WHO’s Attempt to Navigate Commercial Influence and Conflicts of Interest in Nutrition Programs While Engaging With Non-State Actors: Reflections on WHO Guidance for Nation States; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool”

Document Type : Commentary

Author

Law School, Suffolk University, Boston, MA, USA

Abstract

This commentary situates the comments submitted in response to the World Health Organization (WHO) draft guidance on conflicts of interest in national nutrition programs in light of: (1) WHO policies to protect WHO integrity; (2) the Framework of Engagement with Non-State Actors (FENSA); (3) WHO’s attempt to seek funds due to cuts in member contributions; and (4) attempts — often by corporate entities — to redefine conflicts of interest to avoid oversight of conflicts of interest and increase corporate influence. The WHO guidance defines conflicts of interest in ways that deviate from standard legal usage which confuses its analysis and facilitates the creation of conflicted public-private partnerships. The guidance suggests that nations can allow engagement with non-state actors when the benefits are greater than risks without separate check due to conflicts of interest. Instead, the WHO should have recommended that nations seek alternative ways to achieve their goals when non-state actors have significant institutional conflicts of interest.

Keywords

References

  1. World Health Organization (WHO). Principles Governing Relations Between the World Health Organization and Nongovernmental Organizations. https://apps.who.int/iris/handle/10665/162134.  Accessed July 21, 2020.
  2. Richter J. Holding Corporations Accountable: Corporate Conduct, International Codes and Citizen Action. Zed Books and Palgrave Macmillan; 2001.
  3. McCambridge J, Daube M, McKee M. Brussels Declaration: a vehicle for the advancement of tobacco and alcohol industry interests at the science/policy interface? Tob Control. 2019;28(1):7-12. doi:10.1136/tobaccocontrol-2018-054264
  4. Maani Hessari N, Ruskin G, Mc KM, Stuckler D. Public meets private: conversations between Coca-Cola and the CDC. Milbank Q. 2019;97(1):74-90. doi:10.1111/1468-0009.12368
  5. Stuckler D, Basu S, McKee M. Global health philanthropy and institutional relationships: how should conflicts of interest be addressed? PLoS Med. 2011;8(4):e1001020. doi:10.1371/journal.pmed.1001020
  6. Birn AE. Philanthrocapitalism, past and present: The Rockefeller Foundation, the Gates Foundation, and the setting (s) of the international/global health agenda. Hypothesis. 2014;12(1):e8. doi:10.5779/hypothesis.v12i1.229
  7. Reddy SK, Mazhar S, Lencucha R. The financial sustainability of the World Health Organization and the political economy of global health governance: a review of funding proposals. Global Health. 2018;14(1):119. doi:10.1186/s12992-018-0436-8
  8. Boseley S. Political context of the World Health Organization: sugar industry threatens to scupper the WHO. Int J Health Serv. 2003;33(4):831-833. doi:10.2190/u0mw-wm82-n5bh-e20c
  9. Lidén J. The World Health Organization and Global Health Governance: post-1990. Public Health. 2014;128(2):141-147. doi:10.1016/j.puhe.2013.08.008
  10. Birn AE, Richter J. U.S.  Philanthrocapitalism and the Global Health Agenda: The Rockefeller and Gates Foundations, Past and Present. In: Waitzkin H, ed. Health Care Under the Knife: Moving Beyond Capitalism for Our Health. Monthly Review Press; 2017. http://www.peah.it/2017/05/4019/.  Accessed July 21, 2020.
  11. Richter J. Public-Private Partnerships and International Health Policy-Making How Can Public Interests Be Safeguarded? Helsinki: Ministry for Foreign Affairs of Finland, Development Policy Information Unit; 2004. http://www.aaci-india.org/Resources/PPPand-International-Health-Policy-Makingpublic-private.pdf. 
  12. World Health Organization (WHO). Guidelines on Interaction with Commercial Enterprises to Achieve Health Outcomes. https://apps.who.int/iris/bitstream/handle/10665/78660/ee20.pdf;jsessionid=40E4BB1D377737A2C58034778CB54097?sequence=1.  Accessed July 21, 2020.
