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<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:6pt;color:black">Multistakeholder partnerships in
global nutrition governance: protecting public interest? | Tidsskrift for Den</span><span style="font-size:6pt;color:black"> norske legeforening</span><span style="font-size:9pt;color:rgb(5,64,137)"><br></span></p><p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:9pt;color:rgb(5,64,137)">GLOBAL HELSE</span>
</p><p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:9pt;color:rgb(140,138,142)"><br></span></p><p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:9pt;color:rgb(140,138,142)">A N N L O U I S E L I E</span></p>
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<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:9pt;color:rgb(140,138,142)">S A B R I N A I O N A T A G R A N H
E I M</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:9pt;color:black"> </span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Multistakeholder partnerships,
involving public and private actors, have become key instruments in global food
and nutrition governance. Such partnerships have the potential for conflicts
between profit and public health goals, which may harm the integrity of
nutrition policy. How can conflicts of interest be adequately addressed, and by
whom?</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Multistakeholder partnerships
involving governments, international organisations, civil society and private
sector actors have become key instruments for implementing the 2030 Agenda and
the Sustainable Development Goals. In food and nutrition governance, such
partnerships have proliferated as mechanisms to address the multiple burdens of
malnutrition, from hunger and undernutrition to obesity and diet-related
non-communicable diseases. While promoted as effective responses to complex
development challenges that require expertise and resources from multiple</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">sectors, partnerships between public
and private actors can create tensions between profit motives and public health
goals. Businesses whose profit depends on marketing and sales of unhealthy food
and beverages may for example contribute to reframe malnutrition problems in
their own interests (e.g. as the result of individual behaviour only),
influence public health agendas and priorities, and interfere with legislative
processes to derail industry regulation.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Such undue influence may, however, be
overcome through effective prevention and management of conflicts of interest.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">The question is how, and who should be
responsible for developing ‘the rules of the game’?</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">In order to explore these questions,
we discuss the respective roles of the World Health Organization (WHO) and the
Scaling Up Nutrition Movement (SUN Movement) in providing normative guidance
for governments on how to protect nutrition policy from undue influence. The
SUN Movement was established in 2010 as a global multistakeholder partnership
for nutrition, involving governments, international organisations, business,
civil society organisations and private donors, committed to supporting 59
developing countries in their efforts to reduce undernutrition. While WHO has
been mandated by its Member States to develop guidance on conflicts of interest
in nutrition, the SUN Movement has developed its own guidance for its member
countries. Rather than protecting the integrity of public sector agencies, the
guidance of the SUN Movement seems primarily to aim at protecting the
inclusiveness of the multistakeholder process. This not only risks undermining
public health priorities, but also the authority and legitimacy of WHO’s role
as a norm-setting agency.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Rather than protecting the
institutional integrity and independence of public sector agencies, the SUN
Movement is legitimising its own mission through its guidelines. Over time,
this can lead to reduced public trust in public health agencies, and be an
impediment to the fulfilment of existing international nutrition goals,
including those in the Sustainable Development Goals. Rather than uncritically
promoting multistakeholder partnerships for food and nutrition, more efforts
should be made to protect democratic processes and prevent corporate influence
on public policy.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black"> </span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:6pt;color:black"> </span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black">What are conflicts of interest?</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black"><span> </span>Thompson defines conflicts of interest as ‘a
set of conditions in which professional judgment concerning a primary</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">interest (such as a patient’s welfare
or the validity of research) tends to be unduly influenced by a secondary
interest</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">(such as financial gain)’ (1, p. 573).</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Conflicts of interest can occur at
different levels; for instance, at institutional level, when an organisation
has financial</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">ties that conflict with its vision and
mission; or at the individual level, when a financial interest may impair an</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">individual’s (e.g. health
professional’s, civil servant’s) ability to make a judgement in the public
interest. Both</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">institutional and individual conflicts
of interest can damage public trust in and the credibility of public sector
officials</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">or agencies, and undermine the quality
of policies and services they deliver.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black"><br></span></p><p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black">Conflicts of interest in global food
and nutrition governance</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black"><span> </span>As private sector actors have gained increased
influence in nutrition policy through participation in partnerships with</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">governments, many have raised concerns
about the need to safeguard nutrition policy-making from undue influence</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">(2,3). While partnerships may provide
effective solutions to policy problems by drawing on skills and resources from</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">different stakeholders, there should
be a limit to the level of involvement of actors whose interests conflict, or
may seem</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">to conflict, with public agencies’
agendas. Actors that arguably should be kept at arm’s length when food and
nutrition</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">policy is developed are for example
businesses that profit from marketing and sales of products harmful to health.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Negative health impacts are widely
recognised in the case of heavy marketing and widespread use (beyond what is</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">medically recommended) of breastmilk
substitutes, and extensive marketing of food products rich in salt, sugar and
fat</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">to children (4,5).</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black"><br></span></p><p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black">WHO’s efforts to prevent and manage
conflicts of interest in nutrition</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black"><span> </span>Through the endorsement of the Comprehensive
implementation plan on maternal, infant and young child nutrition<span> </span>by Member</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">States in 2012, WHO was mandated to
‘form alliances and partnerships to expand nutrition actions with the</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">establishment of adequate mechanisms
to safeguard against potential conflicts of interest’ (6). Member States also</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">mandated WHO to ‘develop risk
assessment, disclosure and management tools to safeguard against possible
conflict of</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">interest in policy development and
implementation of nutrition programmes consistent with WHO’s overall policy and</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">practice’ (6).</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Since then, WHO has adopted a policy
to guide its engagement with non-state actors (7) and is currently working to</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">develop guidelines for countries on
prevention and management of conflicts of interest in the nutrition policy
process.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">The guidelines will be presented at
the World Health Assembly in 2018. When adopted, they should serve as</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">authoritative advice to governments on
how to engage with non-state actors without compromising the integrity of</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">health authorities or nutrition goals.
