Reflecting the new wave of global public health, which now seems to be finally reoriented towards embracing its social mission and responsibilities, the 12th World Congress on Public Health, recently held in Istanbul, dedicated many of its sessions to ethics and the right to health. Indeed, the Congress title, ‘Making a Difference in Global Public Health: Education, Research and Practice’, sounded like a call to action. But faultless theory and socially responsible statements, set out and declared in Istanbul, were accompanied by corporate sponsorship which we see as inappropriate, and sessions that were in conflict with the interests of public health. This commentary reflects the views of a number of participants at the Congress about the corporate influence on public health conferences and, more generally, inappropriate corporate influence on public health teaching, research and practice.
Soft soap and commercial formulas
From 27 April to 1 May 2009 about 2000 participants from over 100 countries gathered in Istanbul, Turkey, for the 12th World Congress on Public Health. This important and prestigious event was organised by the World Federation of Public Health Associations (WFPHA) and the Turkish Public Health Association.
However, as participants at the Congress, and as public health professionals, we were surprised to find in our congress bags, gifts in the form of free products and promotional material from transnational corporate sponsors. These were Pfizer, Nestlé and Colgate-Palmolive. More disturbingly, we found that sessions in the scientific programme were being advertised by corporate flyers. One was on ‘Personal hygiene and health’. This, promoted by Colgate-Palmolive, was on oral health and hand-washing, linked with Colgate toothpaste and Protex hand soap. Another was on ‘Diet, physical activity and health: national implementation of the global strategy’. This promoted a talk by, among others, Nestlé’s Vice-President of Public Affairs, who in the event displayed some of his company's product lines and corporate practices.
Nowhere in the official programme were these industry-sponsored sessions differentiated from the true scientific sessions of the Congress. This breaching of the boundary between commerce and science was widened by the evident lack of any requirement for the Congress as a whole, or for speakers and panellists on the corporate-sponsored sessions, to declare any conflicts of interests or affiliations with the sponsors. This information was not and has not been disclosed, even after direct requests made during the session that included the Nestlé presentation. These practices, of which the Istanbul Congress is just an example, are clearly a form of corporate marketing and commercial interest over public policy and have been reported to harm independent scientific research and information(Reference Angell1, Reference Angell2), raising concerns about the ways in which conference organisers and presenters manage conflicts of interest.
Need to protect the public interest
The practice of corporate sponsorship of scientific events is not new. For example, the forthcoming Congress of the Latin American Society of Nutrition in Santiago(3) and the International Congress on Nutrition in Bangkok(4) are supported by many corporate sponsors. In Istanbul, what we found most unacceptable was the contradiction between the values, principles and goals of the Congress, as stated in its final Istanbul Declaration (5), and the fact that corporations whose profits depend, at least in part, on products and practices that can be problematic or harmful to public health were enabled to promote their policies and products in the guise of good science.
During the Congress we respectfully petitioned the WFPHA to undertake the following actions, addressed also to other conference organisers. We did this with a positive and collaborative attitude, aiming to strengthen WFPHA independence and credibility, since we strongly believe in its leading role as international health advocate.
1. Adopt a clear code of ethical conduct on sponsorship.
2. Ensure transparency by, for example, providing a detailed description of the financial arrangements with commercial companies and a full declaration of all conflicts of interest.
3. Promote and encourage a greater reliance on public and private non-for-profit support.
4. Reduce expenditure, by for example avoiding luxury venues. This should eliminate reliance on private sponsorship, and also enable greater attendance by public health practitioners and students, as well as resulting in a smaller ecological footprint.
The petition, signed by many participants, was handed to the WFPHA President during the Congress closing ceremony. A letter on the issue and the petition requests has been sent to all WFPHA Board members. We understand that Board members are sympathetic with the views stated here.
Damage done by transnational corporations
Beyond the case of the WFPHA Congress and its corporate sponsors, evidence from the scientific literature, as gathered by health professional and civil society organisations, and as published in the media, indicates the damage that the policies and actions of industry, particularly giant transnational corporations, can do to public health worldwide. Troublesome examples can be found in the field of nutrition.
Case studies from the international literature include the battle over trans fats in processed food, and the marketing of unhealthy foods and drinks to children. In both cases, there is evidence of harmful effects on health, specifically CVD, and increasing childhood overweight and obesity(Reference Freudenberg and Galea6–Reference McGinnis, Gootman and Kraak8).
