Sitting on the FENSA: WHO engagement with industry

Abstract

When decisions are made that will impact on people's health, who should be represented at the policy-making table? Is it sufficient to rely upon representatives from national governments (the State), or should other stakeholders participate-and if so, to what purpose? To advise? Make decisions? Or as funders? These issues lie at the core of a governance debate 1 that has been rancorously discussed in relation to WHO for several years. In May 2016 the World Health Assembly (WHA) reached consensus: "WHO engages with non-State actors ….to encourage [them] to…protect and promote public health"-and considered non-State actors as "nongovernmental organizations [NGOs], private sector entities, philanthropic foundations and academic institutions" 2. The resolution known as FENSA (Framework of engagement with non-State actors) had a long and difficult gestation, but is seen by many as a critical element of the ongoing WHO reform. Members States were generally supportive of the Framework, but NGOs voiced concern that "FENSA will increase….problematic entanglements between WHO and powerful private sector actors", and were disappointed that the Framework fails to "acknowledge the different nature-and thus different roles-public and private sector actors should play in global health governance" 3. In contrast, the private sector International Federation of Pharmaceutical Manufacturers and Associations welcomed the framework as giving "an equitable voice to a vibrant community of public and private organizations whose shared goal is to make this world healthier" 4. Concerns have long been raised about potential and actual conflicts of interest arising from WHO's engagement with non-State actors (NSA), particularly those whose mandate hinges

Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure

“…Industry welcomed FENSA as providing an opportunity for reaching shared goals “to make this world healthier” [64], but NGOs raised concerns over potential “problematic entanglements” [65]. While FENSA established rules of engagement between WHO and non-state actors, the framework has been criticised (by ourselves) as not containing sufficient guidance on governing the activities of industry in relation to public health outcomes [66]. …”

Gender blind? An analysis of global public-private partnerships for health

“…Given the key role that the private sector plays in determining the nature of risk (including manufacturing gendered risks) of exposure to health-reducing products, there is a strong argument for the need for interaction between global health communities and private companies. However, the broad yet specific challenge is how to manage the risks inherent in such interactions [48], mitigate conflicts of interest, and ensure that population health is protected [49] while also addressing the gendered nature of health determinants and health system responses.…”

World Health Organization and the search for accountability: a critical analysis of the new framework of engagement with non-state actors

“…In order not to create frictions with the private sector, instead of addressing the larger issues of governing the activities of industries, FENSA focuses narrowly on the issues of risk assessment and management for WHO itself when engaging with the private sector 15 . Even if the provisions about due diligence to protect WHO are well implemented, they will not necessarily translate into improved corporate practices at global and national levels that will act to promote and protect the health of their consumers.…”

“…Although FENSA had a difficult gestation, many see it as a crucial element of WHO's reform 15 . At the beginning, this topic appeared in the reform agenda as "participation of non-governmental organizations (NGOs)".…”