Under the World Health Organization (WHO) Action Plan 2013-20, the global goal is to achieve a 25% relative reduction in premature mortality from non-communicable diseases (NCDs) by 2025. With the Sustainable Development Goals, the aim is to reduce mortality from NCDs by 30% in 2030.
A tall order.
NCDs – mainly cardiovascular diseases, cancers, chronic respiratory diseases and diabetes – are the biggest cause of death worldwide. According to the WHO, more than 36 million people die annually from NCDs (63% of all global deaths), including 14 million people who die before the age of 70. More than 90% of these premature deaths from NCDs occur in low and middle-income countries. Africa is the continent that has the largest growth in diabetes prevalence.
At the same time, less than 2% of international development assistance for health goes to fight NCDs.
International agencies, bilateral donors and private foundations are reluctant to scale up assistance to address the NCD challenge out of fear that it will divert investment from combatting infectious diseases, including TB, Malaria and HIV/AIDS, and so put important advances at risk.
If this indeed is a zero-sum game, more resources outside the standard funding framework must be found. The most obvious way is for the private sector to contribute by offering healthy and not just safe workplaces. This is also in the enlightened self-interest of businesses as the positive return on this investment is well documented.
More and more companies are engaged in the business of such shared value, where benefits for society and for the company are mutually reinforcing. For example, Novo Nordisk engages in preventing, treating and ultimately curing diabetes by engaging with municipalities around the world under the Cities Changing Diabetes programme.
Another example is Kaiser Permanente working with the public health advocates to establish the Healthy Eating Active Living (HEAL) Cities Campaign to make healthy choices easier for the people who live, work and go to school in California cities and towns in 2008.
The HEAL Cities Campaign promotes a menu of policy options that city leaders can adopt to improve their cities' nutrition and physical activity environments. It has since spread to four additional states and is locally implemented through partnerships between state municipal leagues and state-wide public health organizations in Colorado, Oregon, Maryland and Virginia. To date, there are 328 HEAL cities where over 2,400 elected officials are engaged and 888 HEAL policies have been adopted.
A number of simple, yet important lessons for collaborative efforts can be successful:
1. Band together around an agenda
This requires leadership on all parts, but also requires that private sector companies (or anyone else for that matter) come to the table without a fixed agenda. Part of developing a shared agenda is also about setting boundaries (what is within the discussion and outside the discussion) and clearly states the scope of the collaboration. Although it takes a bit longer to develop a joint hypothesis, it is our experience that the time spent on developing one is well invested, and often has increased trust as a by-product.
2. Explore extraordinary measures for impact
By identifying the measures of success together, this further builds trust (“data-driven trust”). We need to apply a holistic “systems thinking” approach in considering and tracking the both societal and economic benefits of interest to the various public and private stakeholders.
3. Keep an eye on the money
Due to the rising challenge of NCDs, many public sector institutions are looking at ways of reducing, or at least controlling costs. So, rather than suggesting new ways of spending more money, the private sector should focus more on contributing with new solutions that can increase affordability or lead to a more efficient use of resources.
4. Be constructively impatient
Good solutions take time to develop – particularly if they require multi-stakeholder buy-in. Much too often, private sector companies do not understand the process of driving a multi-stakeholder dialogue, and become impatient very quickly to the frustration of everyone else involved. Yet at the same time, the continuous quest to move forward is also appreciated by public sector partners. Finding the balance is key.
5. Make a declaration of transparency
Every single partner should state upfront what their interests are in participating in the collaboration and share with all participants what they believe they will gain from it. Throughout the process, this open, consistent and continuous dialogue must be maintained as collaborations are dynamic processes in which conflicting interests may well arise throughout the lifespan of the project
6. Establish (and fund) infrastructure to support the collaboration
Many public institutions work on a fixed budget with limited flexibility to fund the development of new initiatives. It is our experience that small investments in ensuring an organizational backbone to drive discussions forward, including actions such as calling for meetings, finding a venue, writing minutes, etc., are essential for success. Also, the private sector may fund third-party research or data collection that may inform the joint agenda development and/or the identifications of metrics.
The points above are borderline banal. At the same time it is puzzling how often private sectors companies miss one or more of these points when collaborating with the public sector.
Obviously, the private sector should not take the place of elected politicians. In the end, the municipal council, the county committee, the national parliament, or WHO, will decide on the policy to be implemented.
In support of this notion the World Health Organization’s Global Coordination Mechanism on Non-Communicable Diseases and the World Economic Forum hosted a caucus meeting that aimed to discuss how coherence between policies and the private sector can help to tackle NCDs, deliver healthier populations, and achieve the global goals on health.
Good policy often becomes better by being informed by relevant stakeholders, including the private sector and civil society organisations.