Service on Health Issues (Oct15/16)
WHO - Partial agreement on engagement policy with industry
Geneva, 26 October (K M Gopakumar) – World Health Organization Member States have reached agreement to engage with industries in the context of non-communicable diseases (NCDs).
The Secretariat is to exercise particular caution on WHO’s engagement with industries linked to NCDs.
This consensus was reached after almost two and half days of negotiation on Paragraphs 44 and 44bis of the Framework of Engagement with Non-State Actors (FENSA) during informal consultations. The consultation took place on 19 -21 October at the WHO headquarters in Geneva.
These two paragraphs earlier titled as ‘engagement with particular industries’ are aimed at rules of disengagement with certain types of industries such as tobacco and arms. However, during the negotiation many Member States pointed out that apart from tobacco and arms industry it is important for WHO to either disengage or restrict engagement with certain other industries such as food and beverages, alcohol etc.
Paragraph 44 sets the rules of engagement with the tobacco and arms industries. Paragraph 44 bis sets the terms of engagement with private sector industries having negative impact on human health.
The new Paragraph 44 reads:
“WHO does not engage with the tobacco industry or non-State actors that work to further the interests of the tobacco industry. WHO also does not engage with the arms industry.”
Even though there was consensus on complete disengagement with the arms and tobacco industry, the contentious issue is related to the proposal of disengagement with firms affiliated to the tobacco and arms industry. The July text stated: “WHO does not engage with the tobacco or arms industries [and its affiliates].”
After the consultations in September the Chair proposed the following text: “WHO does not engage with tobacco industry or manufacturers.” The Chair also proposed a footnote on the tobacco industry which reads: “This includes entities linked to or supporting the tobacco industry as defined under the FCTC (Framework Convention on Tobacco Control)”.
Non-members of the FCTC, such as the United States and Switzerland, opposed any reference to FCTC. The Chair’s text dropped the term ‘affiliates’ and added this as a footnote instead. The Chair also limited the scope of the footnote to the tobacco industry.
The Secretariat expressed concern over the inclusion of arms industry affiliates in the list of disengagement. The non-paper of the Secretariat stated: “An extensive interpretation of the non-engagement with the arms industry could lead to important missed opportunities, such as engagement with the IT sector on e-health and mhealth, since most of the companies operating in this field have either close ties with defence industry or have developed expertise, branches and subsidiaries in this area”.
The agreed Paragraph 44 covers the tobacco industry and any other entity furthering the interest of the tobacco industry. However, it only excludes the arms industry not other NSA’s furthering the interest of the arms industry. The agreed Paragraph uses the term "arms industry" rather than the restricted term of “arms manufacturers “ proposed in the Chair’s text.
The agreed paragraph 44 bis states:
“WHO will exercise particular caution, especially while conducting due diligence, risk assessment and risk management, when engaging with private sector entities and other non-State actors whose policies or activities are negatively affecting human health and are not in line with WHO’s policies, norms and standards, in particular those related to non-communicable diseases and their determinants”.
Paragraph 44bis does not propose disengagement with the private sector such as the alcohol, food and beverages industry but rather engagement with particular caution.
This paragraph imposes a duty on the Secretariat to exercise particular caution while engaging with the private sector and other NSA especially those “related to non-communicable diseases and their determinants”. However, this new paragraph does not spell out the details of “particular caution”. This gives an absolute freedom to the Secretariat to define “particular caution”. Further, the particular caution is to be exercised in case of engagement with the private sector or other NSAs, whose policies or activities are negatively affecting human health and are not in line with WHO’s policies, norms and standards.
The word “and” gives an impression that the particular caution should be exercised only when the two conditions are fulfilled. First, policies or activities are negatively affecting human health. Secondly the policies and actions are not in line with WHO’s policies, norms and standards. The question arises on whether the Secretariat is bound to take particular caution when the policies or activities of an NSA negatively affect human health but they are in compliance with WHO’s policies, norms and standards. The concern is whether the Secretariat can do away with the particular care requirement in the case of a food and beverage company saying that the policies and action of the company are in line with WHO’s policies, norms and standards.
