Aravena Rivas, Yanela Alejandra; (2025) Impact of the governance system on sugar consumption patterns in the Chilean population. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Excessive sugar consumption is a risk factor for several health conditions. Governance systems shape dietary behaviours through complex context-dependent mechanisms. Chile has passed legislation to promote healthier eating, allowing its study in the Chilean context. Aim: To determine the role of the governance system in shaping sugar consumption patterns in the Chilean population from a systems thinking perspective. Methods: A mixed methods study using a systems thinking approach was undertaken. The qualitative stage included an analysis of lobbying practices by the food industry and a rapid qualitative analysis of documents and stakeholder interviews on policymaking processes to reduce unhealthy eating, which informed the creation of a causal loop diagram of the Chilean governance system and its impact on sugar consumption. The qualitative findings were used to develop a proof-of-principle agent-based model to simulate purchasing behaviours of high-in-sugar foods. Results: Food industries extensively lobbied the Chilean government to nurture corporate reputation and influence legislation. Characteristics of the governance system and policymaking mechanisms shaped sugar consumption patterns through legislation affecting the access, availability and affordability of sugary foods. Reinforcing feedback loops prioritising economic goals influenced by neoliberal ideology created food systems promoting unhealthy diets. Barriers to public health legislation include government fragmentation, food industry influence, and a neoliberal political mindset. The analysis identified several leverage points including using existing legislation to propose new policies, focus on more powerful high-level legislation (i.e. laws), developing supporting coalitions, using research to support policymaking efforts, regulating food industry influence, strengthening civil society participation, and monitoring to update policies in dynamic contexts. Conclusion: Governance systems influence sugar consumption through complex pathways. Eating patterns depend on which pathways dominate. To promote healthier eating, action is needed at different levels of the system together with regulation of industry actors. Governmental institutions have a key role leading these efforts.

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