Public-Private Partnerships in Mexico: Implications of Engaging With the Food and Beverage Industry For Public Health Nutrition

Document Type : Original Article

Authors

1 World Public Health Nutrition Association, London, UK

2 Instituto Nacional de Salud Pública, Morelos, Mexico

3 School of Public Health, University of Nevada Reno, Reno, NV, USA

4 Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA

5 Trinity College Dublin, Dublin, Ireland

Abstract

Background 
In the last few years, Mexico adopted public health policies to tackle non-communicable diseases (NCDs), such as front of package nutrition labelling, food marketing restrictions to children, and a soda tax. In parallel, transnational food and beverage industries (F&BIs), their allies, and the government have agreed on public-private partnerships (PPPs) to implement policies or deliver programs. However, research has questioned the benefits of PPPs and exposed its limitations as a suitable mechanism to improve public health. This study analyses how four PPPs between the Mexican government, the F&BI, and allies are working to achieve their goals. We critically assessed the objectives, scope, reported impacts, governance principles and perceived risks and benefits for the public health agenda of these PPPs.
 
Methods 
This qualitative study is based on 26 interviews with key actors, and 170 publicly available documents, including 22 obtained through freedom of information (FOI) requests related to four purposively selected PPPs aiming to improve health.
 
Results 
We found that the four PPPs studied had minimal public information available on their implementation and impact. The private partners tend to dictate the design, information management, and implementation of the programs, while promoting their brands. Few independent evaluations of the PPPs exist, and none reported on their effectiveness or public health benefits. Good governance principles, such as accountability, transparency, fairness, participation, integrity, and credibility, were barely followed in each of the cases studied. Public officials did not automatically question the conflict of interest (CoI) of such arrangements. When there were COI, the potential risks these posed did not always outweigh the financial benefits of working with the F&BI and its allies.
 
Conclusion 
The four PPPs studied produced minimal gains for public health while boosting credibility for the participating transnational F&BIs. It shows the lack of awareness of how these PPPs might be hindering public health gains.

