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Journal Article•DOI•

Sitting on the FENSA: WHO engagement with industry.

Kent Buse1, Sarah Hawkes2•
Joint United Nations Programme on HIV/AIDS1, University College London2
30 Jul 2016-The Lancet (Elsevier)-Vol. 388, Iss: 10043, pp 446-447
TL;DR: When decisions are made that will impact on people’s health, who should be represented at the policy-making table?
About: This article is published in The Lancet.The article was published on 2016-07-30 and is currently open access. It has received 28 citations till now. The article focuses on the topics: Sitting.
Citations
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Journal Article•DOI•
Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure

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Kent Buse1, Sonja Tanaka, Sarah Hawkes2•
Joint United Nations Programme on HIV/AIDS1, University College London2
15 Jun 2017-Globalization and Health
TL;DR: Reforms are identified that will be needed to the global health architecture to govern NCD risks, including to strengthen its ability to consolidate the collective power of diverse stakeholders, its authority to develop and enforce clear measures to address risks, as well as establish monitoring and rights-based accountability systems across all actors to drive measurable, equitable and sustainable progress.
Abstract: Non-communicable diseases (NCDs) represent a significant threat to human health and well-being, and carry significant implications for economic development and health care and other costs for governments and business, families and individuals. Risks for many of the major NCDs are associated with the production, marketing and consumption of commercially produced food and drink, particularly those containing sugar, salt and transfats (in ultra-processed products), alcohol and tobacco. The problems inherent in primary prevention of NCDs have received relatively little attention from international organizations, national governments and civil society, especially when compared to the attention paid to secondary and tertiary prevention regimes (i.e. those focused on provision of medical treatment and long-term clinical management). This may in part reflect that until recently the NCDs have not been deemed a priority on the overall global health agenda. Low political priority may also be due in part to the complexity inherent in implementing feasible and acceptable interventions, such as increased taxation or regulation of access, particularly given the need to coordinate action beyond the health sector. More fundamentally, governing determinants of risk frequently brings public health into conflict with the interests of profit-driven food, beverage, alcohol and tobacco industries. We use a conceptual framework to review three models of governance of NCD risk: self-regulation by industry; hybrid models of public-private engagement; and public sector regulation. We analyse the challenges inherent in each model, and review what is known (or not) about their impact on NCD outcomes. While piecemeal efforts have been established, we argue that mechanisms to control the commercial determinants of NCDs are inadequate and efforts at remedial action too limited. Our paper sets out an agenda to strengthen each of the three governance models. We identify reforms that will be needed to the global health architecture to govern NCD risks, including to strengthen its ability to consolidate the collective power of diverse stakeholders, its authority to develop and enforce clear measures to address risks, as well as establish monitoring and rights-based accountability systems across all actors to drive measurable, equitable and sustainable progress in reducing the global burden of NCDs.

107 citations

Cites background from "Sitting on the FENSA: WHO engagemen..."

  • ...While FENSA established rules of engagement between WHO and non-state actors, the framework has been criticised (by ourselves) as not containing sufficient guidance on governing the activities of industry in relation to public health outcomes [66]....

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Journal Article•DOI•
Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool

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Rob Ralston1, Sarah Hill1, Fabio da Silva Gomes2, Jeff Collin1•
University of Edinburgh1, World Health Organization2
21 Apr 2020-International journal of health policy and management
TL;DR: Responses to the WHO tool reflected contrasting conceptualisations of COI and implications for health governance, illustrating how contrasting positions on COI are central to understanding broader debates in nutrition policy and across global health governance.
Abstract: Background With multi-stakeholder approaches central to efforts to address global health challenges, debates around conflict of interest (COI) are increasingly prominent. The World Health Organization (WHO) recently developed a proposed tool to support member states in preventing and managing COI in nutrition policy. We analysed responses to an online consultation to explore how actors from across sectors understand COI and the ways in which they use this concept to frame the terms of commercial sector engagement in health governance. Methods Submissions from 44 Member States, international organisations, non-governmental organizations (NGOs), academic institutions and commercial sector actors were coded using a thematic framework informed by framing theory. Respondents’ orientation to the tool aligned with two broad frames, ie, a ‘collaboration and partnership’ frame that endorsed multi-stakeholder approaches and a ‘restricted engagement’ frame that highlighted core tensions between public health and food industry actors. Results Responses to the WHO tool reflected contrasting conceptualisations of COI and implications for health governance. While most Member States, NGOs, and academic institutions strongly supported the tool, commercial sector organisations depicted it as inappropriate, unworkable and incompatible with the Sustainable Development Goals (SGDs). Commercial sector respondents advanced a narrow, individual-level understanding of COI, seen as adequately addressed by existing mechanisms for disclosure, and viewed the WHO tool as unduly restricting scope for private sector engagement in nutrition policy. In contrast, health-focused NGOs and several Member States drew on a more expansive understanding of COI that recognised scope for wider tensions between public health goals and commercial interests and associated governance challenges. These submissions mostly welcomed the tool as an innovative approach to preventing and managing such conflicts, although some NGOs sought broader exclusion of corporate actors from policy engagement. Conclusion Submissions on the WHO tool illustrate how contrasting positions on COI are central to understanding broader debates in nutrition policy and across global health governance. Effective health governance requires greater understanding of how COI can be conceptualised and managed amid high levels of contestation on policy engagement with commercial sector actors. This requires both ongoing innovation in governance tools and more extensive conceptual and empirical research.

