I write this commentary on Derek Yach’s piece as an interpretative analysis not as a judgement of Derek. I write as a friend, but at the same time as President of the International Union of Nutritional Sciences (IUNS). As President of IUNS I have a responsibility to hold Derek, as champion of international public health nutrition, accountable for his actions. Derek Yach’s move out of the WHO was not unexpected; his demotion from his grand sixth-floor office, close to heaven with direct access to the Director-General’s power, to the small room in the near basement of the WHO Geneva Headquarters building, was clearly symbolic of his downfall from the regal Brundtland era. This is the likely price for ‘taking on tobacco and sugar’ and propelling international public health action where it had never been before. Lobbyists pressed on governments and they in turn influenced the new WHO authorities they had contributed to place in power. The lesson we need to learn from this process is that governments can no longer be trusted to choose public interests when pressed by those who help them get elected by supporting their campaigns.
Derek’s move to Yale was characterized by his energetic attempt to bring the New Haven Yale Campus closer to global public health action. We all supported him in this effort which was in line with what we expected of him. Moreover it fitted what many of us would have done in his case. I had the opportunity to participate in one of the memorable events he held while at Yale. Derek seemed almost comfortable, yet uneasy in his newly found academic tribune. However, in this environment, the slowness of process to make ‘things happen’, the need to present lengthy proposals – some approved others rejected – in order to get relatively small amounts of resources, must have eroded his interest and challenged his patience. In the US academic scene, in order to begin to command some respect you must have grants with at least seven-figure budgets, approved projects and patiently be ready to resubmit in the face of rejections. The move to the Rockefeller Foundation was a logical step in his search for a base from where to advance his ideas and illuminate the work of many with a sustained resource base. The promise of funding to do what he really wanted to do, getting back to action rather than being restricted by the will of many others, must have been appealing.
Yet, after the sixth-floor office at WHO in Geneva with a lake view, The Rockefeller Foundation must have appeared not to be up to snuff. In the process of effecting changes in the food industry, advocating for healthier products in line with the global strategy for the prevention of chronic disease he himself shaped, he gained many converts who saw the light and with it business opportunities. He and many others, counting myself, have become closer to industry, especially that part of industry that declares support for an agenda for healthier foods and views this as a business opportunity. These issues are being discussed by IUNS council and at the Standing Committee on Nutrition (http://www.unsystem.org/scn/Publications/html/private_sector.htm). Moreover, consumer demand for healthier products has helped some companies increase sales and profits well beyond expectations. Having Derek lead global health would be the ultimate coup in convincing their shareholders and indeed consumers that they really mean what they say. The gift and the wrappings were too good to pass; I am sure that we can all understand the dilemma Derek must have faced.
With this background we can have an opinion and say ‘Yes, at the end of the day, the power of money is greater than that of values and mission’; cynics will say this is just the essence of human nature. Alternatively we can believe Derek in his strong statement: ‘The time has come to apply knowledge of what works best… focused on achieving practical outcomes for obesity and related health concerns’; or his ‘I have always sought to work where the potential for health gain is great’; and his final ‘I am finding equally committed colleagues in the corporate sector who share the public health community’s desire to make a difference to the lives of their consumers. Let us work together to make that difference’.
My position is that Derek is genuine in his motives and he has chosen this job as a new challenge and opportunity to influence the private sector from within. It takes someone like Derek to take on this daunting task, and I propose that we not only give him the benefit of the doubt, but clearly support his efforts and do our best for him to be effective. When I visited him last April in his office after a stroll in the garden and taking a picture of him by an original Picasso sculpture of Don Quijote and Sancho, I asked his boss Indra Nooyi, the CEO of PepsiCo, ‘Why have you taken our standard bearer in the fight against chronic diseases? Some say he has now joined the enemy’. Her reply was instant and to the point: ‘We have asked Derek to change this company; in five years we want to have most of our product line meet the international standards supporting life-long health… if he fails we fail’. I am convinced that she meant what she said; and in my role as President of the IUNS I agree with Derek when he states ‘The future will judge whether the commitments and promises made by the public and private sectors have been fulfilled. No sector has the monopoly of what works best and what is in the public interest’.
My final comment relates to the need for the international academic nutrition community to join the public and private sector, non-government organizations, donors and all others interested in improving nutrition to re-examine the present global governance structure and introduce the necessary changes to ensure greater accountability and participation of civil society and the private sector alike. Linkages and partnerships need to be significantly enhanced, so that priorities are better reflected in national and international normative guidance, programme implementation, donor funding, research, and advanced training. The pending work ahead demands an inclusive approach with clearly defined objectives and established monitoring and evaluation systems holding parties accountable for what they do or fail to do.
