Engaging the private sector to strengthen NCD prevention and control
Authors: Luke Allen, Ashley Bloomfield
Journal: The Lancet Global Health (2016)

All around the world private enterprises influence health through the sale of both harmful and health-promoting commodities, as well as lobbying and marketing activities.1Kickbusch I Allen L Franz C Commercial determinants of health.Lancet Glob Health. 2016; 4: e895-e896Summary Full Text Full Text PDF PubMed Scopus (278) Google Scholar As globalisation further strengthens the role of the private sector as a major driver of the non-communicable disease (NCD) pandemic, engaging with the private sector to prevent and control these conditions has become increasingly important. In recognition of this fact, the 2011 UN High-Level Political Declaration on NCDs2United Nations General Assembly. A/RES/66/2. UN High-Level Political Declaration on NCDs. 2011. Paragraph 44.Google Scholar called on the private sector to take action in areas such as promoting healthy workplaces, improving affordability and access to medicines, and reformulating unhealthy food products. In 2014, Ministers at the UN General Assembly noted that limited progress had been made in these areas.3United Nations General Assembly. A/RES/68/300. Outcome document of the high-level meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of non-communicable diseases. 2014. Paragraph 26 and 28.Google Scholar The 67th World Health Assembly established a working group (under the auspices of the Global Coordination Mechanism on NCDs4World Health Assembly. A67/14 Add.1. Terms of reference for the global coordination mechanism on the prevention and control of noncommunicable diseases. 2014.Google Scholar) to develop more granular recommendations for governments. This Comment provides an overview of these recommendations, which are described in detail in its full report.5WHOEngaging the private sector: final report of Working Group 3.1. World Health Organization, Geneva2016http://www.who.int/global-coordination-mechanism/working-groups/final_3_1report_with_annexes_6may16.pdf?ua=1Google Scholar The working group noted several impediments to progress, including a lack of awareness around the potential role of the private sector, a lack of supporting regulation and legislative capacity, conflicting public and private objectives, constrained government capability to engage with the wide range of private sector entities, and inadequate use of data to support action, target setting, and monitoring processes. The group noted that conflicts of interest are not ubiquitous and many commercial entities have objectives that closely align with NCD prevention and control. The private sector is heterogeneous, and many businesses influence NCDs positively, including those involved with pharmaceuticals, food, sports and fitness, insurance, banking, advertising, entertainment, transport, and infrastructure. Engagement with businesses can mitigate harm and leverage expertise and resources to bolster the global NCD response. This pro-engagement perspective resonates with calls in the Addis Abba Action Agenda to “unlock the transformative power of the private sector”;6United Nations General Assembly. A/RES/69/313. Addis Ababa Action Agenda of the Third International Conference on Financing for Development. 2015.Google Scholar however, counterpoised paragraphs acknowledge the need for strengthened regulatory frameworks to align business incentives with public goals. Balancing potential gains to public health with potential conflicts of interest is an ongoing challenge, and the working group has developed a series of principles to facilitate effective public–private engagement. First, there must be clear policy goals for the issue at hand, whether these are expanding access to medications, improving public transport, regulating harmful substances, or upgrading water and sanitation infrastructure. Clear goals require careful problem definition, articulation of the desired outcome, and a system-wide approach for evaluating potential solutions. Second, all of the stakeholders that might have a role to play in a potential partnership to prevent and manage NCDs should be identified, including academics, government departments, civil society, philanthropic organisations, and the full gamut of private sector entities. Full assessments of the potential costs, benefits, risks, and impacts are required before public health agencies enter into specific partnerships. Due diligence is essential and should pay special attention to the scope and purpose of the mooted relationship, the partner's interests, policies, values, and past performance. It is important to actively manage real, perceived, and potential conflicts of interest, and to maintain transparent interactions at all times. Such transparency might include making correspondences and meeting minutes publicly available. The need to identify and manage conflicts of interest should be communicated throughout all relevant institutions, with high-level organisational oversight. There should be clear rules on disclosing and managing conflicts for individual officials, especially around gifts, providing services, and managing research funding. Failure to manage perceived conflicts of interest can cause reputational damage, undermine public health work in other areas, and whitewash the image of unscrupulous companies. The parties involved in any partnership should consider whether formal arrangements such as legal contracts or memoranda of understanding are required for the proposed work. Ongoing monitoring and evaluation is important to ensure that both parties play by the rules. Public–private enterprises are more likely to succeed where governments have established statutory and regulatory frameworks that support partnerships and protect the public. Governments can also help to align private sector incentives with national objectives through the use of taxes, subsidies, and reduced compliance costs. Several of these recommendations are mirrored in the recently adopted WHO Framework for Engagement with Non-State Actors.7WHOPress release. Sixty-ninth World Health Assembly closes. May 28, 2016. World Health Organization, Geneva2016http://www.who.int/mediacentre/news/releases/2016/wha69-28-may-2016/en/Google Scholar Although this framework deals exclusively with WHO partnerships, the themes of due diligence, risk assessment, transparency, and accountability all feature prominently. Both sets of recommendations are based on the assumption that some degree of engagement with many private sector actors is essential for progress in contemporary global health. Critics of private sector engagement argue that any such collaboration exposes population health to undue commercial influence and can lead to the so-called corporate capture of public health institutions.8Baby Milk ActionDefend the WHO from corporate takeover.http://www.babymilkaction.org/archives/3802Google Scholar Although there are acknowledged risks, it is important to recognise the diversity among private-sector actors and the absolute centrality of commercial determinants of health in the 21st century.1Kickbusch I Allen L Franz C Commercial determinants of health.Lancet Glob Health. 2016; 4: e895-e896Summary Full Text Full Text PDF PubMed Scopus (278) Google Scholar Although the public health community can feel justifiably uneasy about working with private sector actors directly causing disease and disability, the general consensus is that some degree of engagement is essential (with the exception of arms and tobacco).9Limb M Scientists take first steps to form united front over interactions with global food industry.BMJ. 2015; 351: h6859Crossref PubMed Scopus (2) Google Scholar The working group's findings chart a course though this difficult territory. The principles outlined here and detailed in the full report5WHOEngaging the private sector: final report of Working Group 3.1. World Health Organization, Geneva2016http://www.who.int/global-coordination-mechanism/working-groups/final_3_1report_with_annexes_6may16.pdf?ua=1Google Scholar represent one step in an iterative process that will be strengthened by ongoing discussion. Discriminating between conflicts and confluences of interest is complex and guidance will need to evolve over time. The Global Coordination Mechanism is an organisational partnership that already brings public, private, and third sector agents together in pursuit of NCD prevention and control. In its role as a broker and convener we welcome ongoing dialogue and engagement on this issue. Working group of the Global Coordination Mechanism on NCDs co-chairs: H E Carole Lanteri and Jarbas Barbosa Da Silva Jr. Working Group Members: Palitha Abeykoon, Mariam Al-Jalahma, Sergey Boytsov, Vang Chu, Jalila El Ati, Trevor Hassell, Ambrose Isah, Mary R L'abbé, Urvashi D Mungal-Singh, Anne Lise Ryel, Supattra Srivanichakorn, Leao Talalelei Tuitama. At the time of submission LA was a staff member of WHO. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of WHO.