Elsevier

Health Policy

Volume 115, Issues 2–3, April 2014, Pages 138-140
Health Policy

Perspective
Public–private partnerships with large corporations: Setting the ground rules for better health

https://doi.org/10.1016/j.healthpol.2014.02.003Get rights and content

Abstract

Public–private partnerships with large corporations offer potential benefits to the health sector but many concerns have been raised, highlighting the need for appropriate safeguards. In this paper we propose five tests that public policy makers may wish to apply when considering engaging in such a public–private partnership. First, are the core products and services provided by the corporation health enhancing or health damaging? In some cases, such as tobacco, the answer is obvious but others, such as food and alcohol, are contested. In such cases, the burden of proof is on the potential partners to show that their activities are health enhancing. Second, do potential partners put their policies into practice in the settings where they can do so, their own workplaces? Third, are the corporate social responsibility activities of potential partners independently audited? Fourth, do potential partners make contributions to the commons rather than to narrow programmes of their choosing? Fifth, is the role of the partner confined to policy implementation rather than policy development, which is ultimately the responsibility of government alone?

Introduction

For over three decades, public–private partnerships have been seen as a way to achieve goals that governments and international agencies might struggle to accomplish on their own [1]. They take many forms, with private sector involvement including both corporations, such as pharmaceutical companies engaged in product development, and non-governmental organisations, such as those that bring expertise on specific topics or the health needs of particular groups, and philanthropic organisations, such as the Bill and Melinda Gates Foundation, which contribute funding. They exist at both the global level, such as the Medicines for Malaria Venture and the International AIDS Vaccine Initiative, and the national level, such as the Responsibility Deals established by the English Department of Health bringing together government, public health organisations, and industry to tackle determinants of health such as obesity and alcohol [2].

These initiatives have attracted praise and criticism. There are some clear examples of success, such as the development of innovative financing mechanisms to support vaccine development by the GAVI Alliance [3]. However, there are also many concerns. Many, but not all of these relate to a particular model of public–private partnership, those between the public sector and powerful corporations, including both those engaged in manufacturing products that have implications for health, whether primarily beneficial, such as medicines, such as programmes to produce drugs for neglected diseases, or potentially harmful, such alcohol and energy dense food and drinks (for example, the “Responsibility Deals” negotiated by the UK government) [4].

One concern is the existence of industry partners’ conflicts of interest, given that they many motivations for entering into such partnerships, not all of which are necessarily altruistic. Thus, there have been concerns that some large corporations are now playing a disproportionate role in shaping global and national health agendas [5]. Another is the lack of accountability in some partnerships, which can side-step the existing national and international governance mechanisms [6]. A third is the problem with certain donations, such as medicines, which may not be appropriate to the needs of countries or which may place large burdens on weak national infrastructures that are required to store and distribute them and ensure that they are used effectively [7]. A fourth is the potential for major private-sector donors to distort the priorities of governments and international agencies receiving funds. For example, the core budget of the WHO is much more closely aligned with disease burden than is the element composed of extra-budgetary contributions from donors, an issue that current reforms are seeking to correct [8].

Notwithstanding these challenges, public–private partnerships are likely to grow, being seen as especially welcome by governments facing severe budgetary restrictions because of the current economic crisis. Many will be tempted to enter into partnerships with private corporations to obtain additional funding and expertise, even though they may also be aware of the risks involved. This raises the question of how they can maximise the benefits of such partnerships while mitigating the risks.

Section snippets

Five tests

We propose five tests that governments and international agencies could use to decide whether a private corporation should be accepted as a partner for health. In designing these tests, we draw on, the provisions of paragraph 44 of the “Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases” [9]. None of them are black and white decisions but rather serve as a framework of issues to be considered, with judgements made

Conclusions

Public private partnerships with major corporations are here to stay. They offer potential benefits but they also create many risks. These risks are accentuated as these partnerships become more widely adopted at national level, where there may be a massive disparity between the power of global corporations and national governments. We believe that adoption of the tests that we propose as global norms, this disparity in power can be rebalanced, maximising the benefits but minimising the risks.

References (18)

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