Research to Practice: Cross-sector partnerships in public health fighting obesity and noncommunicable diseases

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Every week, we see new, fascinating research that provides practical insight into solving society’s most complex issues — intersector issues. Practitioners continually tell us they are interested in this research but lack the time and resources to extract takeaways that are truly meaningful to their work. This is why we profile new research here on our blog with a focus on practitioners. This week, we focus on a recent article published in the
Annual Review of Public Health, which looks at cross-sector public health partnerships aimed at reducing and preventing obesity and widespread noncommunicable diseases in high-income countries.

Public health partnerships with the private sector have become increasingly common since the World Health Assembly urged the World Health Organization to bring together non-profit and business-sector partners in raising the universal health level more than 20 years ago. These partnerships have had their successes and challenges, and complex public health problems involving diverse actors and institutions persist.

In their recent article, “Cross-Sector Partnerships and Public Health: Challenges and Opportunities for Addressing Obesity and Noncommunicable Diseases Through Engagement with the Private Sector,” health science professors Lee Johnson and Diane Finegood explore cross-sector partnerships for public health, specifically those that engage partners from the food and beverage industry to target obesity and noncommunicable disease (NCD) prevention in high-income countries. While the private sector can add value to public health partnerships, the authors warn that “poorly chosen partnerships with industries implicated as drivers of the obesity and NCD epidemics for easy money have tarnished public health’s brand and the reputation of many health organizations.” Surveying several partnerships, as well as recent literature on the subject, the authors draw conclusions on key factors to mitigate the risks of these partnerships and to encourage successful outcomes, examining trust, conflicts of interest, and monitoring and evaluation.

Takeaways for Practitioners

  • Raise partnership stakes slowly as trust builds. Because of a “history of industry practices that undermine public health efforts,” trustworthiness of business-sector partners in the food and beverage industry has been “a major issue” for public- and non-profit-sector partners. Yet trust is key; along with other “sociopsychological” considerations such as goal alignment and quality of communication, it may be more influential on the outcome of a collaboration than available resources or focus, according to research cited by the authors.  Partners should begin with low-stakes or low-risk activities, and raise the stakes over time as trust grows.
  • Steer clear of “blind trust.” The authors caution against engaging in “blind trust,” the practice of denying known or readily available evidence for distrust, when entering into a partnership. Authentic trust must be carefully considered and cultivated.
  • Create a code of conduct for cross-sector engagement. When working with business-sector partners, perceived and actual conflicts of interest present a serious dilemma. A perceived conflict of interest “often exists when the private sector provides the public or non-profit sector with funding, even if the funds are provided without restrictions,” the authors write. In true shared decision-making environments, the interests of the public or non-profit entity and the business entity may well conflict (i.e. a campaign to reduce sugar intake funded by a soda company). Practitioners should consider developing a code of conduct for interacting with the private sector in order to manage conflicts of interests between partners.

  • Build in processes for independent review and evaluation of partnerships. The authors identify review and evaluation as “critical success factors” for complex cross-sector partnerships. Developing rigorous methods to evaluate cross-sector partnership is difficult, however, because of partners’ differing understanding of evaluation and because “stakeholders are often reluctant to sacrifice flexibility and expediency in favor of methodological rigor.” The authors suggest involving well-respected, independent entities to monitor and evaluate the collaboration, citing an example of the Robert Wood Johnson Foundation providing such support to the HealthyWeight Commitment Foundation.


A Short Note on Method
The authors investigated examples of cross-sector partnerships that address obesity and NCDs, such as a grant provided by Coca-Cola to the American Academy of Family Physicians for developing consumer education material; population intervention research supported by the Canadian Institute of Health Research and built on a product marketing campaign in which pedometers were distributed in boxes of Kellogg’s Special K cereal; and Shape Up Somerville, an “example of the true partnership” aimed at building and sustaining a healthy community. (This partnership was profiled in an Intersector Project case study.) The authors also reviewed current literature to analyze the contemporary landscape of private-public partnerships in public health targeting reduction and prevention of obesity and NCDs.

Discussion
Public health organizations in the government and non-profit sectors sometimes need partners from the business sector to provide resources, scale their work, and address seemingly intractable health challenges. But some partners could potentially impede public health goals, either by diminishing the health organization’s credibility or contributing to the marketing of unhealthy brands. For example, the logo of a public health entity entering into collaboration with a food-industry partner could be used on packaging for a healthy item, when that brand also sells high-calorie, low-nutrition products. In their article examining risks that can arise when health organizations partner with the food industry, Yoni Freedhoff and Paul Hébert write that health organizations in need of financial or other resources, “should comprise unconditional arm’s-length grants with clauses limiting how corporations use health organization brands. Otherwise, health promotion goals will be compromised by helping to promote unhealthy brands.”

For Further Reading
Further reading and useful tools for collaboration in public health include:

From The Intersector Project Toolkit:

  • Establish Transparency of Viewpoints Enabling open communication among partners allows differing priorities to be addressed and moves the collaboration forward through divergent values and goals. This tool speaks to the authors’ suggestion to understand sectors’ motivations for partnering.
  • Communicate the Interdependency of Each Sector Developing an understanding of each sector’s unique resources and networks encourages continued participation in the collaboration. This tool speaks to the authors’ observation that the “structures of true partnerships recognize interdependencies.”


From The Intersector Project Case Library:


From Intersector Insights:


Other resources: