The impact of trade and investment agreements on the implementation non-communicable disease policies, 2014-2019: protocol for a statistical study

IntroductionRegulating tobacco, alcohol, and unhealthy foods and drinks is a cornerstone of global efforts to combat the Non-Communicable Disease (NCD) pandemic, but implementation of these policies remains slow. It has been suggested that producers of these unhealthy commodities use rules in Trade and Investment Agreements (TIAs) to delay and undermine NCD policy implementation. Yet, there is no systematic empirical evidence linking TIA participation to reduced implementation. Here we present a study protocol for a statistical analysis of the relationship between TIA participation and the implementation of regulations on tobacco, alcohol, and unhealthy food and drink in 154 countries, 2014-2019. Methods and analysisWe aim to examine whether participation in TIAs with the EU and US is associated with implementation of regulations targeting tobacco, alcohol, and unhealthy food and drink. We focus on TIAs with these countries as their TIAs create multiple opportunities to contest health regulations, and a majority of the major unhealthy commodity producers are registered in these jurisdictions. Partial and full implementation is captured in a recently published dataset which systematically coded implementation of 11 NCD policies in 2014, 2016 and 2019. We will combine these outcome data with TIA membership and covariate data from multiple sources. We will calculate descriptive statistics and use both regression adjustment and matching to conduct covariate-adjusted, quasi-experimental comparisons of implementation levels and progress according to whether or not countries have a TIA with the EU or US. Further analyses and robustness checks will examine additional TIA participation arrangements and test the sensitivity of our results to our model specifications. Ethics and disseminationEthics approval will not be required as the study uses anonymised and pre-aggregated data. Findings will be disseminated to policymakers via personal contacts and press releases in parallel with scientific papers and conference presentations. FundingThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.