  13. Policy on WHO Engagement with Global Health Partnership and Hosting Arrangements. 2010. https://www.who.int/docs/default-source/documents/partnerships/partnerships-63rd-wha-agenda-item-18-1-21-may-2010.pdf?sfvrsn=a9b06d88_2.  Accessed July 21, 2020.  
  14. Richter J. WHO reform and public interest safeguards: an historical perspective. Soc Med. 2012;6(3):141-150.
  15. World Health Organization (WHO). Framework of engagement with non-State actors (FENSA). Sixty-Ninth World Health Assembly. 2016. https://www.who.int/about/partnerships/non-state-actors.  Accessed July 21, 2020.
  16. World Health Organization (WHO). Handbook for Non-State Actors on Engagement with the World Health Organization. https://www.who.int/about/collaborations/non-state-actors/Handbook-for-non-State-actors-on-engagement-with-WHO.pdf?ua=1.  Accessed July 21, 2020.
  17. World Health Organization (WHO). Engagement with Non-State Actors: Non-State Actors in Official Relations with WHO: Report by the Director-General. WHO; 2019. https://apps.who.int/gb/ebwha/pdf_files/EB146/B146_35-en.pdf.  Accessed July 21, 2020.
  18. Michéle L, Prato S, Rundal P, Valente F. When the SUN Casts A Shadow: The Human Rights Risks of Multi-Stakeholder Partnerships: The Case of Scaling up Nutrition (SUN). FIAN International, IBFAN, SID; 2019. http://www.babymilkaction.org/wp-content/uploads/2020/02/WhenTheSunCastsAShadow_En.pdf.  Accessed July 21, 2020.
  19. Marks JH. Toward a systemic ethics of public-private partnerships related to food and health. Kennedy Inst Ethics J. 2014;24(3):267-299. doi:10.1353/ken.2014.0022
  20. Hernandez-Aguado I, Zaragoza GA. Support of public-private partnerships in health promotion and conflicts of interest. BMJ Open. 2016;6(4):e009342. doi:10.1136/bmjopen-2015-009342
  21. Marks JH. The Perils of Partnership: Industry Influence, Institutional Integrity, and Public Health. Oxford University Press; 2019.
  22. Richter J. Public-Private Partnerships and Health for All: How Can WHO Safeguard Public Interests? http://www.aaci-india.org/Resources/Public-Private-Partnerships-and-Health-for-All.pdf.  Accessed July 30, 2020.
  23. World Health Organization (WHO). The International Code of Marketing of Breast-Milk Substitutes: Frequently Asked Questions. WHO; 2008. https://apps.who.int/iris/bitstream/handle/10665/43947/9789241594295_eng.pdf.  Accessed July 21, 2020.
  24. Willumsen J. Regulation of Marketing Breastmilk Substitutes: Biological, Behavioural and Contextual Rationale. World Health Organization, Department of Nutrition for Health and Development; 2013. https://www.who.int/elena/bbc/regulation_breast-milk_substitutes/en/.  Accessed July 21, 2020.
  25. World Health Organization, UNICEF, IBFAN. Marketing of Breast-Milk Substitutes: National Implementation of the International Code. https://www.who.int/nutrition/publications/infantfeeding/code_report2016/en/.    Accessed July 21, 2020.
  26. Barennes H, Slesak G, Goyet S, Aaron P, Srour LM. Enforcing the international code of marketing of breast-milk substitutes for better promotion of exclusive breastfeeding: can lessons be learned? J Hum Lact. 2016;32(1):20-27. doi:10.1177/0890334415607816
  27. Godlee F, Cook S, Coombes R, El-Omar E, Brown N. Calling time on formula milk adverts. BMJ. 2019;364:l1200. doi:10.1136/bmj.l1200
  28. World Health Organization (WHO). WHO Framework Convention on Tobacco Control. WHO; 2003. https://apps.who.int/iris/bitstream/handle/10665/42811/9241591013.pdf?sequence=1.  Accessed July 21, 2020.
  29. da Costa e Silva V. Engagement with Tobacco Industry Conflicting with UN Principles and Values. WHO; 2017. https://www.who.int/fctc/secretariat/head/statements/2017/ungc-integrity-review-tobacco-industry/en/.  Accessed July 21, 2020.
  30. Richter J. Time to turn the tide: WHO's engagement with non-state actors and the politics of stakeholder governance and conflicts of interest. BMJ. 2014;348:g3351. doi:10.1136/bmj.g3351
