Non-governmental organisations seeking stronger international regulation of the ultra-processed food and alcohol industries rely predominantly on non-confrontational, collaborative insider strategies directed at international agencies and national governments rather than confrontational public campaigns. According to a qualitative study led by Kathrin Lauber and colleagues published in Globalization and Health, civil society advocates operating in multilateral spaces overwhelmingly concentrate their limited resources on technical consultations, bilateral policy dialogues, and formal institutional channels. Although public health scholarship frequently celebrates civil society as an aggressive watchdog capable of countering corporate power, the empirical findings demonstrate that health advocates working at the global level systematically prioritize diplomatic cooperation with multilateral bodies such as the World Health Organization over noisy public agitation. This strategic orientation reflects both the political mechanics of multilateral institutions and the acute institutional constraints that shape advocacy across commercial determinants of health.
The global production, marketing, and distribution of ultra-processed foods and alcoholic beverages represent central drivers of preventable non-communicable disease burdens worldwide. Transnational corporations in both sectors are predominantly headquartered in high-income economies while aggressively pursuing market expansion across low- and middle-income nations. Effective public health responses require coordinated international governance mechanisms to counteract corporate political and market power, which has historically obstructed binding regulatory instruments, fiscal policies, and marketing restrictions. While political economy scholarship has extensively mapped corporate political strategies, the countervailing tactics adopted by public health non-governmental organisations have remained comparatively under-researched. Understanding how civil society navigates fragmented global governance frameworks provides critical empirical insight into why commercial regulation develops unevenly across distinct health-harming commodities.
To investigate these dynamics, the research team conducted twenty-two semi-structured qualitative interviews with professional civil society advocates actively engaged in global debates surrounding ultra-processed foods, alcohol governance, or multiple non-communicable disease risk factors. This primary cohort comprised twelve advocates representing ten international non-governmental organisations maintaining formal global mandates or official relations status with the World Health Organization, alongside ten advocates working at regional or domestic organisations engaged in multilateral processes. To capture reciprocal governance perspectives, the authors complemented civil society accounts with six semi-structured interviews conducted with international civil servants from relevant intergovernmental organisations, two of whom possessed prior professional experience within international non-governmental bodies. The qualitative data underwent combined inductive and deductive thematic analysis, using established interest group models to categorize strategic behaviors across institutional environments.
The study grounded its analytical framework in political economy and interest group scholarship, particularly the classic inside-outside heuristic expanded by Colli and Adriaensen and adapted to commercial determinants of health by Townsend and colleagues. In this conceptualization, inside strategies encompass formal, technical engagement within administrative structures, including the direct provision of research submissions, official consultation responses, and private meetings with civil servants. Conversely, outside strategies describe public-facing interventions such as protests, boycotts, grassroots mobilization, and aggressive media exposés designed to alter public sentiment. The analytical model further evaluates advocacy targets across state institutions and private commercial markets, categorizing the intended outcomes into substantive policy changes, procedural reforms in governance access, and normative shifts regarding how commercial conflicts of interest are understood by international policymakers.
The empirical findings reveal that globally focused health advocates overwhelmingly identify inside strategies directed at intergovernmental bodies and member states as their most effective operational pathway. Engagement within the United Nations system remains heavily centered upon the World Health Organization, where advocates utilize formal accreditation, participate in technical advisory committees, and contribute detailed written feedback to draft resolutions and action plans. Furthermore, because international organisations are governed by national governments, advocates view member state delegations and Geneva-based Permanent Missions as vital intermediary targets. Rather than functioning as standalone public campaigns, outside tactics such as publishing analytical reports or issuing coordinated joint statements are primarily deployed as secondary levers to support high-level diplomatic negotiations and bolster the political leverage of supportive public health officials during governing body assemblies.
Direct market targeting proved exceptionally uncommon across the sample of health non-governmental organisations, illustrating a fundamental divergence between traditional consumer activism and multilateral health advocacy. Rather than attempting to alter corporate conduct directly through public boycotts, private shareholder negotiations, or collaborative voluntary agreements, advocates systematically direct their monitoring activities toward public authorities. Independent monitoring and documentation of commercial practices are utilized to build robust evidential dossiers that justify mandatory statutory regulation by sovereign governments. Notably, participants actively challenged the normative assumption that non-governmental groups can or should operate as comprehensive corporate watchdogs. Citing severe resource disparities and the structural impossibility of monitoring transnational commercial actors continuously across global markets, advocates emphasized that corporate accountability must ultimately remain the statutory responsibility of governmental and multilateral bodies.
