What Opportunities Exist for Making the Food Supply Nutrition Friendly? A Policy Space Analysis in Mexico

Document Type : Original Article


1 Master’s and Doctorate Program in Medical and Health Sciences, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico

2 Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW, Australia

3 Faculty of Economics, National Autonomous University of Mexico, Mexico City, Mexico

4 Department of Public Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico

5 Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico

6 National Council for Science and Technology (CONACYT), Mexico City, Mexico


As part of a global policy response for addressing malnutrition, food system actions have been proposed. Within food system interventions, policies directed to supply chains have the potential to increase the availability and affordability of a healthy diet. This qualitative study aimed to identify opportunities to integrate nutrition as a priority into the food supply policy space in Mexico.

Data were collected through analysis of 19 policy documents and 20 semi-structured stakeholder interviews. As an analytical framework, we used policy space analysis and embedded the Advocacy Coalition Framework (ACF) and the steps of the food chain of the conceptual framework of food systems for diets and nutrition.

Policy issues relevant to nutrition were viewed differently in the economic and agricultural sectors versus the health sector. Overall, the main policy objective related to nutrition within the economic and agricultural sectors was to contribute to food security in terms of food quantity. Nutrition was an objective in itself only in the health sector, with a focus on food quality. Our policy space analysis reveals an opportunity to promote a new integrated vision with the recent creation of an intersectoral group working on the public agenda for a food system transformation. This newer integrative narrative on food systems presents an opportunity to shift the existing food security narrative from quantity towards considerations of diet quality.

The political context and public agenda are favorable to pursue a food system transformation to deliver sustainable healthy diets. Mexico can provide a case study for other low- and middle-income countries (LMICs) for putting nutrition at the center of food policy, despite the ongoing constraints on achieving this.


