Annex 8A: Case studies of countries with integrated and systems-based strategies Annex 8B: Examples of applied or recommended nutrient

Only the tax regulation on carbonated drinks and energy drinks imposed since 2017 in Saudi Arabia has been shown to produce meaningful change (Alsukait et al. 2020). The expansion of this tax to all SSBs in 2019 has yet to be evaluated. The conditions that will allow for achieving improved dietary preference and intake, and thus resultant health and economic well-being in the longer term, can be classified as being necessary (that is, whenever success is achieved, the condition is present) or sufficient (that is, the condition leads to success but is not the only condition that does so):

• Necessary conditions: o Mechanisms or processes to minimize industry interference o Political commitment met with cross-ministerial and cross-agency coordination and collaboration o Well-designed regulations and policies with a strong evidence base and legal basis that meet regional and global agreements • Sufficient conditions: o Integrated policies o Engagement with civil society (for example, health advocates and health researchers) o Public support o Regional or global momentum o Engagement with selected industry members who show commitment to be part of the solution

Efforts to establish the necessary conditions need to be put in place and activated to ensure success in addressing the health and economic crises facing Saudi Arabia. The probability, degree, and speed of success can be further amplified if some of the sufficient conditions are also met.

ANNEX 8A: CASE STUDIES OF COUNTRIES WITH INTEGRATED AND SYSTEMS-BASED STRATEGIES

Mexico

The National Agreement for Healthy Nutrition (ANSA) was a multisectoral guideline that took many years of concerted effort to be finally agreed upon in 2010 (Barquera, Campos, and Rivera 2013). Mexico’s National Institute of Public Health (Instituto Nacional de Salud Pública), along with other key stakeholders, started formulating its obesity and noncummicable disease (NCD) prevention strategy in the early 2000s. ANSA was nonbinding, but it committed the signatories—comprising seven national ministries and CONMEXICO (an umbrella trade association representing 43 leading food and beverage companies)—to work toward 10 strategic goals in the battle against obesity, including increasing breast-feeding, nutrition literacy, access to potable water, and decreasing the intake of high-caloric foods and beverages. Several published papers have documented the process for its development and challenges along the way (Barquera, Campos, and Rivera 2013).

Concurrently—because of the country’s high prevalence of diabetes, obesity, and related NCDs—there were pushes for specifically addressing the high consumption of sugar-sweetened beverages (SSBs) in Mexico. These pushes included the creation of Beverage Guidelines for Mexico in 2008 (Rivera et al.