In 2016, NCDs accounted for 72% of all deaths. The United Nations has included a target to reduce premature mortality from NCDs by one-third by 2030. In order to achieve this, the UN encourages public-private and civil society partnerships.
In an editorial in the BMJ, Kasi Whitaker, Douglas Webb and Natalia Linou, of the UN Development Programme’s HIV, Health, and Development stressed the need to foster collaboration in order to meet the UN’s ambition.
“New global partnerships for development are necessary because the ambition, scope, and scale of the SDG agenda require coherent action by all parts of society. Although including diverse stakeholders provides opportunities to pool resources and expertise,” they stressed.
However, the authors continued, the involvement of industry “also brings potential risks and questions around legitimacy and accountability” due to “real or perceived conflicts of interest”.
According to the authors “ambiguity” exists on how to engage non-state actors – “especially the food and beverage industries” – in policy discussions on NCDs.
The UN experts took the development of the Montevideo Roadmap as a case in point where conflicts of interest may have resulted in a “softening” of the public policy stance.
In October 2017, the World Health Organization, along with the government of Uruguay, organised a global conference on NCDs in Montevideo, where governments endorsed the Montevideo Roadmap 2018-30 on NCDs.
The roadmap is a consensus document on the need for coordinated and coherent action to combat NCDs. A draft of this document, developed through an intergovernmental process under the leadership of Finland, Uruguay, and Russia, was published online for consultation two months before the final meeting, with a request for comments from member states, UN organisations, and other stakeholders, including industry.
“Close examination of the early draft, written comments made during the consultation period, and the final roadmap show important changes to the document during the process and help identify key influencers and their effects,” Whitaker, Webb and Linou noted.
Overall, they suggested, the final version of the Montevideo had qualifiers such as “according to national context”, “consistent with countries’ domestic legal frameworks and international obligations”, and “where/as appropriate” added throughout the document. “These qualifiers align with feedback from high income member states and reduce the ambition of the roadmap and, possibly, the accountability of nation states for bold action.”
In addition, the authors argued, the influence of the food sector is evident.
“There was also evidence of softening of language towards industry. Taxation of sugar sweetened beverages and alcohol were included as possible options in the draft version but dropped from the final version (only tobacco taxation remained).
“Private sector entities, primarily representing the food and drink industries, were the only group to claim that taxing harmful products is inefficient and ineffective.”
For example, the analysis revealed four submissions stressed that taxes on sugar sweetened drinks in Mexico were not improving public health—despite evidence of “sustained reduction in consumption, particularly among the poorest people”.
The warning went a step further: “Private sector submissions also emphasised the need for cost effective and evidence based interventions and supported a “whole of society” approach. This appropriation of the language of science and development is concerning if the intent is to undermine public health measures by legitimising a counter narrative around what constitutes “evidence based” and by creating policy confusion and opposition in public debates.”
Call for framework legislation
The UNDP experts stressed that the development of framework legislation to establish “processes and structures” that guide decision making would reduce the risk of conflicts of interest. This would “ensure transparency” and “manage commercial relationships”.
“At a minimum, we must have better understanding of the motivations and positions of different stakeholders and how global and public policy processes can be influenced (and potentially undermined) by broad consultations that include commercial entities,” they conclude.
‘All stakeholders have a role to play’
Responding to the UNDP statement, industry body FoodDrinkEurope insisted that the solution to NCDs is “very broad” and “no player can do it alone”.
“All stakeholders have a role to play and our industry has long declared it was part of this solution. This is why we believe we must be involved in these discussions,” a FoodDrinkEurope spokesperson insisted.
The European food sector organisation went a step further and questioned whether the long-term interests of the food industry are indeed invested in maintaining the status quo or subverting efforts to tackle NCDs.
“We do not believe it is in anyone's interest to have unhealthy consumers or workers. We firmly believe in balanced diets and healthy lifestyles, which give consumers the opportunity to consume any product in reasonable quantity, while in parallel enjoying the benefits of physical exercise, proper sleep, stress management, etcetera. There again, the question is that of a joint solution, not simply a government/consumers relation,” the spokesperson stressed.