Australia's Health Star Rating policy process: Lessons for global policy-making in front-of-pack nutrition labelling.

Aim: This study explored factors that shaped the development of Australia's Health Star Rating system for front-of-pack labelling (FoPL) on packaged foods and whether insights could be drawn from this experience to inform the development of global FoPL standards.

Methods: Ten individual semi-structured interviews were conducted with public health or consumer advocates, academics in the field of nutrition labelling and policy, a food industry employee, and Australian public servants. Thematic analysis was undertaken, guided by Kingdon's Multiple Streams Framework, to identify factors which shaped Australian and international FoPL policy processes.

Results: Senior Australian bureaucrats played the policy entrepreneur role to facilitate the development of the Health Star Rating system. The public health and consumer advocacy groups formed an alliance to counter-balance the influence of the food industry in the Health Star Rating development process. Public health and consumer groups have less influence at Codex Alimentarius, where policy-making is constrained by political alliances and consensus voting structures.

Conclusions: Strong leadership, policy entrepreneurship and a coherent alliance between public health and consumer groups enabled the development of a FoPL system in Australia and could contribute to advancing FoPL standards at the international level.