However, in a number of countries burdened by high levels of malnutrition,</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">WHO’s guidelines are at risk of being
undermined even before dissemination, by alternative guidelines developed by</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">the SUN Movement.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black"><br></span></p><p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black">The SUN Movement’s approach to
conflicts of interest</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black"><span> </span>What is the role of the SUN Movement? In contrast
to WHO, the SUN Movement is not a specialised UN agency whose</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">role is to perform normative and
analytical functions mandated by Member States. Rather, the SUN Movement has
the</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">self-appointed role of coordinating
nutrition actors at the global level, advocating for and mobilising funding for</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">nutrition, and supporting
country-level action in the area of malnutrition. One of its key aims is to
establish</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">multistakeholder partnerships for
nutrition within its member countries (8).</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">The close involvement of food
corporations in these partnerships raises concerns about whose interests are
promoted</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">through the SUN Movement. Initially
focused on reducing stunting (low height for a child’s age), the SUN Movement</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">has recently broadened its scope to
reduce all forms of malnutrition, including overweight and obesity (8). This
aim</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">seems to conflict with the interests
of many of the food corporations involved. Through its Business Network, 268</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">companies have committed to supporting
countries’ efforts to scale up nutrition action (9). Among these, a large</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">number of corporations selling
products harmful to health, such as Coca-Cola, PepsiCo and Mars, are members
and</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">represented on the Movement’s
governance boards (10).</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">In 2013 and in parallel to WHO’s
ongoing work on conflicts of interest in nutrition, the SUN Movement started to</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">develop guidelines for its member
countries on how to address such conflicts. The guidance, A Reference Note and
a</span></p><br><span style="font-size:10pt;color:black">Toolkit for Preventing and Managing
Conflicts of Interest,<span> </span>was financed by
the private Bill and Melinda Gates Foundation, and</span>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">developed by a private consultancy
firm (11). This guidance has been widely disseminated within the SUN Movement’s</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">59 member countries and is currently
being used by its members, including the Business Network, to guide</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">governments’ efforts to address
conflicts of interest when developing their nutrition policies and programmes.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">While this might seem like a welcome
development and proactive response by the SUN Movement to prevent conflicts</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">of interest from arising within the
partnerships it promotes, a closer look at the guidance raises concerns
regarding its</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">intentions and the appropriateness of
its interference with WHO’s norm-setting role.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black"><br></span></p><p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black">Concerns regarding the SUN Movement’s
conflicts of interest guidance</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black"><span> </span>There are several reasons why the SUN
Movement’s guidance on conflicts of interest is problematic. Firstly, the
purpose</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">of the guidance does not seem to be to
protect the integrity, independence and public trust in individuals and</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">institutions serving public interests,
but rather to ensure effective functioning of the partnership itself and to</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">strengthen inclusion of new partners (12,
p. 14). The definition applied is unclear and states that a conflict of
interest</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">arises when a secondary interest
conflicts with the aims of the partnership, which in the case of the SUN
Movement is to</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">promote multistakeholder
collaboration. It also states that it is important to manage conflicts of
interest ‘because it can</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">promote inclusiveness in recruiting
and working with stakeholders. (…) and contributes to the effectiveness of the</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">collective effort’ (12, p. 18).</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Secondly, the SUN Movement’s guidance
confuses conflicts of interest with concepts such as ‘diverging interests’</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">between<span> </span>different actors, and by suggesting that any
type of collaboration can lead to conflicts of interest, downplaying</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">the concern about conflicts arising
between primary and secondary interests<span>
</span>(for example public health versus profits)</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">within<span>
</span>an institution or an individual. The guidance also underplays the
significance of conflicts of interest by</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">distinguishing between actual and
perceived conflicts of interest. The concept of ‘perceived’ conflicts of
interest</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">suggests that a conflict of interest
only arises if actual bias or harm to public health occurs. This is misguided
and opens</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">up for treatment of perceived
conflicts of interest as less serious (13). Indeed, the SUN Movement’s guidance
states that</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">perceptions of conflicts of interest
only sometimes merit an intervention (12, p. 14).</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Thirdly, many of the principles of
engagement upon which the guidelines are based conflict with an effective
conflict of</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">interest policy. Of particular concern
are the principles ‘to be inclusive’ and ‘to be willing to negotiate’ (12, p.