  1. Amuna P, Zotor FB. Epidemiological and nutrition transition in developing countries: impact on human health and development. Proc Nutr Soc. 2008;67(1):82-90. doi:1017/s0029665108006058
  2. Tanumihardjo SA, Anderson C, Kaufer-Horwitz M, et al. Poverty, obesity, and malnutrition: an international perspective recognizing the paradox. J Am Diet Assoc. 2007;107(11):1966-1972. doi:1016/j.jada.2007.08.007
  3. Thow AM, Kadiyala S, Khandelwal S, Menon P, Downs S, Reddy KS. Toward food policy for the dual burden of malnutrition: an exploratory policy space analysis in India. Food Nutr Bull. 2016;37(3):261-274. doi:1177/0379572116653863
  4. [Halfway National Health and Nutrition Survey 2016]. https://www.gob.mx/cms/uploads/attachment/file/209093/ENSANUT.pdf. Accessed January, 2019. Published 2016.
  5. Lozano R, Gómez-Dantés H, Garrido-Latorre F, et al. [Burden of disease, injuries, risk factors and challenges for the health system in Mexico]. Salud Publica Mex. 2013;55(6):580-594. [Spanish].
  6. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020. http://www.who.int/nmh/publications/ncd-action-plan/en/. Accessed January, 2019. Published 2013.
  7. Batis C, Aburto TC, Sánchez-Pimienta TG, Pedraza LS, Rivera JA. Adherence to dietary recommendations for food group intakes is low in the Mexican population. J Nutr. 2016;146(9):1897S-1906S. doi:3945/jn.115.219626
  8. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-492. doi:1016/s0140-6736(18)31788-4
  9. Anand SS, Hawkes C, de Souza RJ, et al. Food consumption and its impact on cardiovascular disease: importance of solutions focused on the globalized food system: a report from the workshop convened by the World Heart Federation. J Am Coll Cardiol. 2015;66(14):1590-1614. doi:1016/j.jacc.2015.07.050
  10. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-2260. doi:1016/s0140-6736(12)61766-8
  11. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3-21. doi:1111/j.1753-4887.2011.00456.x
  12. Hawkes C, Jewell J, Allen K. A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: the NOURISHING framework. Obes Rev. 2013;14 Suppl 2:159-168. doi:1111/obr.12098
  13. Swinburn B, Sacks G, Vandevijvere S, et al. INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): overview and key principles. Obes Rev. 2013;14 Suppl 1:1-12. doi:1111/obr.12087
  14. Nutrition and Food Systems. A Report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security. 7 http://www.fao.org/3/a-i7846e.pdf. Accessed January, 2019. Published 2017.
  15. FAO, IFAD, UNICEF, WFP, WHO. The State of Food Security and Nutrition in the World 2020: Transforming Food Systems for Affordable Healthy Diets. Rome: FAO; 2020.
  16. Hyseni L, Atkinson M, Bromley H, et al. The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: scoping review. Eur J Clin Nutr. 2017;71(6):694-711. doi:1038/ejcn.2016.234
  17. Hawkes C, Smith TG, Jewell J, et al. Smart food policies for obesity prevention. Lancet. 2015;385(9985):2410-2421. doi:1016/s0140-6736(14)61745-1
  18. Hawkes C. Promoting healthy diets and tackling obesity and diet-related chronic diseases: what are the agricultural policy levers? Food Nutr Bull. 2007;28(2 Suppl):S312-322. doi:1177/15648265070282s210
  19. Global Panel on Agriculture and Food Systems for Nutrition. Future Food Systems: For People, Our Planet, and Prosperity. London, UK: Global Panel on Agriculture and Food Systems for Nutrition; 2020.
  20. United Nations. United Nations Decade of Action on Nutrition 2016-2025. https://www.un.org/nutrition/sites/www.un.org.nutrition/files/general/pdf/1-nutrition_decade_flyer_intro_for_web.pdf. Accessed April, 2021.
  21. FAO, PAHO, WFP, UNICEF, IFAD. Regional Overview of Food Security and Nutrition in Latin America and the Caribbean 2020 – Food Security and Nutrition for Lagged Territories – In Brief. Santiago: FAO; 2021.
  22. Morales-Ruán MDC, Shamah-Levy T, Mundo-Rosas V, Cuevas-Nasu L, Lozada-Tequeanes AL, Romero-Martínez M. [Evolution of social food assistance programs in Mexico through Ensanut MC 2016 data]. Salud Publica Mex. 2018;60(3):319-327. doi:21149/8818
  23. Monterrosa EC, Campirano F, Tolentino Mayo L, et al. Stakeholder perspectives on national policy for regulating the school food environment in Mexico. Health Policy Plan. 2015;30(1):28-38. doi:1093/heapol/czt094
  24. Barrera LH, Rothenberg SJ, Barquera S, Cifuentes E. The toxic food environment around elementary schools and childhood obesity in Mexican cities. Am J Prev Med. 2016;51(2):264-270. doi:1016/j.amepre.2016.02.021
  25. Théodore F, Juárez-Ramírez C, Cahuana-Hurtado L, Blanco I, Tolentino-Mayo L, Bonvecchio A. [Barriers and opportunities for the regulation of food and beverage advertising to children in Mexico]. Salud Publica Mex. 2014;56 Suppl 2:S123-129.
  26. Bridle-Fitzpatrick S. Food deserts or food swamps?: a mixed-methods study of local food environments in a Mexican city. Soc Sci Med. 2015;142:202-213. doi:1016/j.socscimed.2015.08.010
