Guidance

Principles for engaging with industry stakeholders

Published 25 July 2019

1. Introduction

Addressing the increasing challenge of non-communicable diseases (NCDs) worldwide needs action across various sectors.

Although industry objectives are often at odds with efforts to improve public health, it is recognised that some industries and commercial organisations can play a role in counteracting the negative impact of the products and services they profit from.

Examples include some organisations that profit from gambling, alcohol, over-consumption of some foods and non-alcoholic drinks.

Governments can use regulation and legislation to place important controls on industry. But these measures are slow to implement, may lack adequate scope, and can lead to industry finding workarounds.

Industry stakeholders can support regulatory measures with other positive, appropriate actions that go beyond what’s required of them by law.

United Nations’ (UN) guidelines for partnership with the business sector and the World Health Organization’s (WHO) strategy to reduce harmful use of alcohol, among others, recognise that the private sector can make some necessary resources available, particularly access and reach.

A UN declaration on preventing and controlling NCDs suggests that the private sector should be engaged to make resources available for the “prevention and control of NCDs” and to “strengthen its commitment and contributions” by carrying out health-promoting activities, specifically related to tackling the adverse effects of their products.

But this is a complex field, and well-documented experience suggests that industries - such as the tobacco and alcohol industries - are subtle in hiding their true motivations and objectives. They can also use aggressive tactics to disrupt and undermine positive actions, from public health policy and initiatives.^{[footnote 1] [footnote 2]}

So, there are many reasons for public health agencies to hesitate before engaging with unhealthy commodity industry stakeholders. If public health agencies do engage with these stakeholders, they should do so cautiously and within a well-defined framework that protects the public’s interest and health.

The risks of engaging with industry can include allowing undue influence, sending confusing messages because of conflicts of interest, and reputational damage to public sector bodies.^{[footnote 3]}

Risks associated with private sector partnerships are not necessarily barriers, but public health agencies need to consider these risks before engaging. They will need to do a careful risk assessment to identify and mitigate risks, to make sure there are net public benefits from any partnerships.

2. Scope of this guidance

This guidance provides a framework for assessing potential partnerships or other engagement activities between Public Health England (PHE) and unhealthy commodity industry stakeholders. The aim is to maximise benefits and minimise risk. It draws on international best practice guidance and has been developed in consultation with a wide range of public health stakeholders.^{[footnote 4] [footnote 5] [footnote 6] [footnote 7] [footnote 8] [footnote 9] [footnote 10]}

The approach set out here does not replace or override regulations, policy or guidance on partnerships where it already exists. It can guide decision-making in areas and circumstances where no specific guidance is currently available.

This guidance does not regulate:

• engagement between PHE and other countries
• procurement of goods and services (which is regulated by PHE procurement policy)
• existing income-generating relationships
• engagement with academic institutions (which is regulated by PHE academic framework)
• engagement with non-governmental organisations which operate independently of the private sector

3. Rationale for collaborative relationships

This guidance aims to protect PHE’s work and mandate. PHE will only engage with unhealthy commodity industry stakeholders where it furthers PHE’s primary aim and remit, and where it does not conflict with PHE’s core values as reflected in its code of conduct and the Civil Service code.

PHE will not engage with any unhealthy commodity industry stakeholders known to be complicit in human rights abuses or engaged in the production of weapons. PHE will also not engage with stakeholders who do not meet other relevant obligations or responsibilities required by PHE to protect and improve the public’s health and reduce inequalities.

PHE will take all reasonable steps to weigh up the potential risks and benefits of engaging with each unhealthy commodity industry stakeholder. The purpose of these steps - or ‘due diligence’ - is to identify potential conflicts of interest, to protect the agency’s reputation, and to make sure the partnership will be in line with PHE’s primary purpose of protecting the public’s health.

PHE understands that full due diligence can be time-consuming and expensive, and may not be possible in all cases. PHE will be transparent in these processes, and seek the views of health stakeholders where appropriate.

4. Guiding principles for engagement

These overlapping principles aim to bring some clarity to this sometimes complex and contentious area, and guide decisions on individual occasions of engagement. PHE will adopt this approach at all levels to make sure there’s consistency across the organisation.

