The UK Public Health Network is an advocate for collaboration. It forms the basis of what we do and why we exist – to facilitate coordination, share opinions and exchange knowledge in the public health community. But collaboration between public and private bodies isn’t as candid. It is a multifaceted relationship which has the potential to make lasting change but comes with its challenges.
On 15 July 2020 the UK Public Health Network held an online seminar, chaired by David Kidney (UK Public Health Register CEO), to analyse the benefits and costs of PPPs (public-private partnerships), and determine their relative effectiveness.
Public Health Responsibility Deal
The Responsibility Deal was launched in 2011 in England and was organised around a series of voluntary agreements that aim to bring together government, academic experts, and commercial, public sector and voluntary organisations, to commit to pledges to undertake actions of public health benefit.
Our first speaker, Mark Petticrew from The London School of Hygiene and Tropical Medicine, was involved in the evaluation of the Responsibility Deal and outlined the aims, objectives and conclusions found. Mark revealed that the evaluation found that among the main drawbacks of the Responsibility Deal were that:
- most of the interventions chosen by organisations would have little or no effect on health improvement and
- most of the actions committed to, industries would have taken place regardless of the Responsibility Deal.
Policy substitution is another issue linked with public-private partnerships. This is when the partnership is often used by unhealthy commodity industries to undermine evidence-based policies. Mark used CAPs (Community Alcohol Partnerships) as an example of policy substitution. CAPs describe themselves as ‘one of the most significant alcohol-industry funded initiatives tackling underage alcohol misuse with good evidence of effectiveness’ but, following a review of their activities, and their evaluations, Mark and team found that CAPs evaluations are methodologically weak, uncontrolled, report very little data and claims are based on small numbers. Mark concluded that the purpose of CAPs is potentially more about alcohol industry reputation management and there is no good evidence that they have any effect on alcohol harms.
Our next speaker, Modi Mwatsama from the Wellcome Trust, outlined a meeting on strengthening the governance of diet and nutrition partnerships for the prevention of chronic diseases in 2016. The meeting brought together stakeholders from 14 different countries to critique institutional guidelines on conflicts of interest, how they can be strengthened and make recommendations for action.
A nutrition governance casebook was developed, which included 12 international cases, to increase awareness of the ethical and conflict of interest challenges of PPPs and to strengthen governance.
10 out of 12 cases found that the partnerships failed to achieve the public health objectives that they aimed to do, and no significant progress was made. The main finding from this casebook was that very few public health actors have the tools, skills and resources to identify and mitigate the potential pitfalls of engaging with corporate actors.
Conflicts of interest
12 institutional guidelines on PPPs were examined. Although existing guidance had strengths – it recognised a broad range of different types of conflicts and required independent assessment of ethics and due diligence – there were weaknesses. Existing guidance lacked criteria for disengaging with private partners and failed to identify the conflict of interest risks in relation to wider public health objectives. Minimum good practice criteria for risk management guidelines should include:
- an ethics assessment prior to entry into the partnership (as opposed to this being an afterthought),
- built in ongoing reviews to ensure the partnership is meeting the required objectives, and
- clear articulation of what the exit mechanisms may be.
Public-private partnerships have the potential to be catalysts for change – but the relationship between public and private partners is complex. There needs to be more awareness of PPPs and the role of corporations and, as Modi said, it is important to redress actor imbalances to ensure the public health voice is represented in public policy making. Effective monitoring and research should be implemented to ensure it is a credible relationship which has a lasting impact on health improvement.
Community Alcohol Partnerships with the alcohol industry: what is their purpose and are they effective in reducing alcohol harms? M Petticrew, N Douglas, P D’Souza, Y M Shi, M A Durand, C Knai, E Eastmure, N Mays Journal of Public Health, Volume 40, Issue 1, March 2018, Pages 16–31. https://academic.oup.com/jpubhealth/article/40/1/16/2874246