Tuesday, October 25, 2011

The Rio Political Declaration on Social Determinants of Health

The World Health Organisation (WHO) World Conference on Social Determinants of Health issued the Rio Declaration on 21 October 2011. Click here for a press release from Baby Milk Action.

The draft official Rio Declaration included text calling for collaboration with stakeholders, including the private sector. The Conflicts of Interests Coalition statement of concern was distributed to delegates and the final text makes reference to conflicts of interest in three places:

"Foster collaboration with the private sector, safeguarding against conflict of interests, to contribute to achieving health through policies and actions on social determinants of health;"

"Promote inclusive and transparent governance approaches, which engage early with affected sectors at all levels of governments, as well as support social participation and involve civil society and the private sector, safeguarding against conflict of interests;"

"Promote appropriate monitoring systems that take into consideration the role of all relevant stakeholders including civil society, nongovernmental organizations as well as the private sector, with appropriate safeguard against conflict of interests, in the monitoring and evaluation process;"

Lida Lhotska, the European Coordinator of the International Baby Food Action Network (IBFAN), commented:

"The call to safeguard against conflict of interests is much welcome. However, it should not apply only to Member States but also to WHO as an agency which will be supporting Member States in their efforts to implement the Declaration. WHO in fact does have a unique opportunity to develop a comprehensive institutional policy that would guarantee adequate safeguard against both individual and organisational conflicts of interests as part of the announced WHO's reform."

Thursday, September 29, 2011



Washington Post: 21.9.11   Battle of commercial interests confound fight against noncommunicable diseases   http://www.washingtonpost.com/world/battle-of-commercial-interests-loom-over-fight-against-noncommunicable-diseases/2011/09/20/gIQAy0rZjK_story.html
The Guardian UN calls summit on Lifestyle diseases  20.9.11  http://www.guardian.co.uk/society/2011/sep/16/un-summit-spread-lifestyle-diseases
Nutraingredients: 20.9.11   http://www.nutraingredients.com/content/view/print/562253
Final Political Declaration adopted 19th September 2011: 

Tuesday, September 20, 2011

U.N.-Approved Global Pact for Tackling Nutrition- and Alcohol-related Diseases is Strong on Awareness, Timid on Action

Press release.

NEW YORK (September 19, 2011) — A consortium representing thousands of non-profit public health advocacy groups made the following comment on the “Political Declaration” of the “High Level Meeting on the Prevention and Control of Non-Communicable Diseases” at the United Nations General Assembly in New York City on September 19-20, 2011, approved unanimously at 10:04 a.m. today. (Following several months of negotiation, U.N. officials recently added several hours to the plenary session to accommodate a high level of interest by world leaders and other top government officials to speak to the issue in the Assembly Hall.)

The U.N. Political Declaration shows that governments world-wide have achieved a much better understanding of the extent to which poor nutrition and excess alcohol consumption worsen public health, weaken workforce productivity, and drive-up expensive treatment-intensive costs related to cardiovascular disease, cancer, and diabetes. Leaders also acknowledged that prevention must be a cornerstone of global and national responses to NCDs.Such newly acquired top-level awareness is, alone, a great achievement, but a clear commitment to implement prevention policies is still missing.

Effective public policy reform is the first casualty of timid “partnering” with companies that make products that contribute to an increase in disease risks or products that treat disease symptoms. To their credit, governments agreed that tobacco companies should have no place at the table, but risk trusting multi-trillion dollar global purveyors of alcohol, junk food, and pharmaceutical drugs to voluntarily change their for-profit stripes. Governments cannot continue to allow conflicts of interest with the private sector to go unchallenged and unmanaged in the policy-making process. An ethical code of conduct is needed to guide interactions with the private sector, which we must not forget is answerable primarily to shareholders and not to public health.

The Political Declaration is silent on specifics and short on solid commitment to regulations that could, for example:
  • Mandate salt and sugar reduction in high-salt and high-sugar processed foods;

  • Realign food VAT/GST policies for food and agricultural subsidies with sound nutrition science;

  • Mandate easy-to-understand front-of-pack nutrition labelling;

  • Mandate nutrition information (e.g., sodium and calories) on restaurant menus;

  • Prohibit the use of trans-fat laden partially hydrogenated oils in food;

  • Protect children and young people from marketing of products that raise the risk of disease (e.g. banning the promotion of breast-milk substitutes and high-fat, -sugar and -salt foods to children and young people); and

  • Prohibit advertising and brand sponsorship for alcohol beverages;

  • Increase taxes on alcohol beverages;

  • Require and enforce effective restrictions on impaired driving (such as random breath testing),and minimum purchase age; and