  31. Lhotská L, Gupta A. Whose Health? The Crucial Negotiations for the World Health Organization’s Future. Policy Forum; 2016. http://www.policyforum.net/whose-health/.  Accessed July 21, 2020.
  32. International Baby Food Network, Geneva Infant Feeding Association. A Short Annotated List of (Primarily) IBFAN Key Statements Regarding FENSA and its Risk of Increasing Undue Influences and Undermining Conflict of Interest (CoI) Regulation. 2018. http://www.babymilkaction.org/wp-content/uploads/2016/07/IBFAN-GIFA_FENSA_key_references_18-01-2018.pdf.  Accessed July 21, 2020.
  33. Richter J. Time to turn the tide: WHO’s engagement with non-state actors and the politics of stakeholder governance and conflicts of interest, RR (rapid response) to 'Irrelevant' WHO outpaced by younger rivals. BMJ 2014;348:g3351. https://www.bmj.com/content/343/bmj.d5012/rr/697686. 
  34. Khayatzadeh-Mahani A, Ruckert A, Labonté R. Could the WHO's Framework on Engagement with Non-State Actors (FENSA) be a threat to tackling childhood obesity? Glob Public Health. 2018;13(9):1337-1340. doi:10.1080/17441692.2017.1342852
  35. World Health Organization (WHO). Addressing and Managing Conflicts of Interest in the Planning and Delivery of Nutrition Programmes at Country Level: Technical Report. https://www.who.int/nutrition/publications/COI-report/en/.  Accessed July 30, 2020.
  36. Richter J. Safeguarding against possible conflicts of interest in nutrition programmes: Draft “Approach for the prevention and management of conflicts of interest in the policy development and implementation of nutrition programmes at country level.” https://www.who.int/nutrition/consultation-doi/judith_richter.pdf?ua=1. Accessed July 30, 2020.
  37. World Health Organization (WHO). Safeguarding Against Possible Conflicts of Interest in Nutrition Programmes: Draft Approach for the Prevention and Management of Conflicts of Interest. Geneva: WHO; 2017. https://apps.who.int/gb/ebwha/pdf_files/EB142/B142_23-en.pdf.  Accessed July 21, 2020.
  38. Draft Approach for the Prevention and Management of Conflicts of Interest in the Policy Development and Implementation of Nutrition Programmes at Country Level: Introductory Paper. WHO; 2017. https://www.who.int/nutrition/consultation-doi/nutrition-introductory-paper.pdf?ua=1.  Accessed July 21, 2020
  39. Bertók J. Managing Conflict of Interest in the Public Service: OECD Guidelines and Country Experiences. Paris: OECD; 2003. https://www.oecd.org/publications/managing-conflict-of-interest-in-the-public-service-9789264104938-en.htm.  Accessed July 21, 2020.
  40. Rodwin MA. Conflict of interest in the pharmaceutical sector: a guide for public management. DePaul J Health Care Law. 2019;21:1.
  41. Rodwin MA. Conflicts of Interest and the Future of Medicine: The United States, France, and Japan. Oxford: Oxford University Press; 2011.
  42. Rodwin MA. Medicine, Money and Morals: Physicians' Conflicts of Interest. Oxford: Oxford University Press; 1995.
  43. Rodwin MA. Conflicts of interest in human subject research: the insufficiency of U.S. and international standards. Am J Law Med. 2019;45(4):303-330. doi:10.1177/0098858819892743
  44. Rodwin MA. Attempts to redefine conflicts of interest. Account Res. 2018;25(2):67-78. doi:10.1080/08989621.2017.1405728
  45. Marks JH. Lessons from corporate influence in the opioid epidemic: toward a norm of separation. J Bioeth Inq. 2020;17(2):173-189. doi:10.1007/s11673-020-09982-x
  46. O'Connor A. Coca-Cola Funds Scientists Who Shift Blame for Obesity Away from Bad Diets. New York Times; 2015.
  47. Nestle M. Soda Politics: Taking on Big Soda (and Winning). Oxford: Oxford University Press; 2015.
  48. Ralston R, Hil SE, da Silva Gomes F, Collin J. Towards preventing and managing conflict of interest in nutrition policy? an analysis of submissions to a consultation on a draft WHO tool. Int J Health Policy Manag. 2020. doi:10.34172/ijhpm.2020.52