  27. Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. BMJ. 2016;352:h6704. doi:1136/bmj.h6704
  28. Moise N, Cifuentes E, Orozco E, Willett W. Limiting the consumption of sugar sweetened beverages in Mexico's obesogenic environment: a qualitative policy review and stakeholder analysis. J Public Health Policy. 2011;32(4):458-475. doi:1057/jphp.2011.39
  29. Pérez-Ferrer C, Lock K, Rivera JA. Learning from international policies on trans fatty acids to reduce cardiovascular disease in low- and middle-income countries, using Mexico as a case study. Health Policy Plan. 2010;25(1):39-49. doi:1093/heapol/czp040
  30. Charvel S, Cobo F, Hernández-Ávila M. A process to establish nutritional guidelines to address obesity: lessons from Mexico. J Public Health Policy. 2015;36(4):426-439. doi:1057/jphp.2015.28
  31. Clark SE, Hawkes C, Murphy SM, Hansen-Kuhn KA, Wallinga D. Exporting obesity: US farm and trade policy and the transformation of the Mexican consumer food environment. Int J Occup Environ Health. 2012;18(1):53-65. doi:1179/1077352512z.0000000007
  32. Gillespie S, van den Bold M. Agriculture, food systems, and nutrition: meeting the challenge. Glob Chall. 2017;1(3):1600002. doi:1002/gch2.201600002
  33. Tangcharoensathien V, Srisookwatana O, Pinprateep P, Posayanonda T, Patcharanarumol W. Multisectoral actions for health: challenges and opportunities in complex policy environments. Int J Health Policy Manag. 2017;6(7):359-363. doi:15171/ijhpm.2017.61
  34. Guell C, Mackett R, Ogilvie D. Negotiating multisectoral evidence: a qualitative study of knowledge exchange at the intersection of transport and public health. BMC Public Health. 2017;17(1):17. doi:1186/s12889-016-3940-x
  35. Harris J. Advocacy coalitions and the transfer of nutrition policy to Zambia. Health Policy Plan. 2019;34(3):207-215. doi:1093/heapol/czz024
  36. Delobelle P. Big tobacco, alcohol, and food and NCDs in LMICs: an inconvenient truth and call to action comment on "Addressing NCDs: challenges from industry market promotion and interferences". Int J Health Policy Manag. 2019;8(12):727-731. doi:15171/ijhpm.2019.74
  37. Buse K, Mays N, Walt G. Making Health Policy. England: Open University Press; 2006.
  38. Grindle MS, Thomas JW. Public Choices and Policy Change: The Political Economy of Reform in Developing Countries. Baltimore, London: Johns Hopkins University Press; 1991.
  39. Sabatier PA, Weible CM. The advocacy coalition framework: foundations, evolution, and ongoing research. In: Sabatier PA, Weible CM, eds. Theories of the Policy Process. Colorado: Westview Press; 2014.
  40. Crichton J. Changing fortunes: analysis of fluctuating policy space for family planning in Kenya. Health Policy Plan. 2008;23(5):339-350. doi:1093/heapol/czn020
  41. World Health Organization (WHO). Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. Sixty-Sixth World Health Assembly WHA66.10 Agenda Item 12.1, 13.2. Geneva, Switzerland: WHO; 2013.
  42. Government of Mexico. [Budget of the Special Concurrent Program (PEC) for Sustainable Rural Development, for Fiscal Year 2019]. Mexico: Chamber of Deputies; 2018.
  43. Government of Mexico. [Budget Approved for 2020 of the Special Concurrent Program (PEC) for Sustainable Rural Development]. Mexico: Chamber of Deputies; 2019.
  44. Government of Mexico. [National Development Plan 2019-2024]. Mexico: Chamber of Deputies; 2019.
  45. Government of Mexico. [National Agreement for Food Self-sufficiency]. https://www.gob.mx/cms/uploads/attachment/file/458717/Acuerdo_.pdf. Accessed February, 2019. Published 2019.
  46. Government of Mexico. [National Agricultural Planning 2017-2030_part 1]. https://www.gob.mx/sader/acciones-y-programas/planeacion-agricola-nacional-2017-2030-126813. Accessed February, 2019. Published 2017.
  47. Government of Mexico. [Agreement by which the operating rules of the social milk supply program are issued, in charge of Liconsa, S.A. de C.V. (LICONSA), for fiscal year 2019]. http://dof.gob.mx/nota_detalle.php?codigo=5551716&fecha=01/03/2019. Accessed March, 2019. Published 2019.
  48. Government of Mexico. [Modification to the Official Mexican Norm NOM-051-SCFI / SSA1-2010, general specifications of labelling for prepackaged food and non-alcoholic beverages-commercial and health information]. https://www.dof.gob.mx/2020/SEECO/NOM_051.pdf. Accessed April, 2020. Published April 5, 2010. Published 2020.
  49. Government of Mexico. [Agreement by which the operational guidelines of the Production for Wellbeing Program for fiscal year 2019 are issued]. https://www.dof.gob.mx/nota_detalle.php?codigo=5548620&fecha=23/01/2019. Accessed March, 2019. Published 2019.
  50. Government of Mexico. [Agreement by which the operational guidelines of the Rural Development Program of the Ministry of Agriculture and Rural Development for fiscal year 2019 are disclosed]. https://www.dof.gob.mx/nota_detalle.php?codigo=5551593&fecha=28/02/2019. Accessed March, 2019. Published 2019.
