Non-governmental organisations and the regulation of harmful commodity industries: navigating global governance to change corporate practices.

BACKGROUND: The crucial role of non-governmental organisations (NGOs) in advancing effective regulation of health-harming corporate practices is widely accepted, yet how precisely they shape global health governance is not well-understood. While a vast literature has grappled with corporate power and its political, market, and technological dimensions, less attention has been paid to strategic efforts to counter the influence of corporate actors. Drawing on international relations and political economy scholarship, we seek to understand NGO strategies aimed at achieving greater regulation of the ultra-processed food (UPF) and alcohol industries in global fora, and examine the considerations and constraints which inform NGO strategy choice. METHODS: We conducted 22 semi-structured interviews with professional advocates active in global debates on UPF and/or alcohol governance, complemented by six interviews with officials from international organisations (IOs). Coding combined inductive and deductive approaches, with the latter informed by existing models of advocacy strategy. RESULTS: Participants described ‘inside’ strategies targeting IOs and member states as the primary focus of their organisations’ global advocacy, underpinned by a sense that such approaches are more effective. More confrontational, outside approaches were seen as inappropriate particularly for targeting the World Health Organisation as a key forum. Core advocacy activities thus include participation in consultations and meetings hosted by IOs, although advocates did highlight less radical forms of ‘outside’ strategies, rooted in information provision rather than protest. The direct targeting of corporations was relatively uncommon, with monitoring and exposing of corporate practices primarily aimed at building momentum for governmental regulation. Advocates highlighted the importance of engagement beyond health governance, noting, however, that resource challenges preclude effective entry into new fora for many NGOs. DISCUSSION: The challenge of attaining and maintaining insider status in relevant fora introduces constraints which may explain the reliance on quieter, less confrontational strategies. We reflect critically on the potential value of a noisier approach to addressing health-harming corporate practices, and challenge the notion that a primary function of NGOs can and should be to act as a ‘watchdog’ of corporate practices, instead advancing a wider perspective on corporate accountability.