37 citations

Journal Article•DOI•
Gender blind? An analysis of global public-private partnerships for health

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Sarah Hawkes1, Kent Buse2, Anuj Kapilashrami3•
University College London1, Joint United Nations Programme on HIV/AIDS2, University of Edinburgh3
12 May 2017-Globalization and Health
TL;DR: GPPPH need to become serious in how they “do” gender; it needs to be mainstreamed through the regular activities, deliverables and systems of accountability, and the entire global health community needs to pay greater attention to tackling the major burden of NCDs, including addressing the gendered nature of risk.
Abstract: The Global Public Private Partnerships for Health (GPPPH) constitute an increasingly central part of the global health architecture and carry both financial and normative power. Gender is an important determinant of health status, influencing differences in exposure to health determinants, health behaviours, and the response of the health system. We identified 18 GPPPH - defined as global institutions with a formal governance mechanism which includes both public and private for-profit sector actors – and conducted a gender analysis of each. Gender was poorly mainstreamed through the institutional functioning of the partnerships. Half of these partnerships had no mention of gender in their overall institutional strategy and only three partnerships had a specific gender strategy. Fifteen governing bodies had more men than women – up to a ratio of 5:1. Very few partnerships reported sex-disaggregated data in their annual reports or coverage/impact results. The majority of partnerships focused their work on maternal and child health and infectious and communicable diseases – none addressed non-communicable diseases (NCDs) directly, despite the strong role that gender plays in determining risk for the major NCD burdens. We propose two areas of action in response to these findings. First, GPPPH need to become serious in how they “do” gender; it needs to be mainstreamed through the regular activities, deliverables and systems of accountability. Second, the entire global health community needs to pay greater attention to tackling the major burden of NCDs, including addressing the gendered nature of risk. Given the inherent conflicts of interest in tackling the determinants of many NCDs, it is debatable whether the emergent GPPPH model will be an appropriate one for addressing NCDs.

34 citations

Journal Article•DOI•
Australia in 2030: what is our path to health for all?

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Kathryn Backholer, Fran Baum, Summer May Finlay1, Sharon Friel, Billie Giles-Corti, Alexandra M. E. Jones, Rebecca Patrick, Jane Shill, Belinda Townsend2, Fiona Armstrong, Phil Baker, Kathryn Bowen, Jennifer Browne, Cara Büsst, Andrew Butt, Karla Canuto, Kootsy Canuto, Anthony Capon3, Kirstan Corben, Mike Daube, Sharon Goldfeld, Robert Grenfell, Lucy Gunn, Patrick Harris, Kellie Horton, Lewis Keane, Jennifer Lacy-Nichols, Selina Lo, Raymond Lovett, Melanie Lowe, Jane Martin, Nadia Neal, Anna Peeters, Tahna Pettman, Aileen Thoms, Anne Marie Thow, Anna Timperio, Carmel Williams, Annemarie Wright, Belen Zapata-Diomedi, Sandro Demaio •
University of Canberra1, Australian National University2, University of Sydney3
01 May 2021-The Medical Journal of Australia
TL;DR: This chapter offers glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity, and it is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality.
Abstract: CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

33 citations

Journal Article•DOI•
Unpacking policy formulation and industry influence: the case of the draft control of marketing of alcoholic beverages bill in South Africa

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Adam Bertscher1, Leslie London1, Marsha Orgill1•
University of Cape Town1
01 Sep 2018-Health Policy and Planning
TL;DR: It is shown that achieving policy coherence across government departments poses a major challenge to achieving effective health policy formulation and that networks of actors with commercial and financial interests use diverse strategies to influence policy formulation processes to avoid regulation.
Abstract: Alcohol is a major contributor to the Non-Communicable Disease burden in South Africa. In 2000, 7.1% of all deaths and 7% of total disability-adjusted life years were ascribed to alcohol-related harm in the country. Regulations proposed to restrict alcohol advertising in South Africa present an evidence-based upstream intervention. Research on policy formulation in low- and middle-income countries is limited. This study aims to describe and explore the policy formulation process of the 2013 draft Control of Marketing of Alcoholic Beverages Bill in South Africa between March 2011 and May 2017. Recognising the centrality of affected actors in policy-making processes, the study focused on the alcohol industry as a central actor affected by the policy, to understand how they-together with other actors-may influence the policy formulation process. A qualitative case study approach was used, involving a stakeholder mapping, 10 in-depth interviews, and review of approximately 240 documents. A policy formulation conceptual framework was successfully applied as a lens to describe a complex policy formulation process. Key factors shaping policy formulation included: (1) competing and shared values-different stakeholders promote conflicting ideals for policymaking; (2) inter-department jostling-different government departments seek to protect their own functions, hindering policy development; (3) stakeholder consultation in democratic policymaking-policy formulation requires consultations even with those opposed to regulation and (4) battle for evidence-evidence is used strategically by all parties to shape perceptions and leverage positions. This research (1) contributes to building an integrated body of knowledge on policy formulation in low- and middle-income countries; (2) shows that achieving policy coherence across government departments poses a major challenge to achieving effective health policy formulation and (3) shows that networks of actors with commercial and financial interests use diverse strategies to influence policy formulation processes to avoid regulation.

