Table 4. Political and Regulatory Context Factors Identified in Review.

National Regulatory Factors that Potentially Influence Interpretations of Policy Proposals with Respect to TIA Rules
Availability and quality of evidence	Influences interpretations of necessity and justification. This includes data on their stage in the nutrition transition, burden (or double/triple burden) of malnutrition, and clear need to address diet-related NCDs 62 as well as strong evidence of the health risks associated with consumption of products to be regulated, 50,67 and projected effectiveness of the proposed measure in achieving the objective of improving diets and preventing NCDs. 75 WTO TBT Members questioned the scientific evidence backing the policy in half (5/10) of the STC cases reviewed.
Regulatory framework	May influence interpretations of justification. Six studies reported that a policy measure may be more robustly defensible if it is part of a comprehensive suite of interventions, including less trade restrictive alternatives such as public education campaigns (mitigating the argument that less trade restrictive alternatives are available). 50,54,59,75,77,95
History of regulation	Can influence interpretations of good faith, necessity, and fair and equitable treatment. Long-standing history of food regulation in Ghana may have supported policy space for Ghana’s import standards on fatty meats, by setting a precedent for further nutrition regulations. 62 Denmark’s TFA ban may have had more policy space because the measure started out as a voluntary agreement, in terms of having evidence to show that voluntary measures had been insufficient to achieve desired public health objectives. 67 Domestic conditions surrounding incentives and contractual commitments previously given to the private sector may affect nutrition policy space with respect to investment agreements, as these may serve to establish investors’ ‘legitimate expectations’ of the regulatory environment. 61
National Stakeholder Factors that Potentially Influence Power Dynamics and Capacity to Influence Policy Space
Party to which agreements, and with whom	Power dynamics with trade partners influence governments’ relative negotiating power, and relative capacity to mount or respond to a dispute. For instance, Fa’alili-Fidow et al 78 suggested that PICs had a weaker trade bargaining position with respect to larger, wealthier neighbours on whom they rely for aid. Barlow et al 76 noted that more than 3 quarters of the STCs raised against LMIC public health policies in the TBT Committee were by high-income countries.
Economic stakeholder landscape	The size and importance of different private sector stakeholders (including foreign direct investment) relate to the power of an industry within country to influence government to act (or to act on its own in the case of ISDS). 55 Vertical investment in the food supply chain gives a company greater power within a country’s food system, and increases the cumulative effect that a policy intervention may have on a given investor’s interests and their motivation and capacity to contest it. 61
Activity and influence of civil society	The capacity and resources of civil society to engage in the policy process may influence regulatory chill. Having strong support from CSOs to advocate for health policy, generate supporting evidence, hold governments accountable, push for transparency in the policy process, and generally counter-balance industry influence, has the potential to reduce regulatory chill. 95,105,106 Conversely, industry opposition tactics may include donating to CSOs to encourage them advocating against nutrition regulations such as marketing restrictions. 106
National Institutional Factors that Potentially Influence Policy Space and Regulatory Chill
Capacity for inter-sectoral collaboration within government	Three studies suggested that institutional structures enabling collaboration between trade and health sectors (eg, ministries or departments) in policy design could increase the capacity of governments to assess the legal basis or implications of any threats made, and reduce regulatory chill. 62,75,95 Conversely, internal vetting processes for nutrition policy proposals in which trade and economic departments dominate may increase systemic regulatory chill. 36,57
Financial and legal capacity within TNCs	TNCs’ institutional capacity to engage in domestic health policy-making processes (eg, through lobbying) may contribute to regulatory chill. 95 TNCs’ capacity to engage in trade and investment dialogue and processes and to mount challenges may constrict nutrition policy space, and may increase regulatory chill in a normative sense if such challenges are successfully raised.

Abbreviations: LMIC, Low- and middle-income country; NCDs, non-communicable diseases; WTO, World Trade Organization; TBT, technical barriers to trade; STC, Specific Trade Concern; TFA, trans fatty acid; ISDS, Investor-State Dispute Settlement; TNCs, trans-national companies; CSOs, civil society organisations; PICs, Pacific Island Countries.