Keywords


  1. World Health Organization (WHO). Global Action Plan for the Prevention and Control of NCDs 2013-2020. Geneva, Switzerland: WHO; 2013.
  2. World Health Organization (WHO). WHO Independent High-Level Commission on NCDs. Think Piece: Why is 2018 a Strategically Important Year for NCDs? 2018. http://www.who.int/ncds/governance/high-level-commission/why-2018-important-year-for-NCDs.pdf?ua=1.
  3. World Health Organization (WHO). Tackling NCDs: 'Best Buys' and Other Recommended Interventions for the Prevention and Control of Noncommunicable Diseases. 2017. http://www.who.int/ncds/management/best-buys/en/.
  4. National Public Health Institute (Instituto Nacional de Salud Pública). National Health and Nutrition Survey 2018-19. National Results. 2019. https://www.insp.mx/produccion-editorial/novedades-editoriales/ensanut-2018-nacionales. Accessed October 10, 2021.
  5. World Health Organization (WHO). Driving Commitment for Nutrition Within the UN Decade of Action on Nutrition: Policy Brief. WHO; 2018.
  6. Schäferhoff M, Campe S, Kaan C. Transnational public-private partnerships in international relations: making sense of concepts, research frameworks, and results. Int Stud Rev. 2009;11(3):451-474. doi:1111/j.1468-2486.2009.00869.x
  7. van Kersbergen CJ, van Waarden F. Shifts in Governance: Problems of Legitimacy and Accountability. The Hague: Netherlands Organization for Scientific Research (NWO); 2001.
  8. Sinclair D. Self‐regulation versus command and control? Beyond false dichotomies. Law Policy. 1997;19(4):529-559. doi:1111/1467-9930.00037
  9. Black J. Regulatory conversations. J Law Soc. 2002;29(1):163-196. doi:1111/1467-6478.00215
  10. Bäckstrand K. From rhetoric to practice: the legitimacy of global public-private partnerships for sustainable development. In: Bexell M, Mörth U, eds. Democracy and Public-Private Partnerships in Global Governance. London: Palgrave Macmillan; 2010:145-166. doi:1057/9780230283237_8
  11. Suzuki M, Webb D, Small R. Competing frames in global health governance: an analysis of stakeholder influence on the political declaration on non-communicable diseases. Int J Health Policy Manag. 2022;11(7):1078-1089. doi:34172/ijhpm.2020.257
  12. Canfield M, Anderson MD, McMichael P. UN Food Systems Summit 2021: dismantling democracy and resetting corporate control of food systems. Front Sustain Food Syst. 2021;5:661552. doi:3389/fsufs.2021.661552
  13. Lauber K, Rutter H, Gilmore AB. Big food and the World Health Organization: a qualitative study of industry attempts to influence global-level non-communicable disease policy. BMJ Glob Health. 2021;6(6):e005216. doi:1136/bmjgh-2021-005216
  14. Lacy-Nichols J, Williams O. "Part of the solution": food corporation strategies for regulatory capture and legitimacy. Int J Health Policy Manag. 2021;10(12):845-856. doi:34172/ijhpm.2021.111
  15. Lie AL, Granheim SI. Multistakeholder partnerships in global nutrition governance: protecting public interest? Tidsskr Nor Laegeforen. 2017;137(22). doi:4045/tidsskr.17.0627
  16. Fuchs D, Kalfagianni A, Havinga T. Actors in private food governance: the legitimacy of retail standards and multistakeholder initiatives with civil society participation. Agric Human Values. 2011;28(3):353-367. doi:1007/s10460-009-9236-3
  17. Schönherr N, Findler F, Martinuzzi A. Exploring the interface of CSR and the sustainable development goals. Transnatl Corp. 2017;24(3):33-47.
  18. Tabrizi JS, Azami-Aghdash S, Gharaee H. Public-private partnership policy in primary health care: a scoping review. J Prim Care Community Health. 2020;11:2150132720943769. doi:1177/2150132720943769
  19. Mialon M, Swinburn B, Sacks G. A proposed approach to systematically identify and monitor the corporate political activity of the food industry with respect to public health using publicly available information. Obes Rev. 2015;16(7):519-530. doi:1111/obr.12289
  20. Crosbie E, Thomson G, Freeman B, Bialous S. Advancing progressive health policy to reduce NCDs amidst international commercial opposition: tobacco standardised packaging in Australia. Glob Public Health. 2018;13(12):1753-1766. doi:1080/17441692.2018.1443485
  21. Lencucha R, Drope J, Chavez JJ. Whole-of-government approaches to NCDs: the case of the Philippines Interagency Committee-Tobacco. Health Policy Plan. 2015;30(7):844-852. doi:1093/heapol/czu085
  22. Saltman RB, Ferroussier-Davis O. The concept of stewardship in health policy. Bull World Health Organ. 2000;78(6):732-739.
