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J R Soc Med. 2005 October; 98(10): 476–477.
PMCID: PMC1240108

Public-Private Partnerships and International Health Policy-making: How can Public Interests be Safeguarded?

Reviewed by Andrew Herxheimer

Judith Richter
105 pp Free of charge, online
A hard copy can be ordered by e-mail [if.nimrof@sualitoek]
ISBN 951-724-464-9 (p/b)
Helsinki: Ministry of Foreign Affairs of Finland,
Development Policy Information Unit .

The concept of public-private partnerships (PPPs) became prominent in the Reagan-Thatcher era. It grew from the notion that hierarchical bureaucracies are inefficient and that market mechanisms could make them more efficient, and that politicians and bureaucrats do not always act in the public interest, but may pursue either their own interests or those of powerful interest groups. The first PPPs were local and national, but since the turn of the century many international ones have developed, including major PPPs concerned with public health. Judith Richter's compact review examines the effects of these partnerships on international health policies, and particularly on WHO.

Surprisingly there is no agreed definition of partnership, as practised between some element of the UN system and a commercial organization. According to a 2003 report from the UN Secretary-General focusing on arrangements in which the UN has an interest, either as a partner or as a partnership promoter, 'Partnerships are commonly defined as voluntary and collaborative relationships between one or more parts of the UN system and non-State actors, in which all participants agree to work together to achieve a common purpose or undertake a specific task and to share risks, responsibilities, resources, competencies and benefits.'

The booklet valuably helps to clarify muddy ideas on 'conflict of interest'—what it is, what it means, and what should be done about it. Michael Davis, an American philosopher, defines it as 'a situation in which some interest of a person has a tendency to interfere with the proper exercise of his [or her] judgment in another's behalf'. The central issue is that it renders one's judgment less reliable than normal. But having a conflict of interest is not necessarily wrong—much depends on whether and how one resolves the problem. A further element is important when it comes to public servants: people have a conflict of interest when their interests or commitments compromise their independent judgment or loyalty to individuals they are obliged to serve. A conflict of interest does no harm unless it causes a breach of an ethical or legal obligation, but it makes that more likely.

That still leaves the problem of 'perceived' or 'apparent' conflict of interest. To maintain trust it is essential to provide enough information to show that there is no actual conflict of interest. If the information is inadequate, trust will dwindle. A key feature of the new global PPPs is the 'shared process of decision-making'. It is also implied that interactions with business actors should be based on 'trust', that they should aim at 'mutual benefit', and that they represent a 'win-win' situation. These are large assumptions.

In her research Judith Richter collected information on existing and evolving guidelines and procedures at WHO; UNICEF and the Global Compact Office, and compiled a history of the debates on public-interest safeguards at WHO she interviewed 25 UN officials. Many difficulties and hesitations have impeded the evolution of guidelines to safeguard the public interest. In their present state they cannot be seen to do so, and perhaps they don't. The public and private gains and losses in each of the existing and future partnerships with commercial actors must be assessed systematically, and (we must hope) openly. The need is the same for the newer legally independent global health alliances—and of course also for the many partnerships between national governmental organizations and business: that demands several big books.

The final chapter outlines ways in which Finland and other like-minded countries could help ensure that public interests are safeguarded in international health policy-making. The Finnish Ministry for Foreign Affairs did well to support this project.

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press