Case Studies and Caveats

This chapter outlines several partnership case studies involving the food and beverage sector, especially soda companies. These case studies are drawn from the United States, Britain, and India. The analysis highlights certain problematic features—for example, use of corporate logos, trademarks, and color schemes that are likely to promote consumption of products that are exacerbating obesity and diet-related noncommunicable diseases (NCDs). But, more fundamentally, the analysis ties the case studies to the broader systemic effects discussed in the preceding chapters. These include framing effects, agenda distortion, and impacts on the integrity of and trust in public health agencies.

Toward Systemic Ethics

The chapter urges public officials not to use the language of partnership and argues for a strong presumption against close relationships with industry (however those relationships are described). It offers some guidance for public officials who believe they can make a compelling case to rebut that presumption. This guidance is avowedly more demanding than other approaches. Most importantly, it rejects the isolated analysis of individual relationships and calls for systemic analysis that takes into account the cumulative effects of webs of relationships with industry actors. The chapter develops a framework for independent systemic assessment, monitoring, and evaluation; it also provides for withdrawal. The assessment includes the application of the integrity matrix to highlight tensions involving the mission, purpose, and practices of collaborating institutions. It also draws on frameworks in public health ethics that, in turn, draw on international law.

In Praise of Separation

This chapter offers a novel theoretical approach to the ethical hazards arising from public-private interactions. It outlines the role that separation of powers plays in the public sphere, regulating interactions between different branches of government. Antitrust or competition laws play a parallel role in the private sphere, regulating interactions among corporations. Given these norms for addressing reciprocity and influence in the context of public-public and private-private interactions respectively, the chapter makes the case for analogous norms to govern public-private interactions. Rationales for public-private partnerships (PPPs) are analogous to claims that have been decisively rejected when offered as justifications for violations of separation of powers. These rationales similarly fail to justify the public-private partnership paradigm. If public health agencies wish to preserve their independence, integrity, and credibility, they should maintain arm’s length relationships with industry. The chapter outlines a set of principles that can help public officials interpret existing norms (such as conflicts of interest policies) and develop new norms to govern interactions with the private sector.

The Perils of Reciprocity

Social scientists describe reciprocity as prosocial behavior. Some philosophers argue it is a fundamental virtue. Subtle and fluent reciprocity between life partners may well be commendable. But reciprocity between institutions with divergent missions, purposes, or interests raises serious ethical concerns. In such cases, reciprocity may create subtle forms of influence that imperil institutional integrity. Ethical concerns are most acute when one institution has an obligation to protect the interests of third parties (especially vulnerable populations), and its reciprocal behavior adversely affects those third parties. When a public health agency partners with a corporation whose products or practices have adverse effects on health, asymmetric reciprocity may seriously undermine public health. The concept of stewardship can help public officials identify and address ethically problematic reciprocity.

Introduction

Public-private partnerships (PPPs), multistakeholder initiatives (MSIs), and other close relationships with industry actors have become the paradigm in public health. Nowhere is this more evident than in the food and beverage sector. Public officials tend to downplay the ethical perils of these arrangements, and sometimes they fail to recognize them at all. The chapter explores the terminology and taxonomies of public-private partnerships and the justifications offered for these kinds of interactions. It outlines the main concerns and theoretical contributions of the book and provides a summary of the chapters to assist policymakers and other readers who wish to be more selective in their reading of the text. This book is intended to help public health officials (among others) develop comprehensive strategies to counter industry influence and pilot alternatives to PPPs.

Conclusion

Industry actors understandably develop strategies of influence directed at government bodies, academic institutions, and civil society organizations. These entities have a responsibility to develop counter-strategies to insulate themselves from industry influence. They also need a plan to wean themselves off industry funding. If governments wish to exert leverage over corporations, they need distance rather than proximity. And if they are serious about trying to solve our most challenging public health problems, they must be willing to explore all potential solutions, including those inimical to the commercial interests of industry. We need a new paradigm in public health—one that avoids the ethical perils of public-private partnerships and multistakeholder initiatives. But, before we can develop an alternative paradigm, we must first acknowledge the ways in which status quo is ethically problematic.

Webs of Influence

Corporations and trade associations exert influence on policymakers—both directly and indirectly. Indirect influence results from close relations with research universities and civil society groups such as health professional associations and patient advocacy organizations. These relationships form webs of influence that undermine the integrity of public health agencies; distort public health research and policy; and lead to the framing of public health problems and their solutions in ways that are least threatening to the commercial interests of powerful industry actors. This chapter also explores the nature and ends of the research university; mechanisms of industry influence (such as health halos); the impact of philanthropic foundations; and the history of sugar industry influence.

The Common Good and Common Ground

This chapter reviews the related notions of the common good, the public good, and the public interest. Although corporations can contribute to the common good, they are not guardians of the common good. That is the responsibility of government bodies and public officials. There may be reasonable disagreements about how to define and promote the common good. But policymakers should not conflate the commercial interests of powerful industry actors with the common good. Nor should public officials confound the common good and common ground. Finding common ground with industry ordinarily requires public officials to take off the table interventions that might promote the common good. Public health officials should expressly consider ways to promote the public health that may not create benefits for the private sector, and may even be inimical to the interests of industry.

Institutional Ethics and Integrity

This chapter provides a foundation for addressing the ethical obligations of public sector bodies. It offers a more demanding account of institutional integrity than public officials tend to employ. A core requirement is consistency among what an institution is obligated to do (its purpose), what the institution says it does (its mission), and what that institution actually does (its practices). If an institution’s practices predictably undermine the very goals in terms of which the institution justifies its existence, that institution may be said to lack integrity. Not all cases are so extreme but this gives us a place to start. The chapter also addresses institutional missions that are internally conflicting or in transition.