As autoras respondem

Abstract

S1We wish to begin by thanking the discussants of our article for enlightening the debate on PublicPrivate Partnerships (PPP) in the field of health. The nature of the article sparks debate on the good faith of certain PPPs, especially when they involve large corporations, like the tobacco industry, and the public sector. Although the tobacco industry has a well-established legal framework, it amounts to a company selling a drug that kills one out of two of its consumers. Since 1998, several authors 1 have emphasized that the goal of PPPs should be "to improve the health of populations", which obviously does not apply to the tobacco industry, but which may apply to some companies focused on the development of well-being, as cited in the article 2 . In the case of the tobacco industry, the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), Article 5.3, provides that the interests of public health should be protected from the tactics adopted by this industry, and the article's discussants were incisive about the extent to which PPPs entail the notion of risk and ideologies, pertaining to our status as a consumer society.Galvão's comments call attention to the risks posed to the public good by PPPs. He cites the example of tobacco farmers' health and the factors involved in agricultural and industrial tobacco production, as well as the need to assess the entire production cycle to determine the risk. Tobacco farmers are constantly exposed to harsh sun, highly toxic pesticides, and the nicotine in tobacco leaves. However, this situation could improve dramatically if Articles 17 and 18 of WHO-FCTC were complied with and farmers could access credit lines to reduce the area of their tobacco crop, transforming their properties into places where healthy, pesticide-free foods is produced.The discussant Johns raised an extremely relevant issue, namely the increase in obesity due to the consumption of ultra-processed foods, and suggests adding the element of "risk of association" to the analysis for categorization of PPPs. It is inconceivable for a public health institution to partner with the fast food industry to maintain its functioning, as occurs in some Brazilian institutions. On then other hand, it is equally unthinkable for public health policies not to prioritize health institutions in the prevention and treatment of noncommunicable diseases, with priority for the maintenance and proper functioning of such services.Rodrigues questions the nature of PPPs and asks whether what prevails is collaboration or competition. Likewise, he also questions the feasibility of partnerships with corporations, considering DEBATE DEBATE