Regulating Sugar-Sweetened Beverage Consumption and Promoting Better Health Choices in Trinidad and Tobago

Abstract

Background: Non-communicable diseases (NCDs) pose a significant health burden, particularly in low- and middle-income countries. This research investigates how the complex commercial and social determinants of health (CDOH and SDH) influence policymaking on high sugar intake in Trinidad and Tobago, a Small Island Developing State (SIDS) with a disproportionately high NCD prevalence.

Aim
The thesis aims to understand the influence of CDOH, SDH, and "Caribbean culture" on policies regulating sugar consumption in Trinidad and Tobago. This is particularly relevant given that the country experiences record intake rates of sugar-sweetened beverages, a known risk factor for NCDs.

Methods
This qualitative, ethnographically-informed study involved 28 in-depth interviews with corporate, state, healthcare, and NGO/third-sector stakeholders. Data was analysed using a corporate power lens based on Fuchs and Lederer’s (2007) framework on business power, and the CDOH literature. This was applied to understand the mechanisms by which power influences health policymaking and consumption practices in the local context. Mintz’s (1985) work on the historical and cultural associations of sugar in the Caribbean was also applied to understand the complex concept of ‘culture’ in NCD policymaking.

Results
The findings show that the sugar debate is dominated by corporate influence, creating a disjuncture between scientifically recommended upstream policies (e.g., taxation) and implemented interventions (e.g., behaviour change campaigns). Corporate actors deliberately promoted individual-focused measures to avoid more impactful regulations. The legacy of "King Sugar" and a normalised "cultural palate" for sweetness also emerged as significant challenges. Additionally, the research uncovered critical gaps in data and evaluation capacity, a problem exacerbated by the country’s reclassification as a "developed" nation.

Conclusion
Effectively addressing NCDs in Trinidad and Tobago requires a nuanced, context-specific approach that acknowledges the profound influence of CDOH and SDH, as well as the historical legacies and cultural practices related to sugar, on the policy landscape.