24 citations

References
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Journal Article•DOI•
Taking responsive regulation transnational: Strategies for international organizations

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Kenneth W. Abbott1, Duncan Snidal2•
Arizona State University1, University of Oxford2
01 Mar 2013-Regulation & Governance
TL;DR: In this article, the authors propose two regulatory strategies: collaboration and orchestration for trans-national regulatory standard-setting (TRSS) schemes, which can escalate in response to defection by deploying reputational and market sanctions.
Abstract: Responsive Regulation (RR) introduced important new ways of thinking about regulation. But RR was designed for domestic settings in which a single agency had clear jurisdiction, full regulatory capacity, and extensive information, and could (contingently) deploy stringent sanctions against well-defined targets. Under globalization, many regulatory problems have shifted to the transnational arena, characterized by multiple regulators, public and private, with limited capacities, authority, and information, and modest sanctioning ability; globalized production also renders the targets of regulation diffuse and difficult to identify. RR holds important lessons for transnational regulation, but it must be adapted to these challenging conditions. Some components of transnational RR are already emerging, including numerous private and public–private schemes that regulate business through voluntary norms: “transnational regulatory standard-setting” (TRSS). Alone, however, TRSS schemes face serious limitations. Intergovernmental organizations (IGOs) are best positioned to “take RR transnational” by supporting and working with the nascent TRSS system. Two regulatory strategies are particularly promising: collaboration and orchestration. In “regulatory collaboration,” IGOs promote business self-regulation, much as in RR; they can escalate in response to defection by deploying reputational and market sanctions. In “orchestration,” IGOs support and steer intermediaries, including TRSS schemes and NGOs, which use their material and ideational capacities to regulate target behavior. Orchestration cumulates regulatory competencies, creates avenues of escalation, and provides many benefits of RR “tripartism.”

103 citations

Related Papers (2)
The political origins of health inequity: prospects for change

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15 Feb 2014-The Lancet
Ole Petter Ottersen, Jashodhara Dasgupta, Chantal Blouin, Paulo Marchiori Buss, Virasakdi Chongsuvivatwong, Julio Frenk, Sakiko Fukuda-Parr, Bience P Gawanas, Rita Giacaman, John O. Gyapong, Jennifer Leaning, Michael Marmot, Desmond McNeill, Gertrude I Mongella, Nkosana Moyo, Sigrun Møgedal, Ayanda Ntsaluba, Gorik Ooms, Espen Bjertness, Ann Louise Lie, Suerie Moon, Sidsel Roalkvam, Kristin Ingstad Sandberg, Inger B. Scheel 
Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries

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23 Feb 2013-The Lancet
Rob Moodie, David Stuckler, Carlos Augusto Monteiro, Nick Sheron, Bruce Neal, Thaksaphon Thamarangsi, Paul Lincoln, Sally Casswell 
Frequently Asked Questions (8)
Q1. What contributions have the authors mentioned in the paper "Sitting on the fensa: who engagement with industry" ?

In this paper, the World Health Assembly ( WHA ) reached consensus: `` WHO engages with non-State actors to encourage them to protect and promote public health '' and considered non-state actors as `` nongovernmental organizations [ NGOs ], private sector entities, philanthropic foundations and academic institutions ''. 

WHO and its governing body have taken an important step in democratizing the invite list to the policy table and establishing the dining etiquette. 

Do the authors rely upon self-regulation by industry (e.g., marketing codes or voluntary initiatives to reduce harmful exposure), co-regulation of the activities of industry (e.g. public sector partnerships with the private sector are an overarching approach within of WHO’s 2013-2020 Global Action Plan on NCDs8), or public regulation of private sector activities. 

A small but not insignificant part of the project entails embracing the public interest NGOs, which it has too long treated as adversaries, as the partners it needs to generate both public support and political incentives to induce national leaders to act. 

Concerns have long been raised about potential and actual conflicts of interest arising from WHO’s engagement with non-State actors (NSA), particularly those whose mandate hingesforemost upon the pursuit of profit rather than public health. 

Members States were generally supportive of the Framework, but NGOs voiced concern that “FENSA will increase….problematic entanglements between WHO and powerful private sector actors”, and were disappointed that the Framework fails to “acknowledge the different nature – and thus different roles – public and private sector actors should play in global health governance”3. 

Now WHO needs to jump decisively off the right side of the fence and take more impactful measures, globally and nationally, to protect the health of the public by aggressively supporting governments and their partners to govern the health impact of Big Industry. 

A Reuters investigation, for example, found not only that regional office PAHO had accepted money from companies such as Coca-Cola, Nestle and Unilever, but also that at least two of the 15 members of WHO’s Nutrition Guidance Expert Advisory Group had direct financial ties to the food industry5.