VHPO

This stream is initiated by Maggie Davis, Department of Health (HD), UK.

Health Promotion Sponsorship and Collaboration

The work of the Commission on the Social Determinants of Health has helped to articulate the political to practice actions that are needed to promote and maintain health. This gives an opportunity for health promoters to reflect further on their role in shaping the world that we live in for future well being, as well as act on healthy lifestyles now.

It is recognised that health promotion needs to work on the macro level to address global issues and on the national policy and local action levels (reference Bangkok Charter).

It remains the case that action on these levels requires work across sectors and by a range of stakeholders (international agencies, governments, professions, academia, NGO, business interest and communities).

Increasingly the role of commerce and business in either maintaining or damaging health is being understood, not only at the professional level, but also by the wider public.

High profile organisations and entrepreneurs, such as Gates and Soros, attract public attention and are generally thought to be a force for good. Other companies with global reach, such as Coca Cola and McDonald’s, are frequently associated with health harming products and cultural imperialism. However, even those companies that have health benefits at heart can be perceived as being problematic as, with budgets that can exceed the GPR of the countries they are donors to, there is a possibility of imposing priorities and even of subverting democratic processes by undermining national decision making. Anti-capitalist protestors, now a feature of G20 summits, are perhaps symptomatic of public unease at the disconnect between people and the power to make decisions about trade issues that effect their lives. This has clearly been exacerbated by the recent economic crisis which has reinforced and illustrated the interconnectivity of business interest across the globe and the potential for this to have catastrophic impacts on people’s lives.

Within this context, it is clear that health promoters need to make themselves fully aware of the political and social aspects of commercial enterprise and explore their roles as advocates for health and as change agents. In order to be able to make informed decisions about whom we should work with and how, it is essential that we apply intellectual rigour and political situational analysis to come to a view of what is best available knowledge.

In connection with commercial enterprise, there are many examples of success by the health lobby. This largely falls into two approaches;
The first is where there is out and out opposition to a specific company in general, or particular activities of a company. This might include media campaigns and boycotts and an example might be the email campaign against Nestle’s claim for $6million from Ethiopia at a time of impending famine.
The second approach is to work with a company, as either a partner or a critical friend, to help them to change their practice (usually in terms of labour or unhealthy products). An example of this might be the reduced salt formulae for Heinz beans in the UK.
There are no examples, as far as I am aware, where companies with non-health supportive behaviours have made changes because of “buying” the use of their logo or promotional material at a conference or on a publication.

It has to be the case that business would wish to work with us because there is something in it for them. This may be a win-win situation, for example, where we can help them to be better corporate citizens or employers and their reputation is enhanced or their workforce is more productive in return. It is at best naive to enter into a relationship with a commercial enterprise without being fully aware of what the potential trade offs are.

As health promotion is a value driven profession with a strong ethical base, it is clear that there are considerable reputational risks in getting the relationship wrong and it is, therefore, important for IUHPE to be clear about its rules of engagement with commerce and business which aims to:

• Promote meaningful dialogue with business and enterprise in order to promote health developing and maintaining behaviours.

• Ensure that we do not promote businesses that do not share our core principles and ethics or exhibit health damaging behaviours.

This means we need robust ethical frameworks that allow us to raise funds for projects and conferences that do not compromise our reputation or undermine our core aims. This discussion is intended to clarify the issues for IUHPE in working with business and develop guidance for the Union and its members for the future.

Questions for IUHPE

1. By what criteria do we select profit-making organisation that it is appropriate to take funding from?

2. By what criteria do we select profit-making organisation that it is appropriate to enter into dialogue, or to do joint work with?

Conclusion
There are risks and benefits in working with profit making organisations. It would be helpful to articulate these more fully and to develop clear ground rules for what is acceptable engagement. It is hoped that discussion through this forum will bring us to a position where there is no ambiguity about our position as a Union in relation to this complex issue.

Maggie Davies, Department of Health (DH), UK.

I certainly welcome this discussion! I'm leading the Ethics Working Group of ISECN (IUHPE Student and Early Career Network). In this working group we aim to produce a draft for a Code of Ethics for health promotion globally (see VHPO archive for the summary of a discussion stream on this topic). We are very soon launching a web survey asking the broad hp community about their views on important issues to be covered in such a Code of Ethics. In my opinion, one of the topics to be covered should be excactly the one in question here: 'Health Promotion Sponsorship - who gets access and why?'

How do we balance the increased opportunities to 'do good' that comes through increased funding, against possible counterproductive consequences of such sponsorship, seen in a broad sense? What could the counterproductive consequences be?

Also, referring to a time dimension, how do we weigh potential partners as 'good' or 'bad'? Their recent history, or their past history of 'wrongdoings' - for how long do we 'quarantine sponsors'? Can impressions of potential sponsors change, wrongdoers of the past be taken into the present warmth? Wrongdoers in which fields? And by which external standards do we judge a potential sponsor to be 'in the clear'?

Torill Bull
Research Centre for Health Promotion
University of Bergen, Norway

I believe that socially conscious movements have gone too far -- or not far enough -- in distancing themselves from potential funding organisations.

What do I mean by 'not far enough'?

