Theoretical framework

Fuchs and Lederer [13] provide a systematic framework for assessing corporate power, specifically business power in global governance. They suggest that to effectively consider the material and ideational sources of power, three distinct forms of power must be considered: 1] instrumental 2] structural, and 3] discursive.

Instrumental power is how corporations seek to influence the political process through practices such as the lobbying of political actors and associated financial activities [13]. By expanding their lobbying practices, corporations can gain a competitive advantage over civil society actors [14, 15].

Structural power concerns the agenda-setting and rule-setting practices that corporate actors employ [3, 13, 16]. Agenda-setting is corporate actors influencing the importance placed on issues, determining what is worthy of policy consideration and what is not [the Overton window [17]]. In addition, corporations can directly influence policy rule-setting, for example through implementing self-regulatory measures [13].

Finally, discursive power “influences the frames of policy problems and solutions, of actors in the political process, and of politics and the political as such” [12, p8]. In particular, discursive power concerns who is considered a legitimate actor within the policy process, as well as contributing to the creation and maintenance of social norms. Although this form of power and agenda-setting within structural power are closely related, discursive power is arguably much more encompassing than agenda-setting alone. It speaks to what is considered socially normal and acceptable, for example in this case the pervasiveness of advertising of HFSS products and society’s normalisation of unhealthy food in society.

Our analysis not only employs this framework to engage with corporate power, as is the focus of Fuchs and Lederer’s [13] work, but extends and develops the framework to include a consideration of non-corporate power [e.g. parents, young people and advocacy groups] as well as State power. In the context of this study, the State refers to government and government bodies. The study demonstrates that analysing corporate power alone [although important] may result in an incomplete understanding of the power dynamics at play within UCI debates [18]. We are unaware of any other analyses of this kind, despite academic attention on the importance of considering power within the obesogenic environment [19, 20].

Data collection

We recruited participants through a variety of means: 1) advertisements distributed through community groups; 2) social media; 3) known contacts in community organisations or professional networks; and 4) snowball sampling. We facilitated focus groups with young people (conducted between June 2016 and July 2016) and parents (conducted between December 2016 and March 2017) in person within community settings or participants’ homes and digitally recorded. We conducted professional stakeholder interviews in person and via the telephone between June 2017 and March 2018, with all digitally recorded. We professionally transcribed the focus groups and interviews checked against the recordings for accuracy.

Data analysis

We employed thematic analysis [33] following Spencer et al.’s [34] analytical hierarchy approach and coded data in NVivo 12. In applying this approach, we generated descriptive accounts identifying and mapping key themes across the data. Next, we generated explanatory accounts to identify patterns of association within the data and consider explanations for why those patterns occur. It was at this point we identified that we required a specific analysis on how participants viewed and responded to power, as it appeared key to understanding their views on regulation of online advertising of HFSS products to young people. During this phase of analysis, we identified themes such as lobbying, management of self-regulation by industry, maintenance of individual autonomy as well as improper State intervention into individual’s lives were being generated through the analysis. A broader concern on power underpinned each of these themes: who has it, who does not have it, and what can be done about problematic power dynamics. We recognised it as being particularly prevalent during discussions surrounding the role of advertising in children’s lives and the regulation of such marketing. As such, we conducted a specific analysis employing Fuchs and Lederer’s [12] framework, and further developed the explanatory accounts generated previously.

We analysed datasets individually at first, to gain an in-depth understanding of the data, before synthesising the three data sets using a thematic approach to generate commonalities and patterns across the data [33] in Microsoft Word.

Instrumental power

There were several instances where participants discussed instrumental power as defined earlier, and this section focuses on how participants responded to the lobbying and financial power of industry and the State. The majority of parents expressed concern over the financial relationship between industry and the State:

I don’t think that [regulation] would ever come into play because there’s too much a financial gain that there is to be had…the government and the companies are making so much…

(Parent Focus Group 4 participant 14 –child aged 6)

Parents also expressed concern as to industry’s lobbying practices:

I mean who else is gonna hold, what is essentially a powerful industry with quite, the food industry is huge, and they have massive access to the law and lobbying MPs.

(Parent Focus Group 3 participant 10—young people aged four, six and nine)

Non-industry stakeholders expressed a similar discomfort with industry’s investment in lobbying decision-makers. For example, non-industry stakeholders discussed industry’s lobbying of the Department of Culture, Media and Sport (DCMS):

…we know that behind the scenes there is certainly a lot of lobbying and DCMS and again…why marketing and promotions never happened within the final plan [Childhood Obesity Plan].

(Advocacy Stakeholder 3)

In contrast, industry stakeholders considered public health advocacy groups as lobbyists:

Advertising to young people is a…particularly topical issue at the moment, and there’s a lot of interest in the subject, particularly from politicians and lobby groups [advocacy groups]…

(Advertising Industry Stakeholder 5)

This could be considered as industry positioning public health advocacy groups as exerting their own instrumental power.