Unlike the WHO, the Office of the High Commissioner for Human Rights (OHCR), United Nations Educational, Scientific and Cultural Organisations (UNESCO) and UN Population Fund have a policy of excluding the alcohol industry from any engagements.
The cautious approach with regard to engagement with NSA especially private sector in the area of NCD is important in the light of growing attempts of transnational corporations in influencing the policies aiming at addressing prevention and control of NCDs. TNCs are using various strategies to prevent the policies on NCDs from affecting their commercial interest and profits. Echoing the same sentiment WHO Director-General Dr. Margret Chan recently said in her address at WHO’s Regional Committee of Europe:
“ … Many of the risk factors for NCDs arise from the behaviours of multinational corporations. In the interest of prevention, ministries of health, notoriously under-funded, are now challenged to change corporate behaviours. Wow! You have a tough job.
World Bank data show that, in 2011, more than 60% of the world’s 175 largest economic entities were companies, not countries. Data also show that this concentration of power is rapidly growing.
The new distribution of power raises an absolutely critical question for health in the sustainable development era. Who really governs the policies that shape our health?
Is it democratically elected officials acting in the public interest? Is it multinational corporations acting in their own interest? Or is it both? That is, governments making policies that are heavily influenced by corporate lobbies.” http://www.who.int/dg/speeches/2015/europe-regional-committee/en/
The World Health Assembly decision (WHA resolution 66.10) adopts WHO’s Global Action Plan for the prevention and control of NCDs as a follow up to the Political Declaration of the High Level Meeting of the UN General Assembly on NCDs in 2011. The resolution requested WHO Director-General to “provide technical support to Member States, as required, to engage/cooperate with non-health government sectors and, in accordance with principles for engagement, with non-State actors, in the prevention and control of non-communicable diseases”. The footnote clearly stated that the engagements should be without prejudice to on going discussions on WHO engagement with non-State actors. Therefore paragraph 44 bis of FENS is a determining factor to define the rules of engagement between WHO and the private sector.
Further, the action plan identified the following actions: “Facilitate coordination, collaboration and cooperation among the main stakeholders including Member States, United Nations funds, programmes and agencies (see Appendix 4), civil society and the private sector, as appropriate, guided by the Note by the Secretary-General transmitting the report of the WHO Director-General on options for strengthening and facilitating multi-sectoral action for the prevention and control of non-communicable diseases through effective partnership, including the strengthening of regional coordinating mechanisms and establishment of a United Nations task force on non-communicable diseases for implementation of the action plan”.
The Global Coordination Mechanism on NCDs has a working group on how to realize governments’ commitments to engage with the private sector for the prevention and control of NCDs.
The scope and purpose of the WHO Global Coordination Mechanism on NCD is to facilitate and enhance coordination of activities, multi-stakeholder engagement and action across sectors at the local, national, regional and global levels, in order to contribute to the implementation of the WHO Global NCD Action Plan 2013-2020: http://www.who.int/nmh/en/
Many feel that in the absence of robust provisions in FENSA the private sector would use the engagements to prevent an effective response to NCDs. Rebecca Perl of World Lung Foundation suggests the two following steps to prevent the corporate capture of NCD agenda. “1) Kept multinational food and beverage companies (particularly those who sell products that are a major contributor to obesity, heart disease and diabetes) from NCD policy formation (2) Establish a broader conflict of interest policy regarding non-state actors so all NCD prevention and policy is driven by independent research and evidence”. (http://globalhealth.thelancet.com/2015/10/21/who-decision-critical-fight-against-obesity-and-non-communicable-diseases )
As per the information provided on the WHO Program and Budget portal currently WHO is not receiving any private sector finance. However, this is not entirely true. At least two NGOs viz. International Association of Dental Research (IADR) and International Society of Hypertension (ISH), are both ontributing 0. 4 % of WHO’s NCD budget, have corporate membership . Corporate Members of IADR includes Colgate, Uniliver, GSK etc.
