocates harness structural power through different stages of the policy process. For example, the resources developed by the National Coalition to Prevent Childhood Obesity [105], formed in 2017 with support from UNICEF Argentina [106], lent a collective voice of legitimacy to the positions advocated by a handful of organizations working at the forefront of the process:

“…that was also a very important support because it is different to say to the legislature “[Organization A] has this policy brief”, no, this policy brief is supported by more than 40 organizations representative from all the country. That is, well, the legislators paid a lot of attention.” [Advocate, Civil Society].

During the legislative debate, formal coordination across civil society organizations also became an important strategy for building capacity both within and across organizations. This was particularly the case when five civil society organizations collectively secured a grant funded by Bloomberg Philanthropies and managed by the Global Health Advocacy Incubator (GHAI). With the support of the grant, these organizations were able to expand and diversify their own activities in support of the law, as well as to organize activities collectively. The latter was identified as a challenge by several advocates, as it required novel coordination across organizations with different reputations, approaches, and leadership structures; however, it was also noted as a key strategy to harness collective action and effectively counter corporate power:

“I mean, the inequality of arms was evident from the beginning: the industry has all the means for advertising, for paying nutritionists, to go in the media to demonize the law, and we had nothing. But this influx of money through GHAI to the organization allowed us to counteract that.” [Advocate, Academia].

Instrumental powerWielding evidence

The generation and dissemination of knowledge and evidence was one of the key activities advocates led to influence the policy process (see Table 2 for a summary of key studies). For instance, a series of studies led by the research-oriented civil society organization, the Inter-American Heart Foundation - Argentina (FIC-Argentina) in 2015–2018 demonstrated the widespread exposure of children and adolescents to different forms of UPF marketing in Argentina [107,108,109], elevating the issue of the need for regulation. Along a similar vein, two studies conducted by the Ministry of Health – the 4th National Survey of Risk Factors (2018) [110] and the 2nd National Survey of Nutrition and Health (2019) [111] - provided updated evidence on UPF consumption trends in Argentina and the burden of diet-related chronic disease to underscore the extent of the challenge in Argentina.

Table 2 Knowledge and evidence documents generated by policy advocates in Argentina

“What was one of the arguments of the industry? “Okay, okay, how do we know that the, let’s say, this front labelling with this black octagon, is the most effective for Argentina? Because this has been effective in Chile, but how do we know if it is effective in Argentina?” So, we have evidence, we have scientific evidence, but this scientific evidence has not been validated here.” [Advocate, Academia].

As such, both the Ministry of Health and FIC conducted studies to compare the performance of different labelling schemes amongst the Argentine population [68,69,70], as well as to demonstrate that the proposed PAHO NPM was in the greatest accordance with the dietary guidelines for the Argentine population compared to other models [71, 72]. One participant pointed to the importance of involving multiple organizations in the generation of evidence to support effective policy design:

“Another strategy was to work hand to hand with the Ministry of Health,and we agreed on what evidence we have to produce, at the same time, both of us: to have a study from the Ministry of Health that says that the octagon warning level was the best, and another study, that says the same, but from the Civil Society. So, it is not only the Civil Society that has this evidence, but the Ministry of Health, too. And the same with the nutrient profile system.” [Advocate, Civil Society].

Building technical literacy

This tenet of instrumental power refers both to the building of technical literacy amongst advocates themselves and amongst decision-makers. Regarding the former, advocates synthesized knowledge on key aspects of the policy process, such as the legal and political landscape surrounding the law. For instance, advocates in civil society led a series of analyses on legal aspects that would influence the policy process, particularly through a collaborative regional study with other countries in MERCOSUR. This included a mapping of the national regulatory framework on FOP labelling [114], an analysis of legal barriers and facilitators to FOP labelling [115], and a report on legal lessons learned from the precedent of tobacco control [116]. Civil society advocates also worked to consolidate knowledge of the political landscape, such as by mapping decision-makers in Congress to understand their stances and guide targeted advocacy:

“One of our main strategies was to monitor and study the members of the Senate and the Chamber of Deputies; to identify how much power of decision they had within their commissions…. We also wanted to identify who our champions were going to be, also the ones who were never going to agree to this law, and the ones we could be able to sway in our favor. So, we mostly focused on those we could convince, and that’s when we asked legislators to have meetings with them and their advisors.” [Advocate, Civil Society].

