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A realist review of voluntary actions by the food and beverage industry and implications for public health and policy in low- and middle-income countries.

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Karim, Safura Abdool 
Foley, Louise 
Hofman, Karen Joanne 


The increasing availability of unhealthy processed food products is linked to rising rates of non-communicable diseases and obesity in low- and middle-income countries. Voluntary actions (VAs) are often adopted in lieu of regulating the composition, production, marketing and sale of unhealthy commodities, but their effectiveness is unclear. This realist review examines VAs adopted by the food and beverage industry in low- and middle-income countries. We developed a conceptual framework and followed a three-stage search to identify literature and VAs and, adhering to the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines, we produced a synthesized analysis of VAs. VAs, often initiated in response to governments' efforts to introduce regulations, were difficult to evaluate due to vague language and a lack of enforcement mechanisms. The review found no evidence indicating that VAs are effective in safeguarding public health. Yet their implementation has resulted in weaker responses and policy substitution, and so we suggest that VAs have the potential to negatively influence public health and policy. The United Nations should rescind their endorsement of industry involvement and mandatory measures should be favoured over VAs.



3002 Agriculture, Land and Farm Management, 30 Agricultural, Veterinary and Food Sciences, 3006 Food Sciences, Cardiovascular, 3 Good Health and Well Being

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Nat Food

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Springer Science and Business Media LLC
Department of Health (via National Institute for Health Research (NIHR)) (16/137/34)
This research was funded by the National Institute for Health Research (NIHR) (GHR: 16/137/34) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care. AE, SAK, and KH are supported the SAMRC/Wits Centre for Health Economics and Decision Science – PRICELESS SA (grant number 23108).