What You Don’t Know About the Codex Can Hurt You: How Trade Policy Trumps Global Health Governance in Infant and Young Child Nutrition

Document Type : Original Article

Authors

1 Economics Department, University of California, Davis, Davis, CA, USA

2 Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia

3 University of California, Davis, Davis, CA, USA

4 Centre for Primary Care and Public Health, Queen Mary University, London, UK

Abstract

Background 
International food standards set by the Codex Alimentarius Commission (CAC), have become more prominent in international trade politics, since being referenced by various World Trade Organization (WTO) agreements. We examine how this impacts implementation of the World Health Organization (WHO) International Code of Marketing of Breast-milk Substitutes.

Methods 
Using trade in commercial milk formulas (CMFs) as a case study, we collected detailed data on interventions across various WTO bodies between 1995 and 2019. We used language from these interventions to guide data collection on member state and observer positions during the CAC review of the Codex Standard for Follow-up Formula (CSFUF), and during CAC discussions on the relevance of WHO policies and guidelines.

Results 
Exporting member states made 245 interventions regarding CMFs at the WTO, many citing deviations from standards set by the CAC. These did not occur in formal disputes, but in WTO Committee and Accession processes, toward many countries. In Thailand, complaints are linked to weakened regulation. Exporters also sought to narrow the CSFUF at the CAC in a way that is at odds with recommendations in the International Code. Tensions are growing more broadly within the CAC regarding relevance of WHO recommendations. Countries coordinated during WTO committee processes to advocate for reapportioning core WHO funding to the CAC and in order to further influence standard-setting.

Conclusion 
The commercial interests of the baby food industry are magnifying inconsistencies between health guidelines set by the WHO, standard-setting at the CAC, and functions of the WTO. This poses serious concerns for countries’ abilities to regulate in the interests of public health, in this case to protect breastfeeding and its benefits for the health of infants, children and mothers.