  23. Matthes BK, Lauber K, Zatoński M, Robertson L, Gilmore AB. Developing more detailed taxonomies of tobacco industry political activity in low-income and middle-income countries: qualitative evidence from eight countries. BMJ Glob Health. 2021;6(3):e004096. doi:1136/bmjgh-2020-004096
  24. Ulucanlar S, Fooks GJ, Gilmore AB. The policy dystopia model: an interpretive analysis of tobacco industry political activity. PLoS Med. 2016;13(9):e1002125. doi:1371/journal.pmed.1002125
  25. Fanzo J, Shawar YR, Shyam T, Das S, Shiffman J. Challenges to establish effective public-private partnerships to address malnutrition in all its forms. Int J Health Policy Manag. 2021;10(12):934-945. doi:34172/ijhpm.2020.262
  26. National Centre for Preventive Programs and Disease Control (Centro Nacional de Programas Preventivos y Control de Enfermedades). Ratification of Epidemiological Emergency Declaration EE-5-2018. http://www.cenaprece.salud.gob.mx/programas/interior/emergencias/descargas/pdf/1371.pdf.
  27. National Centre for Preventive Programs and Disease Control (Centro Nacional de Programas Preventivos y Control de Enfermedades). Epidemiological Emergency Declaration EE-3-2016. 2016. http://www.cenaprece.salud.gob.mx/programas/interior/emergencias/descargas/pdf/EE_3.pdf.
  28. National Institute for Statistics and Geography (Instituto Nacional de Estadística y Geografía). Characteristics of Deaths Reported in Mexico in 2019 (Características de Las Defunciones Registradas en México Durante 2019). Press Release No. 480/20. https://www.inegi.org.mx/contenidos/saladeprensa/boletines/2020/EstSociodemo/DefuncionesRegistradas2019.pdf. Accessed October 20, 2021.
  29. Crosbie E, Carriedo A. Applying a commercial determinants of health lens to understand, expose and counter industry co-option, appeasement and partnership: Comment on "'Part of the solution': food corporation strategies for regulatory capture and legitimacy". Int J Health Policy Manag. 2022;11(11):2744-2747. doi:34172/ijhpm.2022.7371
  30. Secretaría de Salud Pública. Estrategia Nacional para la Prevención y el Control del Sobrepeso, la Obesidad y la Diabetes. 2013. http://promocion.salud.gob.mx/dgps/descargas1/estrategia/Estrategia_con_portada.pdf. Accessed February 4, 2014.
  31. Carriedo A. A Policy Analysis of the 2014 Mexican Soda Tax [dissertation]. London: London School of Hygiene & Tropical Medicine; 2017.
  32. Sartorius RH. The logical framework approach to project design and management. Eval Pract. 1991;12(2):139-147. doi:1177/109821409101200204
  33. Buse K, Walt G. Global public-private partnerships: part II--what are the health issues for global governance? Bull World Health Organ. 2000;78(5):699-709.
  34. Siddiqi S, Masud TI, Nishtar S, et al. Framework for assessing governance of the health system in developing countries: gateway to good governance. Health Policy. 2009;90(1):13-25. doi:1016/j.healthpol.2008.08.005
  35. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:1191/1478088706qp063oa
  36. Maxwell JA. A Realist Approach for Qualitative Research. SAGE Publications; 2012.
  37. Marks JH. The Perils of Partnership. New York: Oxford University Press; 2019.
  38. World Health Organization (WHO). The World Health Report 2000: Health Systems: Improving Performance. WHO; 2000.
  39. Murray CJ, Frenk J. A framework for assessing the performance of health systems. Bull World Health Organ. 2000;78(6):717-731.
  40. World Health Organization (WHO). Safeguarding Against Possible Conflicts of Interest in Nutrition Programmes: Draft Approach for the Prevention and Management of Conflicts of Interest in the Policy Development and Implementation of Nutrition Programmes at Country Level. 2017. https://www.who.int/nutrition/consultation-doi/Discussion-paper-nutrition.pdf. Accessed September 19, 2019.
  41. Instituto Nacional de la Infraestructura Física Educativa. Informe de Resultados. Instituto Nacional de la Infraestructura Física Educativa; 2016.
  42. Instituto Nacional de la Infraestructura Física Educativa. Informe de Rendición de Cuentas de Conclusión de la Administración 2012-2018. Ciudad de México: Instituto Nacional de la Infraestructura Física Educativa; 2018:34.
  43. Instituto Nacional de la Infraestructura Física Educativa. Informe de Actividades INIFED 2015-2017. Instituto Nacional de la Infraestructura Física Educativa; 2018:40.
  44. Secretaría de Educación Pública. Tercer Informe de Labores 2014-2015. 2015. http://www.planeacion.sep.gob.mx/Doc/informes/labores/2012_2018/3er_informe_de_labores.pdf. Accessed July 18, 2020.