In both cases, the food manufacturing industry has energetically opposed government attempts to develop binding rules and regulations(Reference Freudenberg and Galea6, Reference Gomes9). Strategies have included lobbying, court action, sponsored research, and calls for more and more research. These have been and are being used to prevent or delay regulations and to extend the period of maximum profitability – and the duration of adverse health impacts. When pledges and proposals for self-regulation have been made by industries, in order to ‘clean’ corporate public images and further delay government action on effective public regulation, they have often been disregarded(Reference Gomes9).
As pointed out by various authors(Reference Angell1, Reference Angell2, Reference Freudenberg and Galea6), the role of corporations in our daily lives and in the governance of public interest has increased, and there is growing evidence of negative impact on public health. In the past decade, lobbying expenditures from the pharmaceutical and food and drink industries have increased dramatically. Advertising and marketing budgets of the largest food and drink companies massively exceed expenditures on health promotion and education(Reference Lang10). The processed food and drink industries have now systematically penetrated sectors of public life that had previously been spared, including schools. In the pharmaceutical field, companies now finance most clinical research on prescription drugs, with growing evidence and concern over conflicts of interest and biased results(Reference Angell1,Reference Angell2).
The public interest, as well as health sector independence, is endangered by market and profit-driven strategies in the absence of effective regulations. Action needs to be taken to promote and implement binding regulations that protect population rights and public goods.
Health professionals: the time to act is now
Governments and international institutions, as well as the private sector, have a fundamental role in global governance. But top-down approaches are not the only answer, and can be untimely and ineffective. Too often these subject people's health to market pressures, and also lack monitoring and enforcement tools. As committed public health professionals, we believe that our profession, as individuals and as members of our representative associations, can itself make a difference. We the professionals, may, can and should:
• Supported by scientific evidence, act even in the absence of international or national regulations in the name of health protection.
• Impact the health of people and influence health-care systems organisation as well as public policies.
• Through independent action, reject and counteract corporate strategies that are harmful to health.
• Advocate and monitor regulations, also in partnership with civil society organisations.
We the authors therefore call on all professionals working for health. We propose for public discussion the following actions to be undertaken globally.
Act to keep scientific and public health research and conferences free of direct corporate sponsorship and influence. For example:
• Advocate development and implementation of ethics-based codes of conduct on financing and sponsoring by scientific associations and educational institutions (following good practices like those of the International Paediatric Association).
• Insist to conference organisers and scientific societies that all scientific conferences and meetings that include sponsorship by the private sector provide complete and full disclosure of conflicts of interests.
Take direct action against corporations that cause damage to public health. For example:
• Avoid whenever possible, both in professional and personal life, the purchase or use of products by corporations known to act against public health, human rights and the equitable governance of public good.
• Report cases of corporate interference in the public health field and of unethical behaviour and policies, informing the scientific community as well as the general public.
Develop and strengthen the capacity of civil society and public institutions to regulate and control the activities of the corporate sector. For example:
• Advocate and work for the adoption at national and local levels of international regulations and guidelines, independent monitoring systems, effective implementation tools (such as taxation of unhealthy products) and enforceable sanctions.
• Advocate increased public engagement in financing and supporting scientific research and dissemination, together with reduction of unnecessary expenses (such as luxury venues for congresses).
• Create, share and support innovative tools and practices aimed to reduce reliance on the private sector and to maintain the independence and reliability of science.
The public health sector is one key area where real change can be achieved towards a better world for all. We can all now stand on the ground of the Commission on Social Determinants of Health(11), recognising that the knowledge, and the means to change, are at hand.
Health professionals and their representative associations should now actively engage in critically analysing and revising the contexts in which they are involved, and the practices they can directly influence, encourage or oppose. Incoherence between socially committed declarations and conventional practices that tend to preserve the status quo is no longer to be tolerated. It needs to be openly challenged in public and scientific debate, and in practice.
The petition to the WFPHA, and this call to action, is meant to follow this path. We believe that the time for a change is not tomorrow, but the present time in which we all live, which is right now.
Acknowledgements
This commentary has benefited from stimulating discussions, begun during the WFPHA Congress in Istanbul and continued online through at least four continents, between the authors and many colleagues, including Adriano Cattaneo, David Legge, David Sanders, Fabio Gomes and Marko Kerak.