Structural power

Discursive power

Legitimate authority figure: Industry

Further to their de-legitimation of the State as an authority figure, industry attempted to legitimise their own role in the policy-making process by emphasising their responsibility:

And industry’s role is to…be as responsible as possible and not just adhere to the code, but always…try and go above it and lean into issues rather than do the minimum.

(Food and Drink Industry Stakeholder 11)

In contrast to industry participants’ emphasis on their role as legitimate authority figures, most parents, non-industry stakeholders and a minority of young people were sceptical of this legitimacy. Young people provided limited discussion on industry’s role as a legitimate authority figure. Those who did discuss it positioned industry unfavourably:

And the food industry… … scumbags.

(Young people’s Focus Group 1 –two females aged 14 and 14 and two males aged 13 and 14)

Legitimate authority figure: Parents

All participants framed parents as possessing [or should possess] authority over young people’s diets. They framed regulation of online advertising of HFSS as a policy solution, but only if it did not infringe on parental autonomy:

Yeah…there’s got to be a certain amount of …parents having the confidence and being allowed to parent their own young people as well without the government constantly putting legislation in place ‘oh you’ve got to do this you’ve got to do that’.

(Parent Focus Group 2 participant 5 young people aged five)

However, what was notable was that some participants believed that increased statutory regulation would provide parents with greater power in this arena:

So, it’s not just about restricting freedom…What we’re saying is let’s take the power and the choice of what your young people are eating, let’s take it away from the food industry and give it back to you as parents.

(Academic Stakeholder 9)

Industry similarly positioned parents as legitimate authority figures. Food and Drink Industry Stakeholder 8 suggested that parents were primarily responsible for young people’s dietary preferences and the impact of online advertising of HFSS products. However, they highlighted industry’s role as being part of the solution, suggesting that industry’s role was to provide help to parents:

So back to your question about parents you know, they—we need to find ways to support them, and that isn’t easy, it’s clearly not easy, ‘cause we’re not doing a great job it, you know, not us, not government, not schools.

(Food and Drink Industry Stakeholder 8)

Policy and practice implications

The key implication of this study is that to garner increased public support for regulatory policies that seek to help parents and young people reclaim young people’s diets, it may be pertinent to emphasise the empowering elements of those regulatory policies that tap into people’s deeply held values or beliefs [40]. As such, advocacy actors may wish to shift their framing of regulation from one that restricts industry practices, to one that empowers individuals as recommended in previous research on public health ethics [49]. One technique may be to employ values-based framing in public health messaging aimed at policymakers and the public, which involves engaging with people’s deeply held values to motivate concern and action, rather than solely focusing on the ‘facts’ of a policy or regulation [40]. This could potentially serve two important purposes. One, it may aid in increasing the likelihood of policymakers implementing policy that seeks to address problematic power dynamics, as previous research indicates the importance of values and stories within the policy making process [40, 50]. Two, it may also aid in increasing public acceptability of such policies.

Furthermore, this study demonstrates the utility of using such distinctions of power, which may help galvanise the public and non-industry actors in addressing the problematic power dynamics explored in this study. By breaking down power into three distinct, albeit inherently intertwined, forms of power we may be better able to develop strategies and policies designed to mitigate some of the problematic effects. Previous studies of power arguably present power as a rather unwieldy, fuzzy concept that makes it difficult to practically see where intervention can be taken, and where increasing public power may occur. This study may be useful in beginning to address this issue, for example aiding families and young people in contributing to the setting of the policy agenda or increasing non-State and non-industry actors’ discursive power.

Limitations of study

Although this study has presented novel findings, we acknowledge some limitations. Firstly, we employed a secondary analysis of focus groups with young people, and as such the design of that data set was not conducted in line with the focus groups with parents or professional stakeholder interviews. This may have led to a slight incongruence of the data. However, LCW, SH and SC were involved in the original study with young people, and as such brought in-depth knowledge to this current study that otherwise would not have been available. In addition, it is unusual to have a broad range of stakeholders included in a study, particularly those stakeholders who policy is most likely to impact. Furthermore, the larger study [18] did not originally set out to analyse power, and as such questions were not necessarily framed to elicit direct responses on power dynamics. Despite this, the fact that power was so prominent in the data without direct questioning suggests its importance in the debate. It also suggests the importance of conducting further research into the issues of perceptions of power within CDoH when considering the public acceptability of policy designed to address the CDoH. Lastly, the methods we used in the study did not allow for a large number of participants to be included (like a survey may do), however the findings generated from the analysis may be transferable to other policy arenas or unhealthy commodity regulatory debates. To further expand on this research and extend its utility, it may be pertinent to conduct work that explicitly seeks to conduct in-depth analyses on power with the public. This could take place in the form of a population-wide survey, or through a more deliberative process such as citizens’ juries [51].