  45. Inter-American Development Bank. ME-L1176: Proyecto para el Desarrollo Integral de Organismos Operadores de Agua y Saneamiento (PRODI). 2015. https://www.iadb.org/es/project/ME-L1176.
  46. Nestlé. Alianza con Secretaría de Educación de Veracruz. Nestlé. https://www.nestle.com.mx/media/pressreleases/nxns_convenio_veracruz. Accessed June 30 2020.
  47. Coca-Cola FEMSA. 2018 Annual Report. 2018. https://femsa.gcs-web.com/static-files/4780ef52-1850-40bd-ac57-56077cf9814a. Accessed June 19, 2020.
  48. Coca-Cola FEMSA. 2011 Annual Report. 2011. http://files.shareholder.com/downloads/FEMSA/3617245315x0x555085/d0e78409-f52b-40cb-91ad-70830917ccd9/femsa_AR11eng.pdf. Accessed June 10, 2020.
  49. Coca-Cola FEMSA. 2012 Annual Report. 2012. https://img.coca-colafemsa.com/assets/files/en/Investor_Information/Annual_Reports/Annual%20Report%202012.pdf. Accessed June 10, 2020.
  50. Coca-Cola FEMSA. 2013 Annual Report. 2013. https://img.coca-colafemsa.com/assets/files/en/Investor_Information/Annual_Reports/Annual%20Report%202013.pdf. Accessed July 14,2020.
  51. Coca-Cola FEMSA. 2014 Annual Report. 2014. https://img.coca-colafemsa.com/assets/files/en/Investor_Information/Annual_Reports/Annual%20Report%202014.pdf. Accessed May 4, 2020.
  52. Coca-Cola FEMSA. 2015 Annual Report. 2015. https://img.coca-colafemsa.com/assets/files/es/inversionistas/Reportes%20Anuales/KOF-Annual-Report-2015.pdf. Accessed July 3, 2020.
  53. Comunicación Social Cámara de D. Nota N°. 7347 Pide Beltrán Reyes a SEP y Conade informar sobre resultados del programa Ponte al 100, para contrarrestar obesidad y sobrepeso en la población infantil. 2017.
  54. Comunicación Social Cámara de D. Boletín 0098 En las escuelas públicas, sólo se han instalado dos mil 675 Directiva de la Cámara de 0098 bebederos de agua potable; la meta sexenal es de 40 mil. 2015.
  55. Rinaldi C. Public-private partnerships with unhealthy commodity industries: are they undermining real progress in non-communicable disease prevention? Comment on "Competing frames in global health governance: an analysis of stakeholder influence on the political declaration on non-communicable diseases". Int J Health Policy Manag. 2022;11(7):1212-1214. doi:34172/ijhpm.2021.118
  56. Gómez EJ. Coca-Cola's political and policy influence in Mexico: understanding the role of institutions, interests and divided society. Health Policy Plan. 2019;34(7):520-528. doi:1093/heapol/czz063
  57. World Public Health Nutrition Association. WPHNA position paper on strengthened governance and accountability in public health nutrition. World Nutr. 2021;12(3):2-10. doi:26596/wn.20211232-10
  58. Patay D, Schram A, Friel S. The challenges in protecting public health interests in multisectoral governance in the context of small island developing states: the case of tobacco control in Fiji and Vanuatu. Global Health. 2023;19(1):31. doi:1186/s12992-023-00931-y
  59. Marks JH. Toward a systemic ethics of public-private partnerships related to food and health. Kennedy Inst Ethics J. 2014;24(3):267-299. doi:1353/ken.2014.0022
  60. Patay D, Ralston R, Palu A, Jones A, Webster J, Buse K. Fifty shades of partnerships: a governance typology for public private engagement in the nutrition sector. Global Health. 2023;19(1):11. doi:1186/s12992-023-00912-1
  61. Carriedo A, Cairney P, Barquera S, Hawkins B. Policy networks and competing interests in the development of the Mexican sugar-sweetened beverages tax. BMJ Glob Health. 2023;8(Suppl 8):e012125. doi:1136/bmjgh-2023-012125
  62. Gobierno de México. Presentan en Palacio Nacional estrategia para una alimentación saludable. 2020. https://www.gob.mx/bienestar/prensa/presentan-en-palacio-nacional-estrategia-para-una-alimentacion-saludable/. Accessed September 30, 2020.
  63. Buse K, Walt G. Global public-private partnerships: part I--a new development in health? Bull World Health Organ. 2000;78(4):549-561.
  64. Rowe S, Alexander N, Kretser A, et al. Principles for building public-private partnerships to benefit food safety, nutrition, and health research. Nutr Rev. 2013;71(10):682-691. doi:1111/nure.12072
  65. World Health Organization (WHO). WHO Guidelines on Collaboration and Partnerships with Commercial Enterprises. Geneva: WHO; 1999.
  66. World Health Organization (WHO). Framework Convention on Tobacco Control. 2003. http://www.who.int/fctc/en/index.html.
  • Receive Date: 04 March 2023
  • Revise Date: 27 August 2023
  • Accept Date: 28 January 2024
  • First Publish Date: 29 January 2024