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References

  1. World Health Organization (WHO). Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: WHO; 2003.
  2. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-490. doi:1016/s0140-6736(15)01024-7
  3. Walters DD, Phan LTH, Mathisen R. The cost of not breastfeeding: global results from a new tool. Health Policy Plan. 2019;34(6):407-417. doi:1093/heapol/czz050
  4. United Nations Children's Fund (‎‎UNICEF). Children, Food and Nutrition: Growing Well in a Changing World. New York, NY: UNICEF; 2019.
  5. World Health Organization (WHO). Maternal, Infant and Young Child Nutrition: Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children. Geneva, Switzerland: WHO; 2016.
  6. Piwoz EG, Huffman SL. The impact of marketing of breast-milk substitutes on WHO-recommended breastfeeding practices. Food Nutr Bull. 2015;36(4):373-386. doi:1177/0379572115602174
  7. Rollins NC, Bhandari N, Hajeebhoy N, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491-504. doi:1016/s0140-6736(15)01044-2
  8. Sobel HL, Iellamo A, Raya RR, Padilla AA, Olivé JM, Nyunt US. Is unimpeded marketing for breast milk substitutes responsible for the decline in breastfeeding in the Philippines? an exploratory survey and focus group analysis. Soc Sci Med. 2011;73(10):1445-1448. doi:1016/j.socscimed.2011.08.029
  9. Pries AM, Huffman SL, Mengkheang K, et al. Pervasive promotion of breastmilk substitutes in Phnom Penh, Cambodia, and high usage by mothers for infant and young child feeding. Matern Child Nutr. 2016;12 Suppl 2:38-51. doi:1111/mcn.12271
  10. Understanding the Infant Formula Value Chain. Aukland: Coriolis Research, Strategy, and Consulting; 2014. https://coriolisresearch.com/pdfs/coriolis_dairy_infant_formula_value_chain.pdf. Accessed July 3, 2020.
  11. Fortune Business Insights. Infant Formula Market Size, Share and Industry Analysis, Distribution Channel, and Regional Forecast 2019-2026. Report ID FBI101498. 2019.
  12. Euromonitor International. Passport Global Market Information Database. London: Euromonitor International; 2019.
  13. International Code of Marketing of Breast-milk Substitutes. Geneva: World Health Organization. 1981. https://apps.who.int/iris/bitstream/handle/10665/40382/9241541601.pdf?sequence=1. Accessed July 3, 2020.
  14. United Nations General Assembly. Convention on the Rights of the Child. Geneva: Office of the High Commissioner on Human Rights; 1989. https://www.ohchr.org/en/professionalinterest/pages/crc.aspx.
  15. World Health Organization (WHO), International Baby Food Action Network (IBFAN), United Nations Children's Fund (‎‎UNICEF). Marketing of Breast-Milk Substitutes: National Implementation of the International Code, Status Report. Geneva: WHO; 2018.
  16. Brady JP. Marketing breast milk substitutes: problems and perils throughout the world. Arch Dis Child. 2012;97(6):529-532. doi:1136/archdischild-2011-301299
  17. Thow AM, Jones A, Schneider CH, Labonté R. Global governance of front-of-pack nutrition labelling: a qualitative analysis. Nutrients. 2019;11(2):268. doi:3390/nu11020268
  18. Alter KJ, Raustiala K. The rise of international regime complexity. Annu Rev Law Soc Sci. 2018;14:329-349. doi:1146/annurev-lawsocsci-101317-030830
  19. Lee K. The World Health Organization (WHO). London: Routledge; 2009.
  20. Richter J. Holding Corporations Accountable. New York, NY: Palgrave Macmillan, St. Martin's Press, LLC; 2001.
  21. Jacobs A. Opposition to Breastfeeding by U.S. Stuns the World. The New York Times. https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html. Accessed July 3, 2020. Published July 8, 2018.
  22. Herrera A. Reactions after US tries to weaken UN breastfeeding measure: Breastfeeding is already “pretty damned hard”. PRI The World. https://www.pri.org/stories/2018-07-10/reactions-after-us-tries-weaken-un-breastfeeding-measure-breastfeeding-already. Accessed August 20, 2020. Published July 10, 2018.
  23. Haelle T. Dairy Industry Trumps Infant Health with U.S. Rejection of Breastfeeding Resolution. Forbes. July 2018. https://www.forbes.com/sites/tarahaelle/2018/07/10/dairy-industry-trumps-infant-health-with-u-s-rejection-of-breastfeeding-resolution/#6cce7a8fadcc. Accessed August 30, 2020.
  24. Johnson C, Erickson A. U.S. Effort to Weaken International Breast-feeding Resolution Has a Long History. Washington Post. https://www.washingtonpost.com/news/to-your-health/wp/2018/07/09/u-s-effort-to-weaken-an-international-breast-feeding-resolution-has-a-long-history/. Accessed August 25, 2020. Published July 9, 2018.
  25. Irwin R, Smith R. Rituals of global health: negotiating the World Health Assembly. Glob Public Health. 2019;14(2):161-174. doi:1080/17441692.2018.1504104