The 5 principles are:

1. Clarity of purpose: any engagement will primarily aim to advance PHE’s mission to protect and improve the nation’s health and wellbeing and reduce health inequalities.

It will be demonstrable that PHE’s work will be more effective through engagement, and that associated resources, including staff time to build and sustain any collaboration, will be proportionate and serve PHE’s statutory purposes.

2. Independence: the activity should be compatible with PHE’s remit and statutory functions. It should not compromise PHE’s integrity, independence or credibility.

3. Transparency: the extent and terms of any engagement with industry stakeholders will be open and transparent. PHE will be clear about the potential benefits and risks to the public.

4. Evidence-based: the engagement will support and enhance (without compromising) the scientific and evidence-based approach that underpins PHE’s work.

The expected public health benefit should be based on a solid evidence base. PHE will not reject innovative approaches due to an incomplete evidence base.

Any approach should be:

• consistent with existing evidence
• be limited in terms of resources
• focused around extending the evidence base, by evaluating outcomes

5. Accountability: departure from the agreed terms will start a review of the engagement. PHE will aim to evaluate all engagements with unhealthy commodity industry stakeholders, and report its experience and the outcomes.

5. Commodity specific guidance

Given the structural links between companies and across industries, the priority was to develop a set of general guiding principles that PHE could adapt to specific topic areas.^{[footnote 11]}

The principles are meant to be overarching and cross-cutting, but this section briefly outlines governance practices that are specific to one topic.

5.1 Tobacco industry and related actors

The United Kingdom government is signed up to the WHO Framework Convention on Tobacco Control (FCTC). This requires parties to protect public health policy from the vested interests of the tobacco industry.

PHE follows the relevant FCTC guidelines and has published a protocol for engaging with stakeholders with links to the tobacco industry. This protocol protects PHE’s tobacco policy from all manufacturers of nicotine-containing products, which does not stop partnerships with pharmaceutical companies or e-cigarette manufacturers, but provides a framework for transparency.

PHE will continue to seek advice from the Tobacco Implementation Board to make sure its actions are fully compliant with the FCTC.

5.2 Alcohol industry and related actors

PHE is adopting in full the most recent WHO principles and guidance for engaging with “representatives of the alcohol industry for achieving positive outcomes for public health”.

This includes adopting the WHO definition of the alcohol industry:

For the purposes of this document, the term ‘alcohol industry’ means manufacturers of alcoholic beverages, wholesale distributors, major retailers and importers that deal solely and exclusively in alcohol beverages, or whose primary income comes from trade in alcohol beverages.

In addition, in this document the term ‘alcohol industry’ includes business associations or other non-State actors representing, or funded largely by, any of the aforementioned entities, as well as alcohol industry lobbyists and commercial interests in alcohol beverage trade other than above when the interaction with WHO can be linked to their interests in alcohol beverage trade.

Other non-State actors who receive funding from the alcohol industry (including funding for research) or have considerable links to the above-mentioned entities should be reviewed on an ad hoc basis in order to determine whether they should also be viewed as ‘alcohol industry’.^{[footnote 12]}

PHE will limit the nature of its engagement with the alcohol industry to a dialogue and exchange of information, for achieving positive outcomes for public health. Engagement with the alcohol industry will not lead to or imply partnership, collaboration or any other similar type of engagement that could give the impression of a formal relationship.

This is because there is a danger such engagements “would put at risk the integrity, credibility and independence” of PHE’s work.

PHE will also follow the WHO recommendations relating to meetings with the alcohol industry. This includes making sure that there is a clear purpose and full transparency. At least 2 staff members must represent PHE at meetings with the alcohol industry. This should also ideally include one member of the alcohol programme team. The alcohol industry, as defined above, will not directly or indirectly fund any PHE activities.

PHE will seek advice from its Alcohol Advisory Group before considering any engagements with alcohol industry stakeholders.

5.3 Food and non-alcohol drink industry and related actors

Recent research found there’s no clear agreement among public health practitioners about what’s acceptable or effective when engaging with the food and drink industry. Work is ongoing to explore recommendations for assessing opportunities to engage with the food industry, while preventing or managing conflicts of interest^{[footnote 13]}. However, this is very complex, as diet is essential in all people’s lives.