Conducting targeted advocacy efforts, such as through one-on-one meetings with key legislators and/or their advisors, was used as a strategy to build technical literacy on the bill in Congress. This proved to be particularly important in the face of CPA that targeted technical aspects of the law. For example, resistance during the later phases of the legislative debate did not oppose the law itself, but rather focused on the need for ‘modifications’ to the text of the law, which, if heeded, would have stalled the passage of the bill. This was particularly the case with Article 6, which established the PAHO NPM as the foundation for the adoption of FOP warning labels and was highlighted by industry stakeholders as a system that would unfairly affect their products [117]. In this context, advocates described the importance of holding meetings with legislators to clarify key concepts:

“We talked to legislators and advisors; we explained why the bill was written the way it was written; that we must use PAHO’s nutrient profile system; that the industry kept insisting on using a different profile system. You can base the law on unlimited profiles and the law would end up a mess. So, we explained to them the importance of each and every article of the law, that the law must be approved unchanged.” [Advocate, Professional Nutrition Organization].

In addition, conducting targeted advocacy was identified as an important approach to advocacy in the context of unequal resources:

“….they [the industry] knew that they had to engage with all political actors, not just “some”. On the other hand, NGOs and civil society have fewer resources, so they concentrated their relationships with key stakeholders.” [Advocate, Advisor to Legislator].

Exposing conflicts of interest and harnessing public pressure

Another key population that advocates sought to influence was the public, accomplished through the strategic use of communication channels. For example, advocates described using traditional and social media to expose industry tactics and encourage accountability of decision-makers, including ‘naming and shaming’ those who had conflicts of interest. Other identified strategies to harness public pressure included conducting communication campaigns with national coverage in public spaces, radio, digital and print media, such as the, “Don’t let them cover your eyes,” (“Que no te tapen los ojos”) [118] campaign, and making use of a digital platform, ‘Activá el Congreso’ [119], which enabled individuals to write directly to legislators. The involvement of advocates who could more effectively reach the public, such as journalists, influencers, youth activist groups and celebrities, was vital to harnessing public pressure. Bringing the debate surrounding the law into the public domain was noted as a key strategy to counter imbalances of power through the policy process:

“…one more thing about this imbalance is that it is only possible to restore it if civil society plays a very aggressive role on the internet, in the media, employing certain communication strategies….If the discussion had only taken place within the Chambers, we probably would have lost the case.” [Advocate, Legislator].

Leveraging public pressure proved particularly critical at junctures in the legislative debate where it seemed that the bill would not successfully advance due to interference. For example, following the half-sanction of the bill in the Senate, the bill was assigned for consideration by an unusually high number of commissions within the Chamber of Deputies [120], a strategy advocates identified as one motivated by conflicts of interest held by the president of the Chamber of Deputies to hinder the passage of the bill. Here, one advocate stressed the importance of public pressure in overcoming this obstacle:

“that’s when Civil Society launched campaigns on Twitter denouncing the number of committees that the bill was assigned to; that made [the president of the Chamber of Deputies], who in another context would not have changed his mind, feel singled out and decide to reduce the number of committees to three, although they finally ended up being four.” [Advocate, Legislator].

Once the commissions in the Chamber of Deputies issued a positive opinion on the bill, the final vote in the Chamber of Deputies remained as the final step to adopt the bill. Advocates described another instance at this point in the process where political factors almost prevented the passage of the law, in which one of the two major political parties did not present with a quorum at the session in which the law was to be put to a vote, placing the bill at risk of losing parliamentary status if not approved before the end of the year [121]. Again, advocates pointed here to the importance of public pressure to overcome this obstacle:

“Another enabling factor appears when society starts to personally start caring about the law. This was very apparent when the Chamber of Deputies didn’t reach a quorum on the bill… then began to circulate a very strong campaign in social media, where the public would call out these people and say, “How come they don’t want to vote on a bill that involves the health of the people?”. To me, that was a very compelling moment, I didn’t know that the bill had affected society in this way.” [Advocate, Professional Nutrition Organization].

Discursive powerGenerating counterarguments

Over the course of roughly a year from when the bill was first proposed in 2020 to its passage in 2021, the topic of FOP labelling transformed from a relatively niche and technical topic predominantly discussed within institutional spaces, to one of great political and public interest, with its own hashtag (#EtiquetadoClaroYA) on social media. This transformation reflects a shift in the dominant discourse surrounding the implications of the law for society. Advocates worked to shape the discourse surrounding the law, which required that they be poised to counter a range of economic, technical, legal, and ethical arguments made by the industry and associated stakeholders throughout the policy process (see Table 3 for a summary of key arguments and counterarguments). The knowledge and evidence generated by advocates, as previously detailed in Table 2, played a key role in supporting several of these counterarguments.

Table 3 Common arguments used to oppose the proposed regulation and advocate counterarguments through the policy process of the Promotion of Healthy Eating Law in Argentina [122,123,124]

Advocates noted that economic arguments, particularly given the context of economic instability and decline in Argentina, gained the most traction against the law.

