Global Health Philanthropy and Institutional Relationships: How Should Conflicts of Interest Be Addressed?

Abstract

David Stuckler and colleagues examine five large private global health foundations and report on the scope of relationships between these tax-exempt foundations and for-profit corporations including major food and pharmaceutical companies.

Balancing the benefits and risks of public–private partnerships to address the global double burden of malnutrition

“…Examples of civil society organizations (CSO) include social movements, voluntary organizations, NGO, grassroots organizations and other non-profit stakeholders (24) Collaboration Comprises activities that enhance the capacity of partners to produce mutual benefit and work towards a common purpose (62) Conflict of interest Arises when an individual's or organization's ability to exercise judgement in one role is influenced by obligations in another role or by competing interest. For example, a person or organization may put aside primary interests (such as advocacy for public health) in favour of a secondary set of interests (such as the financial well-being of a commercial entity or receiving a financial benefit) (92,(101)(102)(103)(104) Contributions in-kind A non-monetary donation of a branded product or service made by a company to an NGO (59,72) Double burden of malnutrition The coexistence in a household, community or population of child and maternal undernutrition (i.e. wasting, stunting and underweight) and micronutrient deficiencies (i.e.…”

“…PPP evaluations have identified risks that can undermine the appropriateness, effectiveness and credibility of alliances due to: displacing donor priorities with those of recipient countries; excluding certain stakeholders from decision making; neglecting to effectively address conflicts of interest and biases; raising insufficient resources to implement partnership activities and sustain alliances; and inadequately managing human resources (61,92) . Six challenges discussed below must be addressed to reduce risks to all partners: (i) balancing private commercial interests with public health interests; (ii) managing conflicts of interest and biases; (iii) ensuring that co-branded activities support healthy products and healthy eating environments; (iv) complying with ethical codes of conduct; (v) undertaking due diligence to assess partnership compatibility; and (vi) monitoring and evaluating partnership outcomes.…”

“…Conflicts of interest may arise when NGO staff receive personal gifts or in-kind resources from companies to influence decision making, research or public positions (92,(101)(102)(103)(104) . Further, it is arguable that NGO may be susceptible to 'white hat bias' (105) , a tendency to disregard facts and distort the truth to serve righteous ends.…”

“…For example, the Bill & Melinda Gates Foundation has generously supported programmes targeting global health and undernutrition. At the same time, the Foundation has generated a portion of its wealth through direct investments in companies that produce and market products linked to rising obesity and NCD rates, including McDonald's Corporation and The Coca-Cola Company, and indirect investments in Coca-Cola, Kraft Foods and Nestlé through Berkshire Hathaway (92) . These considerations do not necessarily preclude PPP but should rather be viewed as opportunities to be addressed to strengthen partnerships.…”

Corporate sponsorship of global health research: Questions to promote critical thinking about potential funding relationships

“…While the issue of inappropriately-targeted research arguably extends to funding priorities of governments, corporate priorities are established through publicly-unaccountable mechanisms that support their commercial interests. 7 Recently, research on physical activity's relationship to obesity has been promoted by the Coca-Cola Company as a way of diverting attention away from sugar consumption. 8 Less obviously, the Rockefeller Foundation in the early 20 th century promoted a model of international health based on technical interventions (e.g., hookworm eradication) that would demonstrate quick results, rather than tackling diseases such as tuberculosis, with its greater burden of disease but more complex and politically-controversial interventions (e.g., reducing poverty).…”