Public-Private Partnerships: A contentious issue that demands discussion

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An issue that keeps coming up at conferences I’ve been at lately has been the role of industry in public health. It’s an interesting question, as funding for prevention requires a level of political will and foresight that will not lend immediate dividends, and may not for 10, 20 or even 30 years. Given how many politicians now exist in a perpetual election cycle where any misstep is captured and covered ad nauseum, not having immediate payoffs are a risky proposition. Add to this an aging population that requires immediate and tangible medical care, and (in those countries that have public healthcare) there is a tough decision that has to be made: immediate and tangible dividends, or long term goals that you may not be around to enjoy.

As a result, groups have turned to other partners to acquire funding for public health interventions. These range from other public health groups, NGOs/NPOs as well as industry. While there isn’t much controversy surrounding the first two groups, the third raises no shortage of concerns among both public health people and the public. The basic question is this: Can we partner with industry, and if so, how can we partner with them in a way that keeps both sides happy?

I’ve been mulling this post over for a while now, as there isn’t an easy answer to the above question. As mentioned above, this is an issue that keeps coming up – especially in the obesity area (which comprises one of the focuses of my PhD dissertation). It culminated in an event organized by the Canadian Obesity Network – Student and New Professionals National Executive where they invited 4 speakers to speak on the issue – ranging from those who were profoundly against partnership, to those who were all for partnership, and even those in between. I’m not going to go into whether or not you *should* partner with industry, as both sides of this debate have been covered very well by Dr Arya Sharma and Dr Yoni Freedhoff in their respective blog posts on the topic.

One of the most insightful perspectives I have received on this issue came from Dr Kim Raine from the University of Alberta at the above debate. Dr Raine provided an excellent perspective in the video above (available online here), where she highlighted the statement developed by the Conflict of Interest Coalition that considers the role of conflict of interest when developing partnerships. To paraphase the statement, it basically looks at what each stakeholder hopes to “get out of” the relationship, and separates them into two groups: Public Interest Non-Governmental Organizations (PINGOs) and Business Interest Non-Governmental Organizations (BINGOs). While the former acts in the public interest, the latter aims to maximises profits. Sometimes their objectives match, and sometimes they do not. I would recommend giving the talk a watch, as it highlights some important issues to consider. As the Conflict of Interest Coalition statement states:

The policy development stage should be free from industry involvement to ensure a “health in all policies” approach, which is not compromised by the obvious conflicts of interests associated with food, alcohol, beverage and other industries, that are primarily answerable to shareholders.

These industries should, of course, be kept informed about policy development, through stakeholder briefings for example, but should not be in an influencing position when it comes to setting policy and strategies for addressing public health issues, such as NCD prevention and control. Reference

The videos and posts above lay a compelling argument for why you should (or should not) consider partnering with industry. Now, granted, these were all in the obesity realm, and as such the lines are a little different. For example, the idea of partnering with Coca-Cola for physical activity programs evokes a very visceral reaction for many people. But that’s not the point of today’s post. Today, I want to highlight several ways to tackle these concerns, and how organizations have chosen to set up guidelines to be transparent about how they accept funding.

The Obesity Society (TOS) and the Canadian Obesity Network (CON) have both come up with Corporate Sponsorship Policies. I won’t rehash what Dr Arya Sharma has already stated in his blog post, but a key feature is:

- The donor desires to provide financial support to TOS to further our mission to fight obesity and improve public health.
- The donor agrees that the projects that they support will bear the donor name (e.g. corporate entity, foundation etc) only and not specific products or services.
- The donor agrees that they will have no authority to direct or influence the scientific aspects of research or other projects.
- The donor agrees that the relationship with TOS can in no way be used to imply that TOS endorses the donor or any of its products, services, or mission(s).
- Donors are encouraged to make unrestricted contributions; however, they are permitted to make contributions restricted to a specific purpose, so long as that purpose is consistent with the mission of TOS and does not violate any aspect of the TOS funding policy.

Similar guidelines exist with the Canadian Obesity Network. Both groups limit the role potential funders can have in the operation and use of donations, and do not allow specific products and services to be advertized. In addition, a theme has started to emerge – industry cannot dictate policy and they cannot dictate what the recipient organization can say or do.

Participaction has come up with the Partnership Protocol to help others decide whether to and how to form partnerships. Many of the points are similar to those above, and are what you would expect – respect what both parties bring to the table, communicate effectively and evaluate the partnership throughout. But one of their points stuck in my memory long after I’d read it:

Stay True to Who You Are
Your equity and your brand are your organization’s most important assets and cannot be sacrificed for attractive amenities in a partnership. Seek a partner who will be able to offer an equity that is equal to your organization’s equity. A partner should be able to help you establish credibility and garner incremental recognition. The corporate “match” must be compatible with your values, goals and branding. Safeguard your organization’s credibility and reputation: stay true to who you are.

Often, we start the conversation, and then give up because it’s confusing, difficult and there isn’t a clear cut answer. The difference between a percieved conflict of interest and a real conflict of interest can be very difficult to determine. In the same vein, the credibility of the organization receiving funding may be the most valuable commodity at stake. I’m hoping that more organizations come forward with their own frameworks that they use so that other parties can read those and synthesize their own guidelines that match both the values and morals of their organizations, as well as their committee members.

I’d love to hear what you have to say on the matter. Do you think we can partner with industry in the public health sphere? Only under specific circumstances? Or not at all?

Disclaimer: I served on the CON-SNP Executive for three terms from 2010-2013 and assisted in organizing the above events.

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