  26. Khazan O. The Epic Battle between Breast Milk and Infant-Formula Companies. The Atlantic. July 2018. https://www.theatlantic.com/health/archive/2018/07/the-epic-battle-between-breast-milk-and-infant-formula-companies/564782/. Accessed August 25, 2020.
  27. Baby Milk Action. IBFAN Initial Evaluation of the Implementation of FENSA (Extranet). November 2020. http://www.babymilkaction.org/policy/consultations/ibfan-initial-evaluation-of-the-implementation-of-fensa-extranet. Accessed August 25, 2020.
  28. Ralston R, Hil SE, da Silva Gomes F, Collin J. Towards preventing and managing conflict of interest in nutrition policy? an analysis of submissions to a consultation on a draft WHO tool. Int J Health Policy Manag. 2021;10(5):255-265. doi:34172/ijhpm.2020.52
  29. Lauber K, Ralston R, Mialon M, Carriedo A, Gilmore AB. Non-communicable disease governance in the era of the sustainable development goals: a qualitative analysis of food industry framing in WHO consultations. Global Health. 2020;16(1):76. doi:1186/s12992-020-00611-1
  30. World Trade Organization (WTO). WTO Annual Report 2021. Geneva: WTO; 2021.
  31. Lester S. Finding the boundaries of international economic law. J Int Econ Law. 2014;17(1):3-9. doi:1093/jiel/jgu011
  32. Janeba E. Regulatory chill and the effect of investor state dispute settlements. Rev Int Econ. 2019;27(4):1172-1198. doi:1111/roie.12417
  33. Codex Secretariat (WHO/FAO). Codex Alimentarius Commission Procedural Manual, 26th Edition. Codex Alimentarius Joint FAO/WHO Food Standards Programme Series No. 26. Rome: FAO; 2018.
  34. Food and Agriculture Organization of the United Nations, Secretariat of the Codex Alimentarius Commission. Trade and Food Standards. 2017. https://www.wto.org/english/res_e/publications_e/tradefoodfao17_e.htm. Accessed September 9, 2020.
  35. Molina AC, Khoroshavina V. TBT Provisions in Regional Trade Agreements: To What Extent Do They Go beyond the WTO TBT Agreement? World Trade Organization; 2015. https://www.wto.org/english/res_e/reser_e/ersd201509_e.pdf. Accessed September 9, 2020.
  36. Grossman GM, McCalman P, Staiger RW. The “new” economics of trade agreements: from trade liberalization to regulatory convergence? Econometrica. 2021;89(1):215-249. doi:3982/ecta17536
  37. Thow AM, Jones A, Hawkes C, Ali I, Labonté R. Nutrition labelling is a trade policy issue: lessons from an analysis of specific trade concerns at the World Trade Organization. Health Promot Int. 2018;33(4):561-571. doi:1093/heapro/daw109
  38. Millstone E. Science, risk and governance: radical rhetorics and the realities of reform in food safety governance. Res Policy. 2009;38(4):624-636. doi:1016/j.respol.2009.01.012
  39. World Trade Organization. Agreement on Technical Barriers to Trade. Vol Articles 2.2 and 2.3. https://www.wto.org/english/docs_e/legal_e/17-tbt.pdff.
  40. General Agreement on Tariffs and Trade (Tokyo Round General Agreement on Tariffs and Trade (Tokyo Round Codes). Agreement on Technical Barriers to Trade. https://www.wto.org/english/docs_e/legal_e/tokyo_tbt_e.pdf.
  41. Thow AM, Jones A, Huckel Schneider C, Labonté R. Increasing the public health voice in global decision-making on nutrition labelling. Global Health. 2020;16(1):3. doi:1186/s12992-019-0533-3
  42. World Health Organization (WHO), United Nations Children's Fund (‎‎UNICEF). International Trade Agreements and Implementation of the International Code of Marketing of Breast-Milk Substitutes: Frequently Asked Questions. Geneva: WHO; 2020.
  43. Lester S. Food Regulation, Science, Protectionism, and Regulatory Autonomy/Sovereignty. International Economic Law and Policy Blog. 25 2020. https://ielp.worldtradelaw.net/2020/06/food-regulation-science-and-trade-policy.html.
  44. Halabi SF. The Codex Alimentarius commission, corporate influence, and international trade: a perspective on FDA's global role. Am J Law Med. 2015;41(2-3):406-421. doi:1177/0098858815591525
  45. Wieck C, Grant JH. Codex in motion: food safety standard setting and impacts on developing countries’ agricultural exports. EuroChoices. 2021;20(1):37-47. doi:1111/1746-692x.12293
  46. World Health Organization Secretariat. Basic Documents, 49th Edition. Geneva: World Health Organization; 2020. https://apps.who.int/gb/bd/PDF/bd48/basic-documents-48th-edition-en.pdf. Accessed July 22, 2021.
  47. Koletzko B, Shamir R. Standards for infant formula milk. BMJ. 2006;332(7542):621-622. doi:1136/bmj.332.7542.621
  48. United States Trade Representative. Foreign Trade Barriers. Washington, DC: Executive Office of the President of the United States; 2018:504. https://ustr.gov/sites/default/files/files/Press/Reports/2018%20National%20Trade%20Estimate%20Report.pdf.