  51. Government of Mexico. [Agreement by which the operational guidelines of the Guarantee Price Program for basic food products are issued by the Mexican Food Security, SEGALMEX, sectorized in the Ministry of Agriculture and Rural Development, for fiscal year 2019. https://dof.gob.mx/nota_detalle.php?codigo=5551718&fecha=01%2F03%2F2019. Accessed March, 2019. Published 2019.
  52. Government of Mexico. [Agreement by which the operational guidelines of the Social and Sustainable Agromarkets Program are issued for fiscal year 2019]. http://dof.gob.mx/nota_detalle.php?codigo=5554794&fecha=21/03/2019. Accessed March, 2019. Published 2019.
  53. Government of Mexico. [Agreement by which the operating rules of PROSPERA Social Inclusion Program are issued, for fiscal year 2019]. https://www.dof.gob.mx/nota_detalle.php?codigo=5551581&fecha=28/02/2019. Accessed March, 2019. Published 2019.
  54. Government of Mexico. [Agreement by which the operating rules of the Rural Supply Program are issued by Diconsa, S.A. de C.V. (DICONSA), for fiscal year 2019]. https://dof.gob.mx/nota_detalle.php?codigo=5551715&fecha=01/03/2019. Accessed March, 2019. Published 2019.
  55. Government of Mexico. [Agreement by which the rules of operation of the Community Health and Welfare Program are issued, for fiscal year 2020]. https://www.dof.gob.mx/nota_detalle.php?codigo=5583027&fecha=28/12/2019. Accessed February, 2020. Published 2019.
  56. Government of Mexico. [Agreement by which the operating rules of the Sowing life Program are issued, for fiscal year 2020]. https://www.dof.gob.mx/nota_detalle.php?codigo=5590695&fecha=30/03/2020. Accessed April, 2020. Published 2020.
  57. Government of Mexico. [Decree by which the Mexican Food Security Agency (SEGALMEX) is created]. https://dof.gob.mx/nota_detalle.php?codigo=5548402&fecha=18/01/2019. Accessed February, 2019. Published 2019.
  58. Government of Mexico. [Sectoral Program for Agriculture and Social Development 2019-2020]. Mexico: Ministry of Agriculture and Rural Development; 2019.
  59. Government of Mexico. Final texts of the Treaty between Mexico, the United States and Canada (T-MEC). https://www.gob.mx/t-mec/acciones-y-programas/textos-finales-del-tratado-entre-mexico-estados-unidos-y-canada-t-mec-202730?state=published. Accessed July 2021. Published 2019.  
  60. Food Security and Nutrition: Building a Global Narrative Towards 2030. Rome: High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security; 2020.
  61. Anderson K, Rausser G, Swinnen J. Political economy of public policies: insights from distortions to agricultural and food markets. J Econ Lit. 2013;51(2):423-477.
  62. Thow AM, Apprey C, Winters J, et al. Understanding the impact of historical policy legacies on nutrition policy space: economic policy agendas and current food policy paradigms in Ghana. Int J Health Policy Manag. 2020. doi:34172/ijhpm.2020.203
  63. Chassagnon V. Beyond markets and hierarchies: an economic analysis of vertical quasi-integration. Revue de Philosophie Économique. 2014;15(1):135-165. doi:3917/rpec.151.0135
  64. Williamson OE. Markets and hierarchies: some elementary considerations. Am Econ Rev. 1973;63(2):316-325.
  65. Thow AM, Greenberg S, Hara M, Friel S, duToit A, Sanders D. Improving policy coherence for food security and nutrition in South Africa: a qualitative policy analysis. Food Secur. 2018;10(4):1105-1130. doi:1007/s12571-018-0813-4
  66. Sampson D. Productivism, agroecology, and the challenge of feeding the world. Gastronomica. 2018;18(4):41-53. doi:1525/gfc.2018.18.4.41
  67. Vilar-Compte M, Gaitán-Rossi P, Flores D, Pérez-Cirera V, Teruel G. How do context variables affect food insecurity in Mexico? implications for policy and governance. Public Health Nutr. 2020;23(13):2445-2452. doi:1017/s1368980019003082
  68. Shamah-Levy T, Mundo-Rosas V, Flores-De la Vega MM, Luiselli-Fernández C. Food security governance in Mexico: how can it be improved? Glob Food Sec. 2017;14:73-78. doi:1016/j.gfs.2017.05.004
  69. Pérez-Escamilla R, Lutter CK, Rabadan-Diehl C, et al. Prevention of childhood obesity and food policies in Latin America: from research to practice. Obes Rev. 2017;18 Suppl 2:28-38. doi:1111/obr.12574
  70. Mialon M, Gomes FDS. Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean. Public Health Nutr. 2019;22(10):1898-1908. doi:1017/s1368980019000417
  71. Morris SS, Cogill B, Uauy R. Effective international action against undernutrition: why has it proven so difficult and what can be done to accelerate progress? Lancet. 2008;371(9612):608-621. doi:1016/s0140-6736(07)61695-x
  72. Béné C, Oosterveer P, Lamotte L, et al. When food systems meet sustainability – current narratives and implications for actions. World Dev. 2019;113:116-130. doi:1016/j.worlddev.2018.08.011
  73. Balarajan Y, Reich MR. Political economy challenges in nutrition. Global Health. 2016;12(1):70. doi:1186/s12992-016-0204-6

Articles in Press, Corrected Proof
Available Online from 28 November 2021
  • Receive Date: 10 December 2020
  • Revise Date: 25 November 2021
  • Accept Date: 27 November 2021