Attempts by health advocates to expand their regulatory advocacy beyond traditional health arenas encounter formidable structural and institutional barriers. Although respondents universally recognized that comprehensive regulation requires influencing standard-setting bodies such as the Codex Alimentarius Commission, the Food and Agriculture Organization, the World Trade Organization, and the United Nations Food Systems Summit, sustained engagement across these spaces remains minimal. Participating in non-health institutions demands immense procedural literacy, specialized technical expertise, and dedicated personnel that non-profit budgets cannot sustain. Furthermore, health advocates reported operating as vulnerable outsiders within agricultural and trade bodies dominated by entrenched commercial interests and permissive multistakeholder norms. In several notable instances, health non-governmental organisations deliberately withdrew from processes like the United Nations Food Systems Summit after concluding that excessive corporate partnership had compromised meaningful civil society participation.
The study detailed an interconnected set of substantive, procedural, and normative goals pursued by health advocates within multilateral policy arenas. Substantively, organisations seek the adoption of rigorous technical guidance, such as non-communicable disease interventions, dietary standards, and the World Health Organization SAFER initiative for alcohol policy. Procedurally, advocates prioritize strict institutional safeguards against commercial conflicts of interest to insulate policy formulation from corporate interference. Normatively, civil society seeks to dismantle prevailing individual-responsibility narratives by reframing chronic diseases as systemic outcomes of commercial environments, while simultaneously challenging the uncritical institutional embrace of multistakeholder partnerships. However, while advocates frequently cite the legally binding World Health Organization Framework Convention on Tobacco Control as an inspiring regulatory model, they view comparable global treaties for alcohol or ultra-processed foods as politically distant due to entrenched commercial lobbying and complex societal perceptions of food and alcohol.
The findings illustrate profound structural pressures that explain why global health advocacy remains predominantly quiet and technocratic. Drawing on Stroup and Wong’s concept of the authority trap, the researchers explain that elite non-governmental organisations that successfully attain privileged insider status within multilateral institutions face powerful institutional incentives to preserve their access and professional credibility. Confrontational public protests or severe criticism of institutional leaders threaten long-term consultative relationships, inadvertently pushing established organisations toward cautious, incremental policy victories. Furthermore, interviewees from domestic organisations and the Global South expressed frustration with the bureaucratic, Eurocentric norms of Geneva-based institutions, arguing that the stringent administrative requirements for official relations status reinforce the dominance of well-resourced Northern organisations while marginalizing more disruptive, grassroots advocacy approaches.
In evaluating these observations, the authors emphasize several methodological boundaries, noting that the qualitative sample focused specifically on formally established non-governmental organisations holding insider access within global health governance. Consequently, the research design excluded outsider protest movements, radical food sovereignty networks, shareholder activist groups, and industry-sponsored civil society bodies, while qualitative reporting does not quantify the absolute prevalence of advocacy tactics across the entire civil society sector. In conclusion, the study demonstrates that achieving corporate accountability through global governance requires recognizing the structural limitations of quiet diplomacy. Because technical insider advocacy alone cannot dismantle corporate political power, the authors call upon philanthropic funders and international agencies to resource sustained, strategic civil society engagement across trade and agricultural domains, expanding public health advocacy well beyond conventional administrative boundaries.
Subject of Research: Qualitative analysis of non-governmental organisation advocacy strategies and institutional constraints in global ultra-processed food and alcohol governance
Article Title: Non-governmental organisations and the regulation of harmful commodity industries: navigating global governance to change corporate practices
Article References: Lauber, K., Townsend, B., Arnanz, L., Baum, F., Cullerton, K., Friel, S., Holmes, R., Martin, J., Ralston, R., & Collin, J. (2026). Non-governmental organisations and the regulation of harmful commodity industries: navigating global governance to change corporate practices. Globalization and Health, 22(1), Article 40. https://doi.org/10.1186/s12992-026-01200-4
Image Credits: AI Generated
DOI: 10.1186/s12992-026-01200-4
Keywords: Commercial Determinants of Health, Global Health Governance, Non-Governmental Organisations, Ultra-Processed Foods, Alcohol Policy, World Health Organization, Inside Advocacy Strategies, Public Accountability, Corporate Regulation, Non-Communicable Diseases, Codex Alimentarius, UN Food Systems Summit, Food and Agriculture Organization, Interest Group Theory, Multistakeholder Governance, Institutional Constraints, Framework Convention on Tobacco Control