  49. USDA Foreign Agricultural Service. Thailand’s Milk Code Passed the National Legislative Assembly. Bangkok, Thailand: USDA; 2017:14.
  50. Joint FAO/WHO Standards Programme. Report of the Forty-First Session of the Codex Committee on Nutrition and Foods for Special Dietary Purposes. Rome, Italy: Codex Alimentarius Commission; 2020.
  51. Joint FAO/WHO Standards Programme. Report of the Sevety-First Session of the Executive Committee of the Codex Alimentarius Commission Executive Committee of the Codex Alimentarius Commission. Rome, Italy: Codex Alimentarius Commission; 2016.
  52. Joint FAO/WHO Standards Programme Executive Committee of the Codex Alimentarius Commission. Relations between FAO and WHO Policies, Strategies and Guidelines, and Codex Work. Rome, Italy: Codex Alimentarius Commission; 2016.
  53. Joint FAO/WHO Standards Programme Executive Committee of the Codex Alimentarius Commission. Report of the Seventy-Third Session of the Executive Committee of the Codex Alimentarius Commission. Geneva: Codex Alimentarius Commission; 2017.
  54. Joint FAO/WHO Standards Programme. Report of the Fortieth Session of the Codex Alimentarius Commission. Geneva, Switzerland: Codex Alimentarius Commission; 2017.
  55. Committee on Sanitary and Phytosanitary Measures. Summary of Meeting 2-3 November 2017. Geneva: World Trade Organization; 2017.
  56. Committee on Sanitary and Phytosanitary Measures. Summary of Meeting 1-2 March 2018. Geneva: World Trade Organization; 2018.
  57. Joint FAO/WHO Food Standards Programme. Report of the Seventy-First Session of the Executive Committee of the Codex Alimentarius Commission. Rome, Italy: Codex Alimentarius Commission; 2016.
  58. Council for Trade-Related Aspects of Intellectual Property Rights. Cross Promotion: Communication from Mexico. November 2019. https://docs.wto.org/dol2fe/Pages/SS/directdoc.aspx?filename=q:/IP/C/W660.pdf.
  59. Chan DC, Dickstein MJ. Industry input in policy making: evidence from Medicare. Q J Econ. 2019;134(3):1299-342. doi:1093/qje/qjz005
  60. Cattaneo A, Pani P, Carletti C, et al. Advertisements of follow-on formula and their perception by pregnant women and mothers in Italy. Arch Dis Child. 2015;100(4):323-328. doi:1136/archdischild-2014-306996
  61. Berry NJ, Jones S, Iverson D. It's all formula to me: women's understandings of toddler milk ads. Breastfeed Rev. 2010;18(1):21-30.
  62. Smith J, Blake M. Infant food marketing strategies undermine effective regulation of breast-milk substitutes: trends in print advertising in Australia, 1950-2010. Aust N Z J Public Health. 2013;37(4):337-344. doi:1111/1753-6405.12081
  63. Boza S, Guerrero M, Barreda R, Espinoza M. Recent Changes in Food Labelling Regulations in Latin America: The Cases of Chile and Peru. World Trade Institute; 2017. https://www.wti.org/research/publications/1053/recent-changes-in-food-labelling-regulations-in-latin-america-the-cases-of-chile-and-peru/.
  64. Cororaton, Orden D. The Importance of Technical Barriers to Agri-Food Trade: Evidence from the TBT Specific Trade Concerns Raised at the WTO. Virginia Tech Global Issues Initiative; 2019. https://vtechworks.lib.vt.edu/handle/10919/91418.
  65. Joint FAO/WHO Food Standards Programme Codex Committee on Food Labelling. Proposed Draft Guidelines on Front-of-Pack Nutrition Labelling. May 2020. http://www.fao.org/fao-who-codexalimentarius/shproxy/en/?lnk=1&url=https%253A%252F%252Fworkspace.fao.org%252Fsites%252Fcodex%252FMeetings%252FCX-714-45%252Fdocuments%252Ffl45_06e_final.pdf. Accessed August 30, 2020.
  66. Guilding Principles and Framework Manual for Front-of-Pack Labelling for Promoting Healthy Diet. Geneva: World Health Organization; May 2019. https://www.who.int/nutrition/publications/policies/guidingprinciples-labelling-promoting-healthydiet/en/. Accessed August 30, 2020.
  67. Maggi G, Ossa R. Are Trade Agreements Good for You? National Bureau of Economic Research; 2020. doi:3386/w27252
  68. Baker P, Russ K, Kang M, et al. Globalization, first-foods systems transformations and corporate power: a synthesis of literature and data on the market and political practices of the transnational baby food industry. Global Health. 2021;17(1):58. doi:1186/s12992-021-00708-1
  69. Arendt M. Codex Alimentarius: what has it to do with me? J Hum Lact. 2018;34(4):704-710. doi:1177/0890334418794658
  70. Pries AM, Mulder A, Badham J, Sweet L, Yuen K, Zehner E. Sugar content and nutrient content claims of growing-up milks in Indonesia. Matern Child Nutr. 2021;e13186. doi:1111/mcn.13186

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History

  • Receive Date: 15 January 2021
  • Revise Date: 25 July 2021
  • Accept Date: 17 August 2021
  • First Publish Date: 24 August 2021

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