Stronger Regulation of Private Sector Needed to Ensure Accountability for Women’s, Children’s and Adolescents’ Health

Thursday, September 27, 2018 – UN Headquarters, New York

The 2030 Agenda for Sustainable Development will not be achieved without the active and meaningful involvement of the private sector. But, can the private sector be held accountable for protecting women’s, children’s and adolescents’ health? And if so, who is responsible for holding them to account, and what are the mechanisms for doing so?

These were just some of the questions discussed at the 27 September launch event for the UN Secretary-General’s Independent Accountability Panel for Every Woman, Every Child, Every Adolescent (IAP) report, Private Sector: Who Is Accountable?

This third annual IAP report concluded that governments worldwide must beef up regulation of private companies involved in health service delivery, the pharmaceutical industry and the food and beverage industry to safeguard the right to health for women, children and adolescents.

1
H.E. Mr. Jeff Radebe, Minister of Energy, South Africa

“As governments, we have a responsibility to protect the health and related rights of women, children and adolescents,” said H.E. Mr. Jeff Radebe, Minister of Energy, South Africa, co-sponsor of the event. “We need to do our part to take forward the recommendations by IAP of enacting and strengthening legislation governing the parameters for private sector engagement on health, as well as ensuring inherent meaningful oversight and enforcement. In developing nations, this also applies to the pricing of essential medicines for all citizenry.”

During the crowded event at the UN, several participants from governments and civil society described best practices when working with the private sector. The issue is of vital importance, especially given the private sector’s role in universal health coverage (UHC), the growing privatization of health services and the steady growth of business engagements in health.

2
Børge Brende, President of the World Economic Forum

“We have to mobilize the private sector as a real partner,” said Mr. Børge Brende, President of the World Economic Forum. With the private sector representing 80% of global gross domestic product and official development assistance continuing to dwindle, “the question is not if, but, how, the private sector is to engage,” he said.

The IAP made five recommendations for improving private sector accountability to achieve the Sustainable Development Goals addressing: health service delivery, the pharmaceutical industry and access to essential medicines, the food and beverage industry and impacts on rising obesity and NCDs. They also addressed the UN Global Compact and the Every Woman Every Child (EWEC) partners, and donors, the UN System and other development cooperation communities.

Their main concern is that without strong government oversight, people in poor, rural and marginalized communities may lack the means to avert harm and face the gravest risks and consequences from unregulated private sector clinics and hospitals that offer poor quality care and overcharge patients.

3
Hon. Harriett Baldwin, Minister of State at the Department for International Development, United Kingdom

“In almost every country in the world, health services are provided by a combination of public and private health providers,” said Hon. Harriett Baldwin, Minister of State at the Department for International Development, United Kingdom. “Many private clinics actually serve some of the hardest to reach, most marginalized people. The care these people get from private clinics has to be high quality and also affordable so they are not plunged into further poverty with every illness.”

In addition, aggressive marketing of low-cost junk food and sugary drinks contributes to the global burden of non-communicable diseases (NCDs), such as obesity. The obesity epidemic, which is growing alarmingly fast, especially among children and adolescents, is of particular concern.

4
IAP Co-chairs Carmen Barroso and Kul Gautam

“But the landscape of food and beverage industry accountability is fragmented and limited,” affirmed IAP co-chair Dr. Carmen Barroso, further urging that “prevention of obesity in adolescence is key to put the brakes on this global health crisis.”

5
H.E. Ms. Pirkko Mattila, Minister of Social Affairs and Health, Finland

“It is clear that we need to change entire food systems if we aim to tackle obesity and reduce the NCD burden,” said H.E. Ms. Pirkko Mattila, Minister of Social Affairs and Health, Finland, a co-sponsor of the event. “Increasing global trade and marketing of unhealthy foods is a huge challenge. Food and marketing messages travel across borders and obesity is a growing problem. We need to join forces for global solutions. Therefore, I was pleased to find innovative proposals like a binding global convention as one of the recommendations.”

The dynamic exchange of ideas spurred a vigorous debate among the diverse range of stakeholders participating in the event – including country governments, parliamentarians, civil society, development partners, and the private sector itself. Overall, the report and the IAP’s recommendations were very well received with several participants making pledges to table the recommendations for follow-up.

6
Mr. Martin Chungong, Secretary General of the Inter-Parliamentary Union

“Parliaments are going to have extensive indirect accountability because they have to oversee governments to ensure they oversee the private sector,” said Mr. Martin Chungong, Secretary-General of the Inter-Parliamentary Union (IPU). As a convenor of parliaments around the world, the IPU will put private sector accountability “firmly on the agenda of parliaments.”

