ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2017
Impact of the North American Free Trade Agreement on high-fructose corn syrup supply in Canada: a natural experiment using synthetic control methods.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021.The international journal of behavioral nutrition and physical activity · 2024Pooled it
- Using natural experiments to improve public health evidence: a review of context and utility for obesity prevention.Health research policy and systems · 2020Pooled it
- Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health.The Cochrane database of systematic reviews · 2019Pooled it
- Evolution of birth-cohort patterns in lifestyle-associated cancer mortality across high-income countries.International journal of epidemiology · 2026Article
- Ultra processed foods and their inputs increasingly dominate New Zealand's food and beverage imports: a retrospective analysis.Globalization and health · 2026Article
- Monitoring the impacts of international trade and investment agreements on food environments: a Canadian case study.Public health nutrition · 2026Article
- Trade policy reform, retail food prices and access to healthy diets worldwide.World development · 2024Article
- Brexit, trade and the governance of non-communicable diseases: a research agenda.Globalization and health · 2023Review
- Article
- Influence of Prefecture-Level Yield of Not-for-Sale Vegetables on Vegetable Intake in Japan: A Natural Experiment.Nutrients · 2022Article
- COVID-19, Trade, and Health: This Changes Everything? Comment on "What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership".International journal of health policy and management · 2022Article
- Changes in apparent consumption of staple food in Mexico associated with the gradual implementation of the NAFTA.PLOS global public health · 2022Article
- International Trade and Investment and Food Systems: What We Know, What We Don't Know, and What We Don't Know We Don't Know.International journal of health policy and management · 2021Article
- Is compulsory home quarantine less effective than centralized quarantine in controlling the COVID-19 outbreak? Evidence from Hong Kong.Sustainable cities and society · 2021Article
- Brexit and trade policy: an analysis of the governance of UK trade policy and what it means for health and social justice.Globalization and health · 2021Article
- COVID-19 and the collapse of global trade: building an effective public health response.The Lancet. Planetary health · 2021Review
- Liberal trade policy and food insecurity across the income distribution: an observational analysis in 132 countries, 2014-17.The Lancet. Global health · 2020Observational
- The relationship between joining a US free trade agreement and processed food sales, 2002-2016: a comparative interrupted time-series analysis.Public health nutrition · 2020Article
- Power asymmetries in global governance for health: a conceptual framework for analyzing the political-economic determinants of health inequities.Globalization and health · 2019Article
- USMCA (NAFTA 2.0): tightening the constraints on the right to regulate for public health.Globalization and health · 2019Review
Corrections and comments
- Commented on by
Authors and funding
4 authors.
Funding
Abstract
backgroundCritics of free trade agreements have argued that they threaten public health, as they eliminate barriers to trade in potentially harmful products, such as sugar. Here we analyze the North American Free Trade Agreement (NAFTA), testing the hypothesis that lowering tariffs on food and beverage syrups that contain high-fructose corn syrup (HFCS) increased its use in foods consumed in Canada.
methodsWe used supply data from the Food and Agriculture Organization of the United Nations to assess changes in supply of caloric sweeteners including HFCS after NAFTA. We estimate the impact of NAFTA on supply of HFCS in Canada using an innovative, quasi-experimental methodology - synthetic control methods - that creates a control group with which to compare Canada's outcomes. Additional robustness tests were performed for sample, control groups and model specification.
resultsTariff reductions in NAFTA coincided with a 41.6 (95% confidence interval 25.1 to 58.2) kilocalorie per capita daily increase in the supply of caloric sweeteners including HFCS. This change was not observed in the control groups, including Australia and the United Kingdom, as well as a composite control of 16 countries. Results were robust to placebo tests and additional sensitivity analyses.
interpretationNAFTA was strongly associated with a marked rise in HFCS supply and likely consumption in Canada. Our study provides evidence that even a seemingly modest change to product tariffs in free trade agreements can substantially alter population-wide dietary behaviour and exposure to risk factors.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.