Corporate members of ISH includes Astellas Pharma Inc., Astra Zeneca, Medtronic etc. (http://ish-world.com/membership/corporate-members.htm)
Interestingly Bill and Melinda Gates Foundation that contributes nearly 33.6 % of WHO’s NCD programme, invested heavily into food and beverages companies. According to a short note prepared by Bill Jeffry of Centre for Science in the Public Interest estimates the investment in Coca Cola alone is USD 494 million. As per the WHO Budget portal the total financial contribution till August 2015 in the 2014-15 biennium from Gates Foundation is USD 515,946,000 and 1% of this contribution i.e. USD 5,159,460 is for NCDs.
However, the exact activity undertaken from the contribution of NSAs in the area of NCDs is not available in the public domain. WHO does not reveal the exact purpose of voluntary specified financial contributions.
Article 44bis emerged after the drafting group meetings during the 68th World Health Assembly.
The original proposal of the Secretariat submitted at the 136th of the Executive Board (EB) in January 2015 has only one Para dealing with engagement with particular industries (Para 44).
The original Paragraph 44 stated:
“WHO does not engage with the tobacco or arms industries. In addition, WHO will exercise particular caution when engaging with other industries affecting human health or affected by WHO’s norms and standards”.
However, many Member States were not happy with the term “particular caution” because the draft FENSA did not define the term. In the absence of definition of “particular caution” the Secretariat gets maximum flexibility to determine the elements of particular caution. Further, apart form tobacco and arms industries many Member States also pointed out that there should be total disengagement or restricted engagement with other industries such as alcohol, food and beverage industries.
India, Denmark, Finland, Greece and Zimbabwe on behalf of the African Group proposed a cautious approach to alcohol, food and beverage industries. Some of these countries clearly want to name these industries. Countries like Finland want to achieve the same objective without naming them. Finland in its submission stated that “We believe that there are some industries that have clear interests in health policies (such as those linked with control of NCDs) with whom WHO should use high level of restriction …” The US, Canada, France and Norway opposed the inclusion of industries other than tobacco and the arms industry in the list of disengagement.
There was no consensus on this paragraph till the 68th WHA in May 2015. During the negotiations paragraph 44 was divided into two:
Paragraph 44: WHO does not engage with the tobacco or arms industries [and its affiliates]
Para 44bis: [WHO will exercise particular]/[appropriate]/(DEL) caution [consistent with and subject to the rules of this framework] especially while conducting due diligence and risk assessment analyses when engaging with [non -state actors]/[other industries]/[private sector and some industries] [negatively] affecting human health, or affected by the WHO’s norms and standards.][STOP HERE] [[such as]/[for example][, but not limited to,] alcohol and food and beverage industries] CHAIRS PROPOSAL: 44 bis WHO will exercise particular caution especially while conducting due diligence and risk assessment when engaging with private sector entities or other non -State actors affected by WHO’s policies, norms and standards
In July there was no change in the consultation. After the September consultation the Chair proposed the following text:
44: WHO does not engage with the tobacco industry [ADD FOOTNOTE: This
includes entities linked to or supporting the tobacco industry as
defined under the FCTC] or arms
Engagement with particular non-State actors
Paragraph 44bis: WHO will exercise particular caution especially while conducting due diligence and risk assessment when engaging with private sector entities or other non-State actors, which are negatively affecting human health or affected by WHO’s policies, norms and standards.
The agreed text is based on the Chair’s text.
This agreement reached in the informal consultation is expected to be approved during the resumed session of the Open Ended Inter Governmental Meeting on 7-9 December in Geneva.
The informal consultation focused on creating an exception to the application of FENSA during situations of emergency response but did not reach a consensus. However, there was agreement on some minor issues such as the definition of NSAs.
A developing country delegate informed Third World Network that the Chair will consult with the Secretariat and other Member States to produce a Chair’s text on pending issues. There will not be any further negotiation prior to the resumption of the Open Ended Inter Governmental Meeting.