When it comes to regulating the private sector, both companies and governments face challenges. Private sector actors can be reluctant to accept external regulation. Many commit to self-regulation as part of their business plans, but participatory monitoring with community involvement, external evaluations and independent accountability are often lacking. With transnational corporations, accountability challenges are compounded because they operate within multiple and sometimes overlapping jurisdictional boundaries and have long supply chains with many actors and transactions along the way.

“Businesses engaging in the context of UHC must be aligned with one central objective: improving people’s health,” stated IAP co-chair Mr. Kul Gautam, “but many countries are playing catch-up on private sector regulation after years of expanding engagement in health.”

The panel finds that even in countries with well-developed systems of private sector stewardship, there are challenges and shortfalls in accountability. In many cases, conflicts of interest are pervasive which sometimes distort and derail public policy objectives and regulatory efforts to protect people’s health.

8
Hon. Miriam Jashi, Chair of the Education, Science and Culture Committee of the Parliament of Georgia

In countries like Georgia, which has transitioned over the past 25 years from a centrally planned economy to wide-scale privatization and deregulation of the health sector where 95% of health service providers are private institutions, regulation is essential for securing the right of women, children and youth to affordable and quality health services, said Hon. Miriam Jashi, Chair of the Education, Science and Culture Committee of the Parliament of Georgia. “Indeed, health is not a standard market product,” she said. “Regulation is especially important in middle- and low-income countries, where evidence-based medicine is still not a standard of care.”

While the panel welcomed the self-regulatory efforts undertaken in good faith by private sector actors, “self-regulation without independent validation and oversight is not enough on its own,” said Gautam. “Accountability must go beyond answering to shareholders and investors.”

9
Dr. Anders Nordström, Ambassador for Global Health, Ministry of Foreign Affairs, Sweden, and PMNCH Board Member

Speaking on behalf of the Partnership for Maternal, Newborn and Child Health (PMNCH) Board Chair H.E. Michelle Bachelet, fellow PMNCH Board Member Dr. Anders Nordstrom, affirmed that while the private sector needs to follow rules and laws, the consumers of their products also “have important tasks as citizens in democratic societies,” including exercising their rights by voting at the ballot boxes as well as with their pocketbooks. “We can’t fight the private sector, we need to work with them,” and engage with investors to not invest in tobacco companies, “but in companies and businesses that are good for health.”

However, civil society representatives, including those from the NCD Alliance and Vital Strategies, weren’t so sure that rules and measures in place for keeping the private sector in check are having the desired effect and that more accountability measures need to be put in place to ensure equity for women’s, children’s and adolescents’ health.

10
Ms. Nina Renshaw, Policy and Advocacy Director for the NCD Alliance

“The recipe for success is already known, tried and tested in many countries. These include taxation, measures to restrict advertising and marketing of unhealthy food and drink towards young people, and relative availability and affordability of healthy vs. unhealthy foods,” said Ms. Nina Renshaw, Policy and Advocacy Director for the NCD Alliance.

“Those who lobby against effective measures, proven measures, including the Best Buys, have no place at the table in health policy making,” she continued. “It is for governments to determine their own priorities, to put health first, to protect their citizens, to regulate and set standards. Health-harming industries’ role is to implement, to adjust their practices to the regulatory environment—NOT the other way around.”

11
Dr. Mary-Ann Etiebet, Executive Director, Merck for Mothers

Speaking on behalf of the PMNCH Private Sector Constituency, Merck for Mothers Executive Director Dr. Mary-Ann Etiebet said that “successful engagement will not result from regulation alone” when it comes to holding the private sector accountable. The private sector “can revolutionize the delivery of health care today as well as anticipate the needs of tomorrow,” she said. “We believe that the public and private sector has a shared responsibility” for accountability.

“We need to establish and strengthen trust,” she continued. “We need to understand, target and value the unique contributions each sector can bring to the table around shared commitments to achieve the SDGs. We also need to recognize the yin and yang of our efforts—the mutual and reinforcing principles of the social and health returns as well as the financial returns of our joint investments—because each of these powers the other and is ultimately critical for the success of achieving our shared goals.”

Barroso and Gautam closed the session by saying that the IAP was encouraged by the feedback and commitments made during the event. Noting that “profits are not contrary to regulation,” Gautam referred to “the private sector mantra: Profits, People and Planet,” adding that “profits are fine so long as people and the planet are also served. It is the responsibility of all of us.”

News:

  • IISD, SDG Knowledge Hub “Independent Panel Underscores Private Sector Accountability in Health”, available here
  • DEVEX @UNGA “Getting accountability right for women and children”, available here
  • Comment by Richard Horton “Offline: It’s time to hold the private sector accountable”, Lancet,  available here