  49. Peters A. Conflict of interest as a cross-cutting problem of governance. In: Peters A, Handschin L, eds. Conflict of Interest in Global, Public and Corporate Governance. Cambridge: Cambridge University Press; 2012.
  50. Webster’s Unabridged Dictionary of the English Language. Random House; 2001.
  51. The American Heritage Dictionary of the English Language website. https://ahdictionary.com/.
  52. Rosenbaum L. Beyond moral outrage--weighing the trade-offs of COI regulation. N Engl J Med. 2015;372(21):2064-2068. doi:10.1056/NEJMms1502498
  53. Saver RS. Is it really all about the money? reconsidering non-financial interests in medical research. J Law Med Ethics. 2012;40(3):467-481. doi:10.1111/j.1748-720X.2012.00679.x
  54. Alliance for Food & Health, USA. https://www.who.int/nutrition/consultation-doi/comments/en/.  Accessed July 21, 2020.
  55. The Global Diary Platform, USA. https://www.who.int/nutrition/consultation-doi/global_dairy_platform.pdf?ua=1.  Accessed July 21, 2020.
  56. Grocery Manufacturers Association, U.A. https://www.who.int/nutrition/consultation-doi/grocery_manufacturers_association_united_states_of_america.pdf?ua=1.  Accessed July 21, 2020.
  57. UN Network for SUN Secretariat. https://www.who.int/nutrition/consultation-doi/un_network_sun_movement.pdf?ua=1.  Accessed July 21, 2020.
  58. Economic Cooperation and Development (OECD). https://proxy-redirect.netlify.app/nutrition/consultation-doi/oecd.pdf.  Accessed July 21, 2020.
  59. World Public Health Nutrition Association. https://proxy-redirect.netlify.app/nutrition/consultation-doi/world_public_health_nutrition_association.pdf.  Accessed July 21, 2020.
  60. University of Sydney, Australia.  Global Obesity Centre at the Centre for Population Health Research, Deakin University. https://proxy-redirect.netlify.app/nutrition/consultation-doi/deakin_university_australia.pdf  Accessed July 21, 2020.
  61. Health Latin America Coalition – Commentary on Safeguarding Against Possible Conflicts of Interest in Nutrition Programmes. https://proxy-redirect.netlify.app/nutrition/consultation-doi/healthy_latin_america_coalition_.pdf.  Accessed July 21, 2020.
  62. The Cochrane Collaboration. https://proxy-redirect.netlify.app/nutrition/consultation-doi/the_cochrane_collaboration_united_kingdom.pdf.  Accessed July 21, 2020.
  63. International Baby Food Action Network – IBFAN comments on WHO Consultation: Safeguarding against possible conflicts of interest in nutrition programmes: “Approach for the prevention and management of conflicts of interest in the policy development and implementation of nutrition programmes at country level” (3 Drafts). https://proxy-redirect.netlify.app/nutrition/consultation-doi/ibfan.pdf.  Accessed July 21, 2020.
  64. Geneva Infant Feeding Association – Safeguarding against possible conflicts of interest in nutrition programmes: “Approach for the prevention and management of conflicts of interest in the policy development and implementation of nutrition programmes at country level” (3 Drafts) Comments by Geneva Infant Feeding Association.  https://proxy-redirect.netlify.app/nutrition/consultation-doi/gifa.pdf.  Accessed July 21, 2020.
  65. Brief Response to WHO Consultation from Jonathan H. Marks Director of Bioethics Program at Penn StateUniversity, USA. https://www.who.int/nutrition/consultation-doi/jonathan_marks.pdf?ua=1. Accessed July 21, 2020.
  66. Rodwin MA. Physicians' conflicts of interest. the limitations of disclosure. N Engl J Med. 1989;321(20):1405-1408. doi:10.1056/nejm198911163212010
  67. Marks JH. Beyond disclosure: developing law and policy to tackle corporate influence. Am J Law Med. 2020;46(2-3):275-296. doi:10.1177/0098858820933499
International Journal of Health Policy and Management
Volume 11, Issue 3
March 2022
Pages 386-390

Files

History

  • Receive Date: 03 August 2020
  • Revise Date: 16 August 2020
  • Accept Date: 17 August 2020
  • First Publish Date: 23 September 2020

Share

How to cite

Statistics