Wilm Quentin: NCDs and the private sector—part of the problem or part of the solution?

Wilm_QuentinOne of the last sessions of the European Health Forum Gastein aimed to find answers to the question of how to engage the private sector in the prevention and control of non-communicable diseases (NCDs).

Gauden Galea, director of the Division of NCDs and Life-Course at the World Health Organization’s Regional Office for Europe, and organiser and moderator of the session, asked: “What are the first steps that we can take to activate the private sector in collaboration for NCD prevention and control?”

The question shows that—three years after the 2011 UN General Assembly “Political Declaration on the Prevention and Control of NCDs,” which called for private sector action against NCDs—we are still talking only about the “first steps” that can be taken to activate the private sector in contributing to NCD prevention and control.

It would be great if companies could use their commercial power to promote health—by creating healthy foods and products, which would in turn promote healthy lifestyles and help us to make healthy choices. However, currently, it seems that companies continue to mostly “promote consumption at the expense of health and wellbeing,” as Ilona Kickbusch, director of the Global Health Programme at the Graduate Institute of International and Development Studies, Geneva, puts it. Why is it that companies mostly continue to be part of the problem—producing and marketing unhealthy products that contribute to NCDs—but only rarely part of the solution?

There are a limited number of success stories. One of these is the Danish Forum of Responsible Food Marketing Communication, a self regulatory body, including producers, retailers, advertisers, and media in Denmark. The forum has helped bring about the almost complete elimination of TV commercials that promote unhealthy foods for children, as shown by Mette Peetz-Schou, head of secretariat at the self regulatory body. However, Mette also admits that the threat of government action in regulating food marketing to children played an important part in motivating industry to engage with the forum.

Medical technology companies are, of course, part of the solution, as they help to improve the treatment of NCDs and they can be important partners in advocating for more resources to be spent on NCDs. Trevor Gunn, managing director for international relations at Medtronic, showed in his presentation that official development aid (ODA) is disproportionately focused on communicable disease. While NCDs account for about two thirds of mortality, they receive less than 5% of ODA. More resources are needed to adequately address the challenge of NCDs. However, medical technology companies also have important commercial interests in treating NCDs—and less interest in preventing them.

While over the years much interest has rightly focused on the social determinants of health, participants of the session seemed to agree that it would be important to spend more efforts on understanding and illuminating the commercial determinants of health. Ilona Kickbusch suggested that a Commission on Commercial Determinants of Health should be set up, similar to the Commission on Social Determinants of Health.

My personal conclusion after the session was that “yes, the private sector could be part of the solution.” However, in order for private companies to contribute to the prevention and treatment of NCDs, it will first be necessary for governments to take action: providing appropriate incentives (e.g. through the taxation of unhealthy foods or subsidies for healthy foods); regulating workplace conditions; (at least) threatening to regulate food marketing; mandating food labelling to make it easier for consumers to distinguish healthy from unhealthy food; and providing sufficient funding for the treatment of NCDs in low income countries, which make up 80% of the NCD disease burden.

Wilm Quentin is a senior research fellow at Berlin University of Technology and the European Observatory on Health Systems and Policies. He specialises in comparative health systems and services research in Europe, with a particular focus on payment systems for hospitals and physicians. He is currently working on Health systems in Transition (HiT) health system reviews for the European Observatory on Health Systems and Policies.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: None.