“…the strongest argument in a country in Latin America is about, we are going to lose jobs, employment is going to be affected, which is also an argument that the industry is going to go broke, that the industry cannot endure this… I mean, the rest is more debatable, but the economic factor is important and that is where the industry went.” [Advocate, International Development Agency].

In this context, emerging evidence from Chile demonstrating that neither aggregate employment nor average real wages were affected by food labelling regulation helped support advocates to address these concerns in Argentina [125,126,127]. Advocates also spoke to the importance of emphasizing the economic ramifications of not acting in the form of rising healthcare costs.

Rights-based framing

To address ethical arguments, framing was key. Namely, advocates spoke to the importance of framing the law in communication with decision-makers not just within the paradigm of public health, but other values, such as the right of consumers to transparent information regarding the content of their food:

“…that was very important, to focus on the consumers’ right, not focusing only on that eating better was important, but you have to know what you are eating, then you decide, no? And that was very important to convince the legislators.” [Advocate, Civil Society].

This rights-based framing was also important in harnessing public support, and was pursued in communication campaigns led by civil society, such as the aforementioned “Don’t let them cover your eyes,” (“Que no te tapen los ojos”) campaign, with the slogan, “It is our right to know if a food has excess fat, sugar and/or sodium” [118]. This framing helped to turn the commonly used argument by the industry of individual responsibility and choice on its head by presenting the labels as a tool to enhance individual autonomy rather than hinder it. Another key framing for the law that fostered public support was the protection of vulnerable populations, particularly children and adolescents, from deceptive industry practices:

“I think it was a combination of different narratives, but I would say that the need to protect children and vulnerable social groups was what penetrated the most through society and, also, the industry’s lies…All of this sparked interest and a feeling of alarm at the same time.” [Advocate, Civil Society].

Extending narratives beyond the confines of a nutritional perspective to align the framing of the law with the priority values of different movements also brought more advocates into the fold, such as consumer organizations and environmental activists, reaching a broader audience over time.

Reputation management

The credibility that advocates carried in the arguments they made hinged on their reputation. As such, reputation management was an important aspect of advocates’ work throughout the policy process. For some organizations, particularly those comprised of nutrition professionals, managing internal conflicts of interest was critical. This was the case with the Argentine Federation of Graduates in Nutrition (FAGRAN), an umbrella organization of the Colleges and Associations of Graduates in Nutrition. The work done by the organization to reach an organizational position free of conflicts of interest, spearheaded by a change in leadership in 2018, was a critical factor in providing a degree of legitimacy to the voice of these advocates coming from the field of nutrition. The ability of organizations like FAGRAN to position themselves as entities free of conflicts of interest became a useful tool to spotlight those entities who could not do the same:

“…we told everyone who we were and we told them that we had no conflict of interest. And when you work on the law, people are more willing to listen to what you are saying. On the other hand, whenever we would hear arguments against the law, we knew those people and organizations always had conflict of interest. So, we requested that everyone who participated in the discussion must state whether they had any conflict of interest or not, and if they did, then what kind of conflict of interest it was.” [Advocate, Professional Nutrition Organization].

Outcomes of power: reflections on policy decision

The law was seen as a key milestone in a broader effort to regulate the widespread availability of UPFs and promote healthier food environments. Advocates spoke particularly of the importance of adopting mandatory FOP warning labels, which define the parameters of products that should be targeted by future regulations. As one advocate explained:

“…these labels are a gateway to other regulations. That is, everything works together: environment, advertising, sponsorship, labelling and taxes. Increasing taxes on sugary drinks. But the gateway is FOP labelling. It will make it easier to discuss a tax when the product has three labels” [Advocate, International Development Agency].

Advocates also spoke to the importance of the fact that the law included not only FOP labels, but other components that work synergistically to promote healthier food environments:

“I think that one of the greatest advantages is that you have in a piece of regulation a lot of – you are able to regulate a lot of the aspects included in what should be a healthier food environment. And that’s also something coming from tobacco. When you regulate and you have a tobacco control law, it’s not only about regulating the environment. It’s also about regulating the cigarette package. It’s also about regulating the promotion and advertising and sponsorship of tobacco products. So, this was a similar rationale.” [Advocate, Civil Society].

Ultimately, despite pervasive attempts to prevent or hinder the passage of the law, as well as undermine its scope, the law was passed in accordance with the recommendations made by advocates throughout the policy process. Though advocates pointed to many challenges regarding the road ahead for successful implementation of the law, this milestone was regarded as an important success:

“We enacted the exact law we wanted to enact. I thought it was going to be modified. Because sometimes they propose a good bill and it ends up as a weak law. Ours was whole. It was complete.” [Advocate, International Development Agency].