| Summary: | Introduction: Mexico’s prevalence of adult overweight and obesity is 72.5%, and 34.4% for school children. Mexico has one of the highest consumption of sugar-sweetened beverages globally. In 2012, during the transition to a new President, a new obesity strategy was proposed and developed. As part of this policy, a soda tax was implemented in Mexico in January 2014. The aim of this thesis is to explore how the soda tax emerged as a policy issue in Mexico and how stakeholders influenced its development and implementation. Methods: Thirty-three semi-structured elite interviews were conducted with stakeholders involved in the obesity policy process. Interview data was triangulated with data collected through a documentary analysis, using a systematic search of a wide range of reports, policy and organisations documents generated before and during the soda tax design and implementation phases (January 2011 to December 2015). This resulted in the analysis of 145 documents. An iterative thematic qualitative analysis of both interviews and document data was conducted, guided by the policy network approach, framing theory and multiple steams theory. Results: Many contextual factors were found to have facilitated the soda tax policy development including: the new government needing to find additional sources of revenue; increased public and government awareness of the high sugar sweetened beverage (SSB) consumption in Mexico, and its relationship to obesity and diabetes trends: greater influence gained by national NGOs through use of the media and supported by international organizations, use of existing national networks and new collaborations within Mexico. Some key relationships and links influenced the agenda setting for important policy issues. This included how conflict of interests, accountability, and representations in the formal policy process were managed. This revealed power imbalances around the policy debates and shifts in the attitude, responsibilities and actions of major actors The Ministry of Health (MOH) and Ministry of Finance (MOF) were initially ambivalent and resisted development of a soda tax,not always being strong advocates as would have been expected. The formal policy design process followed a multi-stakeholder approach which actively involved the food and beverage industry (F&BI). They were able to influence policy actions to mitigate the soda tax impact on the F&BI, undermining some outcomes. Actions by other non-state actors (e.g. ) to influence public perception about benefits and constraints of the tax included: the use of marketing strategies, calls for action using the media, framing of arguments as “the right to health” and “the multi-causality of obesity” rhetoric and implementation of corporate social responsibility actions. The effectiveness of the soda tax was highly debated in public before and after implementation, resulting in public polarization. Until the soda tax emerged as a policy option, the influence of the F&BI on health policy had not been perceived as a conflict of interest or problematic and it continues to be ignored as such by some state policy actors. Conclusion: This thesis contributes to the debate on how power is exercised, framed and shifted throughout the health policy process. It discusses the contextual factors that facilitated the soda tax development in Mexico, including how framing of evidence about obesity as a policy problem and possible solutions influenced the agenda setting. It identifies the key organisations and networks that were instrumental in policy making. This research provides evidence about how the F&BI have wielded their influence in regulatory actions within the national strategy for obesity prevention, and specifically the soda tax in Mexico. It highlights how the soda tax also brought about new opportunities for some actors framed around the issue of provision of safe drinking water. The soda tax resulted in the empowerment of advocacy groups and networks nationally supported by international actors, which was counter-balanced by new public-private partnerships and corporate social responsibility actions. This thesis demonstrates that corporate interests continued to have an influence on Mexican health policy after the introduction of the soda tax.
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