If our objection to corporate funders is that they have vested interests that are in dissonance with our values, then why can we not take money from them, but gladly take money from governments and foundations? How can we justify funding health promotion foundations with sin taxes? That is not only taking money from evil forces like the tobacco industry, but doing so by force! Where are the values of participation and empowerment in this funding strategy?

How can we justify accepting earmarked funds from government ministries and research councils, when we know that political processes dictate what the priorities are? Where are the values of participation and bottom-up change in this funding strategy?

How can we accept contract funding from a wide rage of private and public organisations, to engage in evaluation research on terms they dictate, on questions they specify, and whose results they own? Where are ANY of our values in this funding strategy?

The fact is, we make compromises all the time, but find it convenient to not contemplate the compromises too deeply. We wish to avoid the cognitive dissonance that would surely cause us distress if we fully confronted the ethical dimensions of our fund-seeking and fund-accepting behaviour.

There is no clear line beyond which accepting funding from ANY source is unethical, and before which accepting funding from ANY source is ethical.

So, I suggest that the IUHPE enter into dialogue with the corporate world, seeking those types of cooperation where key vested interests and key values are protected and respected... but bending a little, too.... This dialogue amongst ourselves is helpful, but not sufficient for us to make progress on this matter.

post removed by author

We, definitely, are dealing with a thematic element which is a very challenging as well as interesting because it as well is highly dynamic.

Therefore, while not simple and straightforward, I dare to highlight the following key considerations:

(1) Unwavering adherence to the prevailing collective norms and the established healthy social capitals;

(2) Proven and sustained testimony on fulfillment of the fundamentals of fair and transparent business conduct;

(3) Non negotiable fulfillment and observance of the core values of the given social good promoting institution (e.g. IUHPE);

(4) Complete and full acceptance of accountability in respect to the potential damages that may be caused as result of the Health Promotion Sponsorship transaction.

Mulugeta Betre Gebremariam (Dr.)
Addis Ababa University
Addis Ababa
Ethiopia

The thin line between ethical and unethical sponsorship surely needs to be analyzed in depth before embarking on what may seem an uneasy marriage between values based principles and for profit interests, but lessons may be learnt from other partnerships and modus operandi. One might for example consider the norms used by some international humanitarian organizations regarding funding, such as MSF, which attracts 80% of its funding from private donations in order to maintain its neutrality, or the PHM whose 'Friends and Neighbors Policy' has shown that it is possible to raise funds without strings, decreasing the need for government support and use less biased sources of funding.
Given the fact that public-private partnerships are, however, unavoidable, we might as well look for examples where such partnerships exist and have been tested. I would surely agree with the points raised in the previous post, in particular with regard to adherence to prevailing collective norms and values of the social good promoting institution, which is exactly why these norms should be spelled out urgently. Ethical codes of conduct are indispensable for benchmarking any transaction with the for profit sector, because failure to do so may create conflicting situations, as illustrated at the last World Conference on Public Health in Istanbul, where socially responsible statements with regard to ethics and the right to health were unashamedly accompanied by corporate sponsorship - without declaring any conflict of interest or commercial affiliation on behalf of the speakers /panelists on corporate sponsored sessions. This lack of transparency led to a high level of discomfort among conference attendees and resulted in petitioning WFPHA to undertake a set of actions aimed at increasing transparency and promoting a greater reliance on other sources of income. The disquieting involvement of corporate sponsorship in matters of public health and good also led to a call for action originating from (again) the PHM, which is why social movements with a strong bottom-up component may be of great value for not only exemplifying codes of conduct, but also for lobbying and advocacy when the need would arise. The fact that one of the major sponsors behind the WFPHA conference was also attracted for funding the Geneva 2010 conference may warrant further attention in this regard.

Peter Delobelle, MD
Department of Public Health
Vrije Universiteit Brussel, Belgium

Removed, off topic

I used to be on the board of IUHPE for 12 years and I recall that this topic has come forward a few times. I also remember that IUHPE had a document on ethical guidelines. I thus think that posting it on VHPO, with a few comments on why it does not seem to be appropriate anymore by Maggie Davies who started this dialogue, could be helpful in furthering the discussion.

Michel O'Neill
Université Laval
Québec

It would surely be interesting to see a document on IUHPE ethical guidelines, both regarding this discussion and the current work on developing a draft for a Code of Ethics for health promotion!

Torill Bull

Hi maggie,

This is a very interesting and complex topic. Working in tobacco control has certainly opened my eyes in this area. Back to your questions
1. i suggest that all commercial entities whose products and entirely harmful to health should be taxed, and taxed heavily, and the funds used to mitigate the effects of their products e.g tobacco manufactureres.
2. Its is, in my opinion difficult to draw the line on how to partner with commercial entities in planning interventions. their aim is purely profit. however, in some instances, i believe it is important t clearly indicate how far the partnership should go. Consultations should be done seperately from policy formulation. Public health policies should be protected from commercial interests at all times. Persons, whether natural or legal, should be given a forum to share their inputs/concerns however policy decisions should exclusively be made by pro-public health/ health promotion entities.
Regards, Dorcas (Kenya)