Challenges to Establish Effective Public-Private Partnerships to Address Malnutrition in All Its Forms

Abstract

Background: Every country is affected by some form of malnutrition. Some governments and nutrition experts look to public-private partnerships (PPPs) to address the burden of malnutrition. However, nutrition-related PPPs face opposition, are difficult to form, and there is limited evidence of their effectiveness. Methods: We conducted a literature review and 30 semi-structured interviews with individuals involved in or researching nutrition-related PPPs to identify the factors that shape their creation and effectiveness in food systems. Results: Several factors make it difficult to establish nutrition-related PPPs in food systems: a lack of understanding of the causal pathways behind many nutrition problems; a weak architecture for the global governance of nutrition; power imbalances between public and private sector nutrition actors; and disagreements in the nutrition community on the advisability of engaging the private sector. These complexities in turn make it difficult for PPPs to be effective once established due to goal ambiguity and misalignment, resource imbalances, and weak accountability. Conclusion: If effective nutrition-related PPPs are to be established, private sector conflicts of interest must be addressed, trust deficits between private and public sector actors must be surmounted, and evidence must be assessed as to whether PPPs can achieve more for public health nutrition than private and public sector actors working separately.

Advice for Food Systems Governance Actors to Decide Whether and How to Engage With the Agri-Food and Beverage Industry to Address Malnutrition Within the Context of Healthy and Sustainable Food Systems Comment on "Challenges to Establish Effective Public-Private Partnerships to Address Malnutrition in All Its Forms"

“…7 The UN's Committee on World Food Security's Voluntary Guidelines on Food Systems 8 has developed a vision, roadmap and recommendations supported by 138 FAO member states 9 that prioritize a human-rights approach, and identify partnerships as one of many potential forms of engagement with private-sector actors through multi-stakeholder deliberation platforms that will require transparency, democratic and strong accountable governance to produce desirable outcomes. 8 Fanzo et al 3 highlighted the need for prospective partners to differentiate between constructive versus rogue private-sector food and beverage industry actors, and identify effective policy approaches to reduce power asymmetries and hold firms accountable for practices that undermine healthy diets. Among the 30 informants interviewed were representatives of GAIN (the study funder) and the Scaling Up Nutrition (SUN) Business Network, co-convened by GAIN and the World Food Programme (WFP).…”

“…Among the 30 informants interviewed were representatives of GAIN (the study funder) and the Scaling Up Nutrition (SUN) Business Network, co-convened by GAIN and the World Food Programme (WFP). 3 But only two UN agencies-WHO and the United Nations Children's Fund were interviewed and no representatives were included from the FAO, WFP, The World Bank or World Economic Forum to understand their position on partnerships used to address malnutrition. 3 Controversy has simmered for decades about whether private funding and corporate philanthropy should be allowed to influence and erode the multilateral nature of UN agencies with dire implications for democracy within global governance.…”

“…3 But only two UN agencies-WHO and the United Nations Children's Fund were interviewed and no representatives were included from the FAO, WFP, The World Bank or World Economic Forum to understand their position on partnerships used to address malnutrition. 3 Controversy has simmered for decades about whether private funding and corporate philanthropy should be allowed to influence and erode the multilateral nature of UN agencies with dire implications for democracy within global governance. 2,10 Civil society concerns have been raised about the 2021 UN Food Systems Summit that allege a "powerful alliance of corporations, philanthropies are subverting the multilateral UN institutions' food governance to capture the global narrative of food systems transformation…and lack of transparency and accountability for how Summit participants are recruited and engaged to shape the agenda and outcomes to maintain corporate control of food systems. "…”

“…2 Business engagement may be pursued to address governance gaps, conduct research or implement programs to test bundled innovations, advocate for systems-level policy changes and improve corporate reputations. 2 Fanzo et al 3 conducted an evidence review as part of an independent evaluation funded by the Global Alliance for Improved Nutrition (GAIN), and analyzed 30 key informant interviews to understand the challenges associated with using PPPs to promote healthy diets within food systems to address malnutrition (ie, stunting, micronutrient deficiencies, obesity and diet-related non-communicable diseases [NCDs]) worldwide. They did not examine partnerships for agriculture and sustainable diets within the context of climate change.…”

“…Their three major conclusions were that: (1) government and civil society organizations that engage with private-sector entities must address potential, perceived or actual conflicts of interest (COI); (2) substantial trust deficits exist between public-and private-sector actors that must be overcome; and (3) compelling evaluations are lacking to justify using partnerships over legislative or legal policy approaches to achieve diet, food system and health outcomes. 3 This commentary offers advice for food systems governance actors to decide whether and how to engage with privatesector firms to address malnutrition within the context of healthy sustainable food systems. Strategies to identify, manage and mitigate nutrition-related COIs using the World Health Organization (WHO) risk-assessment tool 1 were examined by Ralston et al 4 and eight commentaries; therefore, COI is not addressed in this paper.…”