11). In order</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">to avoid undue influence on public
policy-making, exclusion of actors with perceived or actual conflicts of
interest is</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">sometimes necessary, and there is not
always room for negotiating ways around it. However, the guidance of the SUN</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Movement encourages to ‘limit the
scope and duration of any exclusionary decision’ (12, p. 21) on the grounds
that it</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">contradicts the principles of the
partnership. If multistakeholder partnerships mean that the principle of
inclusion</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">must be followed above all else, this
model is not reconcilable with effective prevention or management of conflicts
of</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">interest. The principle of
inclusiveness is also problematic, as it does not recommend any limitation to
the involvement</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">of non-state actors at any point in
the policy process. Having committed to being members of the SUN Movement,</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">governments’ abilities to withstand
pressure and attempts at industry interference may be undermined, as well as
their</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">political power to decide on the
extent to which private actors should be allowed into policy-making processes,
and at</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">which stage.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">The SUN Movement’s principle number 5,
‘to be predictable and mutually accountable’ is also problematic as it suggests</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">that governmental and non-governmental
actors alike have equal responsibilities. While every partner has a<span> </span>role in a</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">partnership, the roles and
responsibilities of the various actors are not at the same level. Most
importantly, governments</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">are primarily accountable to citizens,
not to other members of such partnerships.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Finally, the SUN Movement’s guidance
is weak in the measures it proposes to prevent and manage conflicts of
interest. It</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">recommends protection of
confidentiality and privacy in the disclosure process (12, p. 18), which
contradicts the</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">principle of transparency. Rather than
ensuring an independent process, the guidance recommends that ‘Mechanisms</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">for managing conflicts of interest
should include all stakeholders – including those with a perceived or potential</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">conflict of interest’ (12, p. 20).
This will seriously limit the effectiveness of a conflicts of interest policy.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">These issues indicate that the SUN
Movement’s Reference Note and Toolkit do not provide an appropriate or
sufficient</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">response to the very real question of
how to protect food and nutrition policy-making from undue commercial</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">influence. Rather than providing clear
advice to governments on how to address conflicts of interest while engaging in</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">partnerships, the SUN Movement’s
guidance seems to encourage inclusiveness above all else, without any risk</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">assessment. This contributes to
governments’ existing confusion about when and how to enter into partnerships,
and</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">may even legitimise engagements that
clearly create conflicts of interest. Additionally, the overlap with WHO’s work
on</span></p><span style="font-size:10pt;color:black"><span> </span>country guidance on conflicts of interest may
lead to slower and weaker measures to protect nutrition, and an</span>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">additional burden on already
overstretched government staff.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black"><br></span></p><p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:15pt;color:black">Protect democratic processes</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black"><span> </span>While multistakeholder partnerships have the
potential to draw on resources and skills from different actors in order to</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">improve effectiveness of nutrition
interventions, they create real risks and challenges to food and nutrition
policymaking</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">that need to be acknowledged and
appropriately addressed.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">The Scaling Up Nutrition (SUN)
Movement (14)</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Established in 2010.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">A global multistakeholder partnership
for maternal and child malnutrition.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Members include UN system
organisations, civil society organisations, businesses, private foundations,
bilateral</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">donors and 59 developing countries.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Stakeholders are organised into four
networks: donors, business, civil society and the UN.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Led by a global multistakeholder Lead
Group and an Executive Committee.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Promotes multi-sector and
multistakeholder partnerships for nutrition in SUN countries.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">Aims to scale up evidence-based
nutrition-specific and sector-wide approaches to nutrition in member countries.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">The analysis of the SUN Movement’s
guidelines on how to prevent conflicts of interest suggests that organisations
with a</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">self-interest in promoting
multistakeholder partnerships should not provide normative guidance to
governments on</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">how to protect public health from
undue influence. The SUN Movement conveys a misguided understanding of what</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">‘conflicts of interest’ means and
contributes to undermine the authority of member-state mandated organisations
such</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">as WHO, and of governments themselves.</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black"> </span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">The fact that the SUN Movement
promoted a parallel process to that of WHO on conflicts of interest can be seen
as an</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">attempt to establish norms of
engagement in line with its own agenda that downplays the risks of stakeholder</span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"><span style="font-size:10pt;color:black">engagement. </span></p>
<p class="gmail-MsoNormal" style="margin:0in 0in 0.0001pt;font-size:12pt;font-family:Cambria"> </p>
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