Table 2

Main arguments against public–private partnerships (PPPs) suggested by authors critical of this strategy

Types of argumentsQuotations from reviewed papers*
Alliances between public health and the private sector of which the products or services are unhealthful have inherent conflicts of interest that cannot be reconciled.
  • Because growth in profits is the primary goal of corporations, self-regulation and working from within are doomed to failure.51

  • Partnerships with food and other industries are analogous to the unsuccessful collaborations with the tobacco industries in the past.45

  • Health promotion measures are unlikely to be successful through industry–public health partnerships when the public health aim is to reduce the consumption of products that industry manufactures or distributes.27

  • The food industry, like all industries, plays by certain rules—it must defend its core practices against all threats, produce short-term earnings and, in so doing, sell more food. If it distorts science, creates front groups to do its bidding, compromises scientists, professional organisations and community groups with contributions, blocks needed public health policies in the service of their goals, or engages in other tactics in “the corporate playbook,” this is what is takes to protect business as usual.10

Collaboration in health promotion confers legitimacy and credibility on industries that produce disease related products. PPPs can damage the credibility of public health institutions.
  • The risks involved in developing partnerships with the corporate sector are also considerable. They include the possibilities that (1) the WHO reputation will be used to sell goods and services for corporate gain, thus tarnishing the WHO's reputation as an impartial holder of health values; (2) the WHO's judgement on a particular product, service or corporate practice may be compromised by financial support provided by the involved company or industry and (3) WHO involvement with an industry or company is perceived as acceptance of unhealthy products, services or practices.32

  • There is a real or intended image transfer effect of industries’ connections with reputable scientists and public health organisations.8

  • It is time to declare a moratorium on further dialogues with industry sources until alcohol scientists and the public health community can agree to what is in their legitimate interests, and how to avoid compromising our well-earned integrity.8

  • For the food industry, partnerships with health charities and health sector organisations are alluring. They buy corporations’ credibility, tie brands to the positive emotions attributed to their partnered organisation and help buy consumer loyalty.21

  • PPPs allow the food industry to claim that they are part of a ‘solution’ to a particular problem via the alliances themselves, as well as industry dollars. Being at least narratively part of a solution allows the food industry to defend against industry-unfriendly legislation and discourse.22 Some packaging suggests that “Just by purchasing this product you are helping to give children in Africa a chance at a better life.”36

PPPs capture institutions (UN agencies, governments, etc), regulatory bodies and science.
  • Companies use the interaction to gain political and market intelligence information in order to gain political influence and/or a competitive edge.49

  • The WHO lacks a hard-line conflict of interest policy, probably because of the much-needed financing that the private sector provides and the fear that enforcement will make investors hesitant.14

  • There is a potential for major private sector donors to distort the priorities of governments and international agencies receiving funds. For example, the core budget of the WHO is much more closely aligned with disease burden than is the element composed of extrabudgetary contributions from donors, an issue that current reforms are seeking to correct.24

  • Evidence suggests that these corporate social responsibility strategies are intended to facilitate access to government, co-opt non-governmental organisations to corporate agendas, build trust among the public and political elite, and promote untested, voluntary solutions over binding regulation.25

  • We now have considerable evidence that food and beverage companies use similar tactics to undermine public health responses such as taxation and regulation; an unsurprising observation given the flows of people, funds and activities, between Big Tobacco and Big Food. Yet the public health response to Big Food has been minimal.51 There is a long history of corporate abuses, best recognised in relation to the tobacco industry, although also becoming increasingly so with the food, alcohol and pharmaceutical industries. These include revolving doors between government and industry, undeclared or underplayed conflicts of interest, measures to define and measure standards, and many others.24

Precautionary principle due to lack of evidence.
  • The precautionary principle argues against PPP because there is no evidence that the partnership of alcohol and ultraprocessed food and drink industries is safe or effective, unless driven by the threat of government regulation.46

  • To date, self-regulation has largely failed to meet stated objectives and instead has resulted in significant pressure for public regulation.51

  • Evidence suggests that educational interventions are the least effective means of reducing alcohol-related harm, and that alcohol industry-funded educational programmes are ineffective and potentially counter-productive, similar to their counterparts funded by the tobacco industry.25

  • Despite the common reliance on industry self-regulation and PPPs, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.46

  • There is little objective evidence that PPPs deliver health benefits, and many in the public health field argue that they are just a delaying tactic of the unhealthy commodity industries.46

  • Today, we have solid evidence that marketing increases consumption of unhealthy foods and beverages, and that a ban would be a very cost-effective measure in the fight against childhood obesity. Still, regulation has so far been forcefully counteracted by an alliance between industry and advertisers, who instead advocate partnerships with the public sector to enhance physical activity. Collaboration should be evidence based.18

Objectives of PPPs contradict public health priorities.
  • There is no evidence for an alignment between public health priorities in health promotion and those of companies. For example, in the field of nutrition, PPPs do not pursue the promotion of traditional food systems, shared meals and fresh and minimally processed foods, rather they promote reformulation and ready-to-heat or ready-to-eat dishes and snacks labelled as healthy.45 51

  • These collaborations rarely establish the types of partnerships that promote the mutual exchange of ideas, resources, expertise or access to specific populations, nor do they result in political advocacy that would benefit public health.40

  • The industry tends to shift the debate away from the population at risk to the realm of individual behaviour.20

  • *Some quotations have been abridged for inclusion in the table.