Social, political, and economic forces shape the diet and nutrition of individuals, families, and communities—but the commercial determinants of health are increasingly recognized as powerful drivers of population health. Food systems carry hidden costs that place further burden on economies, and a large body of research attests to the deleterious effects of sweetened beverages and ultra-processed foods on child health. 

Our recent study analyzed Ecuador's child malnutrition policies approved between 2020 and 2023 to identify how private interests are becoming legally integrated into the public sector. The analysis shows that recent policy changes are enabling corporations to promote their brands, gain tax deductions, oversee public policy, set priorities, allocate resources, and decide on the implementation of the country's child malnutrition strategy.   

Presidential executive orders have appointed corporate representatives to Ecuador's Advisory Council of the Secretariat tasked with fighting child malnutrition. Because these corporate agents are not public officials, they are free from the scrutiny and accountability normally applied to elected or appointed public servants. They do not, for example, have to provide a sworn statement of financial interests yet have access to privileged information the general public does not get to see. 

Chronic child malnutrition is a worldwide public health concern

Chronic child malnutrition is a worldwide public health concern, but the stakes are often high in low- and middle-income countries that suffer from a double burden—a concurrent manifestation of undernutrition and obesity. In Ecuador, one in four children under five years old have chronic malnutrition, and half of all households face food insecurity, significantly affecting child development. By adulthood, more than half are overweight or obese and almost one in five have hypertension or diabetes. 

The fight against nutritional problems, therefore, requires monitoring the role of corporate influence in policy and decision-making. A decade ago, all World Health Organization (WHO) member states endorsed nineteen policies to address noncommunicable disease risk factors—twelve of which are aimed at commercial determinants of health.  

Still, food industries, particularly those producing and selling ultra-processed food and beverage products, continue to thrive, especially in emerging economies.  

The Commercial Path into Ecuador's Food Governance 

Ecuador is one of many countries worldwide where the private interests of the ultra-processed food and beverage industry seem to have a growing influence on nutrition and health policy. A closer look at the sequence of events here over the past four years suggests that commercial gain is taking precedence over the health of the general population.  

In 2020, then President Lenin Moreno created the Ecuador Grows Without Malnutrition National Strategy. A year later, the new administration of Guillermo Lasso changed the name of the Life Course Plan Secretariat that was overseeing the national strategy to Ecuador Free of Child Malnutrition Secretariat. A former pharmaceutical executive was appointed ad honorem government advisor on child malnutrition policy and president of the secretariat's first Advisory Council. He led the publication of the Intersectoral Plan to Prevent and Reduce Chronic Child Malnutrition launched later that year. 

Around the same time, the self-labeled civil society organization Ecuadorian Child Nutrition Network (REDNI) was founded by representatives from the National Association of Food and Beverages Makers, which counts eighty-three transnational and large national corporations among its members, including Bimbo, Mondelez, Coca Cola, PepsiCo, Kellogg's, Nestle, and Omnilife. It would appear that these companies are deploying a playbook developed in their North American and European headquarters.  

Commercial gain is taking precedence over the health of the general population

Subsequent executive orders by former President Lasso completed the legal structure strengthening decision-making authority—and financial benefits—for ultra-processed food and beverage corporations and related commercial entities.  

Although it may be reasonable for private-sector representatives to have a seat at the table to discuss decisions that can directly affect their entities, such as agricultural subsidies or rises in the costs of energy, it is less clear why they should have such a prominent role in nutrition and health policy.

Even if these corporate representatives become involved, clear and transparent mechanisms for their involvement and accountability should be in place.  

Corporate Nonprofits at the Dinner Table 

Industrial players are creating noncommercial entities including nonprofit organizations and NGOs across the globe to gain influence in governmental decision-making. To identify red flags, monitoring groups, the media, and concerned citizens can use a six-item checklist, based on a corporate surveillance framework created by Elizabeth Bennett and her colleagues:  

1. Are representatives of corporate entities participating in national policy committees or fora? 
2. Are high-level government officials employed by corporations within five years of government employment and vice versa?  
3. Are there signs of market concentration of corporations in unhealthy commodity industries in the national economy?  
4. Are they providing financial support—cash or in-kind—to key international organizations?  
5. Do they organize events or campaigns aimed at promoting corporate social responsibility, sponsorship of sports or cultural associations or clubs and charity affiliations?  
6. Do front groups have connections to the food and beverages industry? 

This corporate surveillance checklist facilitated identifying how the ultra-processed food and beverages industry has captured civil society via industry front groups such as REDNI and gained direct participation in Ecuador's government agencies such as the Advisory Council of the Secretariat. While being involved in the Advisory Council, the sector has effectively co-opted the council's mandate to shape nutrition and health policy free of public or civil society oversight.  

Corporations gained benefits such as tax deductions in exchange for engaging in efforts against child malnutrition or tax reductions for products such as sweetened beverages, which runs contrary to WHO recommendations. The pattern described here is similar to that in research conducted during the COVID-19 pandemic, when emergency committee resolutions appeared to prioritize private-sector interests in Ecuador.  

This blurring of lines raises significant concerns about the integrity and transparency of policies intended to combat chronic child malnutrition. National authorities and international cooperation agencies should work toward improved and actionable regulations to limit industry influence in nutrition and health policy and strengthen transparency and accountability mechanisms.  

Transparency in policymaking is not just a matter of good governance; it's a safeguard for public health. When the corporate world's interests are woven into the fabric of national health strategies, the risk of policies that favor profits over public health becomes real. The public deserves clarity and openness on decisions that affect their health. 

This blurring of lines raises significant concerns about the integrity and transparency of policies intended to combat chronic child malnutrition

As a lever toward transparency and accountability, Ecuador's Constitution already provides a legal framework to limit private-sector influence. Current laws prevent banking and media shareholders from owning stock in companies that do not operate in the same line of business. Moreover, the law limits information sharing and revolving doors between public entities and the banking sector and dictates that banks' social responsibility initiatives (e.g., financial literacy workshops) may not be used to promote their brand, products, or services. Such legal precedent should encourage the new administration to introduce reforms targeted at curtailing corporate influence by the ultra-processed food industry in national nutrition and health policy. 

How can citizens connect the dots and identify these concerning overlaps? Civil society groups' vigilance and commitment to scrutinizing government decisions, including via public records requests, are key. The red flags are often policies unusually favorable to a specific industry or the presence of industry representatives in key advisory roles.  

Assessments in other countries are clearly needed in the region of how public health policies are being formulated and under whose influence and the enactment of stricter conflict of interest regulations and improved accountability mechanisms for public officials and private interests, as well as clearer means for a more robust civil society participation in policymaking.