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Give The Money Back, PAHO! Influence, Transparency and Ethics in Global Health Policy

Last month, Reuters reported that the Pan American Health Organization (PAHO), which has a dual role as the regional office for the World Health Organization for the Americas and the health agency of the Organization of American States, began taking hundreds of thousands of dollars from the private sector for the first time in its 100+ year existence. According to the Reuters article by Duff Wilson and Adam Kerlin:

Accepting industry funding goes against WHO's worldwide policies. Its Geneva headquarters and five other regional offices have been prohibited from accepting money from the food and soda industries, among others. "If such conflicts of interest were perceived to exist, or actually existed, this would jeopardize WHO's ability to set globally recognized and respected standards and guidelines," said spokesman Gregory Härtl.

But the Pan American office - known as PAHO, based in Washington and founded 46 years before it was affiliated with WHO in 1948 - had different standards allowing the business donations.

Even so, not until this February did PAHO begin taking industry money, Reuters found: $50,000 from Coca-Cola, the world's largest beverage company; $150,000 from Nestle, the world's largest food company; and $150,000 from Unilever, a British-Dutch food conglomerate whose brands include Ben & Jerry's ice cream and Popsicles.

In a press release following the Reuters article, PAHO claimed that they need to work with all sectors, including governments, academia, civil society, and the private sector, to tackle challenges such as reduction of salt intake, prevention of cancers, tobacco control, diabetes prevention, promotion of physical activity and so on. That is certainly true, but consultation, cooperation and collaboration can take place without the private sector companies giving a large sum of money.

Taking money from companies that are directly contributing to the challenges that PAHO and WHO are trying to address on both a regional and global scale, is a conflict of interest, regardless of what PAHO's apparent "strict guidelines" say. Companies like Nestle, Coca-Cola and Unilever should be invited to suggest solutions and also asked to be part of the solution. But when they are writing a cheque, it would be very difficult for PAHO to speak out against those companies and to directly implicate them as a big part of the problem. What if solutions that are suggested include limiting advertising of junk food or infant formula? Or adding taxes on foods containing high amounts of sugar or sodium? Will those companies, and their money, still be willing to sit at the table as those provisions are suggested, accepted and implemented? Based on past experience, that is highly unlikely. They will fight it tooth and nail.

The World Health Organization disagrees with PAHO's position on taking money. In a press release, it explained how it works with the private sector:

When WHO works with the private sector, the Organization takes all possible measures to ensure its work to develop policy and guidelines is protected from industry influence.

  • WHO may engage with the private sector on occasion, but according to WHO policy, funds may not be sought or accepted from enterprises that have a direct commercial interest in the outcome of the project toward which they would be contributing.

  • All experts on WHO advisory groups for developing norms, standards and guidelines are required to disclose interests regarding the advisory committee’s area of work. If a declared interest is potentially significant, then the expert is either excluded from the meeting or given a restricted role.

For this reason the Organization does not accept funding from the food and beverage manufacturers for work on NCD prevention and control.

That is an organization that has a good understanding of how to act in a responsible and transparent fashion. On twitter and facebook, the WHO spoke out directly against the approach taken by PAHO:

The World Health Organization (WHO) recognizes the importance of working with the private sector. However since part of our work involves setting norms, standards and guidelines for public health, we have very strict guidelines for accepting money from the private sector. WHO does not accept funds from the food and beverage industry for its noncommunicable diseases work. It is unfortunate that the Pan American Health Organization (PAHO-WHO) has accepted money from the food and beverage industry.  PAHO - while it is a WHO regional office for the Americas – is, unlike the other regional offices, also the health agency of the Organization of American States. Therefore in some areas, PAHO has its own operating guidelines. Not all PAHO guidelines are aligned with WHO. One such area is collaboration with the private sector.

Having opted to take money from Nestle, Coca-Cola and Unilever, PAHO is stepping into very muddy waters.

Would these companies really give money to PAHO if they didn't think those funds would buy them some influence? It is highly doubtful.

As in the past, these companies are likely to push for physical activity as the solution to everything, ignoring the fact that overeating and poor eating has a much bigger impact on our weight than exercise does. As in the past, these companies are likely to fight any policy agenda or legislation that could have a negative impact on their ability to increase the sales of their products, even when they've been found to have negative health effects. As in the past, health policy is likely to be watered down in order to not upset the sensitivities of large multinational corporations.

A petition on Care2's Petition Site is urging PAHO to give the money back to Nestle. I would urge you to sign this petition, but also to put pressure on PAHO to return the money from ALL of these organizations and to realign itself with WHO guidelines on working with the private sector. Otherwise PAHO's work, and even PAHO's contribution to WHO's work, will be tainted by the possibility that policies, actions and solutions were watered down through a pseudo bribe from companies that have a direct interest in the outcome of that work.

What do you think the role of the private sector should be in the development of health policy and programs?

Image credit: vlauria on flickr.

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Reader Comments (3)

Thank you for this extremely cogent and thorough discussion of the PAHO / Nestle issue and all you are doing to raise awareness of the terrible conflict of interest for health organizations in accepting money from companies that undermine health with predatory marketing practices! It is exactly why we need to recognize and reward and spend our consumer dollars with companies that have joined the CARE-WHO Alliance and committed to upholding the WHO Code and supporting mothers and babies. Thank you again for all your wonderful work.

November 27, 2012 | Unregistered CommenterBettina at Best for Babes

Private sector companies are legitemate interest groups with associated rights (and responsibilities) to participate in the policy process. However, they should not be able to use their privileged economic position to buy influence in a way that other interest groups (users of Heath services, not-for-profit providers etc) cannot. You make the reasons for this really clear, Annie.

The problem is that even without the use of donations these companies still have a powerful influence on public discourse and, as such, contribute to shaping how health problems are represented and what policy options count as solutions.

We should not just be urging PAHO to give the money back but also to (further?) support health advocacy and activism so that there are alternative voices contributing to the development of health policies and programs.

November 28, 2012 | Unregistered CommenterCate

If we want WHO and PAHO-WHO to be strong enough to turn down industry funding and to thwart industry influence we need to call on our own governments to strengthen their commitment to funding. Canada is a huge contributor, but we can do more. I note with interest the huge effort by Big Food and Big Beverage to keep governments from assessing a tax on junk food. I wonder if one day we'll see court cases against the industry to pay for the health care damages their unethical marketing practices have caused, much the same way tobacco industries are in the courts now.

December 3, 2012 | Unregistered CommenterJodine Chase

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