PHE established a clear and transparent governance process at the start of its engagement work with the food and non-alcohol drink industry. This supports the government’s plan to reduce childhood obesity and its reduction and reformulation ambitions on sugar, calories and salt.

PHE’s process includes:

• an obesity governance board
• public reporting through PHE’s executive board
• regularly publishing lists of all stakeholder meetings (industry and non-governmental organisations) and summaries of discussions in these
• providing draft guidance to stakeholders in an informal consultation process

The principles in this document are compatible with the protocols already in place to steer this work with the food and non-alcohol drink industry. The protocols are in line with the report of the WHO Independent High-level Commission on Noncommunicable Diseases, which states that governments should ”work with food and non-alcoholic beverage companies, in areas such as reformulation, labelling, and regulating marketing”.

PHE will continue to consider this area, in line with best practice recommendations as and when they emerge.

5.4 Gambling industry and related actors

Due to a lack of best practice guidance on engaging with representatives of the gambling industry, PHE is adapting the WHO principles and guidance for engaging with representatives of the alcohol industry to guide its interaction with the gambling industry. This includes adapting the WHO definition of the alcohol industry to cover the gambling industry.^{[footnote 14]}

PHE will limit the nature of its interaction with the gambling industry to a dialogue and exchange of information for achieving positive outcomes for public health. Interaction with the gambling industry will not lead to or imply partnership, collaboration or any other similar type of engagement that could give the impression of a formal joint relationship. This is because there is a danger such engagements would put at risk the integrity, credibility and independence of PHE’s work.

PHE is also adopting WHO recommendations for meetings with representatives of the gambling industry, making sure there’s a clear purpose and full transparency. At least 2 members of staff must represent PHE at meetings with the gambling industry. One member of staff will also ideally be a member of the gambling programme team. The gambling industry will not directly or indirectly fund PHE activities.

6. Implementing the guidance

PHE has developed an internal protocol document outlining the process for implementing these principles.

To make sure they remain valid, PHE will review this guidance and the internal protocol document regularly with the first review planned for early 2020.

PHE will consider recommendations from national teams, advisory groups and emerging best practice.

7. Definitions

7.1 Unhealthy commodity industry stakeholders

PHE defines unhealthy commodity industry stakeholders as for-profit and commercial enterprises and businesses that deliver commercial products that lead to significant associated negative health consequences. For this document, these include tobacco, alcohol, gambling and some food and drink stakeholders. They include manufacturers, distributors, retailers, importers and those whose primary income comes from trade in these products.

The definition also includes entities that are dependent on funding and support from these industries, such as business associations or other non-state actors representing or funded largely by any of the previously outlined entities, as well as:

• industry lobbyists
• coalitions
• corporate philanthropic foundations
• charities
• social aspect organisations

Other non-state actors who receive funding from these industries (including funding for research) or have considerable links to the entities described above, should be reviewed whenever necessary, to determine whether they should be viewed as ‘industry’.^{[footnote 15]}

7.2 Engagement

PHE defines engagement as any formal interaction between PHE and an unhealthy commodity industry stakeholder. This can cover a wide variety of activities from major, longer-term collaborations to briefer interactions.

In line with WHO’s handbook on engaging with non-state actors, engagement can cover participation (such as in meetings or events), resource contributions (financial or in-kind), information sharing, advocacy and technical collaboration.

PHE has set out industry specific restrictions where they apply (such as in the alcohol and gambling sections).

7.3 Conflicts of interest

PHE defines conflicts of interest as an inability to contribute impartially to a programme of work, research, governance or oversight functions.

PHE’s conflict of interest policy sets out the conduct expected of PHE staff where their private interests might conflict with their public duties. This includes the steps staff need to take to safeguard the organisation against conflict of interest. Problems may arise because of personal or corporate conflict of interests.

PHE recognises the long-established principle that public-sector bodies must be impartial and honest in the conduct of their business and that their employees should remain beyond suspicion.

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