Intended for healthcare professionals

Rapid response to:


Do the solutions for global health lie in healthcare?

BMJ 2014; 349 doi: (Published 25 September 2014) Cite this as: BMJ 2014;349:g5457

Rapid Response:

According to the Food and Agriculture Organization (FAO), the Second International Conference on Nutrition (ICN2), “may be the only opportunity in our lifetime to focus world attention on nutrition.”[1] Given that the conference will take place in Rome next month, and that many issues will be determined in negotiations beforehand, a critique of trends in global health could not be more timely.[2]

A central issue is the role of national and multinational food and beverage companies in efforts to address the so-called “double burden of malnutrition,” overnutrition and undernutrition. Governments and intergovernmental organizations (including the UN and the WHO) are relying increasingly on “engagement” with the private sector—in particular, public-private partnerships—to address obesity and non-communicable diseases (NCDs) more broadly.

The approach rests on the view that corporations, civil society, the academy, and government constitute “the golden quadrant,” and that they “need to agree upon finding effective and efficient policies, sustainable practices and food solutions.”[1] The emphasis on agreement with industry comes at a price. As Jocalyn Clark notes,[2] it creates opportunities for companies to influence policy agendas and ensure public health issues are framed and addressed in ways consonant with their interests.

In my own work,[3] I emphasize the importance of considering how public-private partnerships—and industry interactions more broadly—may undermine the mission and integrity of government agencies and intergovernmental organizations. The commercial interests of multinational food companies inevitably diverge in fundamental ways from those of public sector agencies responsible for public health. We can recognize these divergent interests without demonizing industry, and we should do so. When public health officials downplay the divergence, they imperil their public health mission, and the integrity of their institution.

A distinct but related issue is how industry interactions may undermine trust and confidence in the public sector—including intergovernmental organizations. Several articles and letters in this and other medical journals have expressed concern about industry influence at the UN and WHO, and similar disquiet was expressed at the World Health Assembly meeting I attended in Geneva in May.

In the coming weeks, it will become apparent whether the full weight and implications of these concerns are recognized. In global nutrition policy, everyone may now be at the table. But who will determine what we get to eat?


1. Food and Agriculture Organization (FAO), The contribution of the private sector and civil society to improve nutrition.
2. Clark, Jocalyn. Do the solutions for global health lie in healthcare?, BMJ 2014;349:g5457
3. Marks, Jonathan H. “Toward a Systemic Ethics of Public-Private Partnerships Related to Food and Health” Kennedy Institute of Ethics Journal, 24(3): 267–299 (2014) (revising and expanding

Competing interests: No competing interests

08 October 2014
Jonathan H. Marks
Director, Bioethics Program
The Pennsylvania State University
205 Sparks Building, University Park, PA