Partnerships and Politics in Public Health: A Focus on Non-Communicable Diseases
Non-communicable diseases (NCDs) were a hot topic at this year’s UN General Assembly (UNGA). Heads of states and governments adopted a new political declaration at the Third High Level Meeting on NCDs. This document has, however, been widely criticized as ‘weak’ especially its recommendations around the prevention of NCDs. Dr Sylvia Garry and Rachel Thompson reflect on tensions between the public health community and the private sector: while partnerships are being forged around the treatment of NCDs, they argue, greater collaboration for prevention is urgently needed too.
Similar to climate change or antimicrobial resistance, NCDs represent a ticking time bomb for societies and economies. Yet global progress to tackle the rising burden of NCDs has not been adequate. NCDs such as diabetes, heart disease and cancer kill nearly 41 million people each year — many of them well under the age of 70.
Efforts to tackle NCDs require a focus on both improving access to treatment as well as reducing associated risk factors such as alcohol and tobacco use, lack of physical activity and unhealthy diets. There is no single solution and prevention requires a multi-pronged and multi-sector approach. Reducing risk factors requires creating environments that support individuals and their communities to make well-informed, healthier choices.
Governments have a key role to play in facilitating such environments to help prevent NCDs. To aid governments, the World Health Organization (WHO) has produced a series of recommendations that provide a list of cost-effective evidence-based interventions to implement. Prevention of NCDs is not only a public health priority, but also an economic one. It is estimated that every $1 invested in these interventions — known as the ‘Best Buys’ — will yield a return of at least $7 and that they could generate up to $350 billion in economic growth between now and 2030. However, implementation has not been widespread, leading some in the global health sector to label them the ‘wasted buys’.
Although governments have the ultimate responsibility for public health, the private sector — including the food, beverage, alcohol and tobacco industries — are also important. The relationship between the public health community and these industries is, however, a delicate one with criticism historically levelled on both sides. For example, these industries have been explicitly criticized for influencing policy through lobbying and forms of corruption. There has been debate within the global health sector over whether industries that are part of the problem can also be part of the solution.
This sensitive relationship, as well as the broader political economy of NCDs, was apparent at the recent UN High Level Meeting on Non-Communicable Diseases. Strikingly, WHO’s ‘Best Buys’ were not included in the political declaration that was adopted. The omission of references to taxation — such as the sugar tax — or the greater regulation of industry by governments have been particular sources of criticism from civil society. Such omissions may reflect the real-politick of UN-led processes where evidence is side-lined and where politics trumps public health. The lack of discussion on NCDs prevention at corporate-sponsored side events was also criticized, possibly reflecting the reality of asymmetrical partnerships between NGOs and their funders.
Yet there remains a role for some private sector actors in tackling NCDs. Access to treatment is a challenge for many individuals and communities around the world, especially people affected by poverty, displacement and conflict. NCDs are no longer considered a disease of affluence and these poorest communities are at the greatest risk. In these circumstances, partnerships between the pharmaceutical industry and the public health sector can be crucial to combatting the challenges to accessing healthcare.
Overall, however, the ‘weak’ UN political declaration combined with ever-growing corporate visibility in NCDs will likely serve to decrease trust between public health advocates and industry. The challenge now is for the public health community to keep the dialogue open and to recognize the role of industry in not only causing but also combatting NCDs. While there is a delicate balance to be struck in partnerships, antagonism and apathy are no longer an option: it is time to talk meaningfully and cooperate.