  • Expand nutritious school meal programs.
The Political Declaration reinforced its support for the World Health Organization’s landmark Framework Convention on Tobacco Control, and also called for the protection of breastfeeding and implementation of the Code of Marketing of Breastmilk Substitutes, (1) but defers much of the job of addressing nutrition and alcohol to future work of WHO technical experts, Member States, and future U.N. meetings. Work left undone includes:
  • developing tools to navigate the trade law barriers to health policy innovation,

  • establishing workable, but energetic disease reduction targets and detailed policy implementation schedules, and

  • vitally, instituting a mechanism to keep commercially self-interested parties at arms-length and public-interest groups constructively involved.
Note to editors:

The statement of the Conflict of Interest Coalition can be found at:

The final “Political Declaration” at:
http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration.pdf and will soon be issued in the six officials languages of the United Nations.

The Meeting’s program agenda can be found at:

1 (i) Promote, protect and support breastfeeding, including exclusive breastfeeding for about six months from birth, as appropriate, as breastfeeding reduces susceptibility to infections and the risk of undernutrition, promotes infant and young children’s growth and development and helps to reduce the risk of developing conditions such as obesity and non-communicable diseases later in life, and, in this regard, strengthen the implementation of the international code of marketing of breast milk substitutes and subsequent relevant World Health Assembly resolutions;

Spokesperson Contact Information in New York City
Centre for Science in the Public Interest, Canada (CSPI-Canada) is an independent health advocacy organization with offices in Ottawa and Washington. CSPI's advocacy efforts are supported by more than 100,000 subscribers to the Canadian edition of its Nutrition Action Healthletter, on average, one subscribing household within a one block radius of every Canadian street corner. CSPI does not accept industry or government funding and Nutrition Action does not carry advertisements. Contact Point in New York City: Bill Jeffery, LLB, National Coordinator, Mobile/Text: 1-613-565-2140; bjeffery@cspinet.ca ; Skype at: billjeffery2447337; http://www.cspinet.org/canada/foodstrategies.html Follow me this week on Twitter at BillJefferyCSPI

Consumers International (CI) is the only independent global campaigning voice for consumers. With over 220 member organisations in 115 countries, we are building a powerful international consumer movement to help protect and empower consumers everywhere. Contact point in New York: Indrani Thuraisingham, CI’s head of Asia Pacific and the Middle East. Mobile +601 2205 2277. E-mail indrani(at)ciroap.org

Global Alcohol Policy Alliance (GAPA) is a developing network of non-government organizations and people working in public health agencies that share information on alcohol issues and advocate evidence-based alcohol policies. Contacts in New York: Derek Rutherford: drutherford@ias.org.uk, mobile +44-7710235164; Dr. Sally Casswell, Chairperson of the Scientific Advisory Panel: s.casswell@massey.ac.nz, mobile +64-21655346 Øystein Bakke, Secretary: oystein.bakke@forut.no ; mobile +47-41622135; and George Hacker, ghacker@cspinet.org, mobile +1-202-746-9210.

International Association for Consumer Food Organizations (IACFO) is an association of non-governmental organizations that represent consumer interests in the areas of nutrition, food safety, and related food policy matters. IACFO was formed in 1997 to increase consumer representation in the debate over the global food trade and to work with international agencies responsible for harmonizing standards related to the production, distribution, and sale of foods. IACFO regularly participates, as a recognized observer, in meetings of committees of the Codex Alimentarius Commission and meetings convened by the World Health Organization, the World Trade Organization, the UN Food and Agriculture Organization, and the Organisation for Economic Co-operation and Development. IACFO’s members also represent consumer interests before government regulatory agencies on five continents and release reports examining current nutrition policy and food safety issues. Contact Point in New York: See info, below, for CSPI and IBFAN.

International Association for the Study of Obesity (IASO) is a not-for-profit organisation linking over 50 regional and national associations with over 10,000 professional members in scientific, medical and research organisations. It is an umbrella organisation for 52 national obesity associations, representing 56 countries. Its mission is to improve global health by promoting the understanding of obesity and weight-related diseases through scientific research and dialogue, whilst encouraging the development of effective policies for their prevention and management. Contact in New York: Shiriki Kumanyika, PhD, MPH at skumanyi@mail.med.upenn.edu ; mobile: 1-267-252-1642

International Baby Food Action Network (IBFAN) consists of public interest groups working around the world to reduce infant and young child morbidity and mortality. IBFAN aims to improve the health and well-being of babies and young children, their mothers and their families through the protection, promotion and support of breastfeeding and optimal infant feeding practices. IBFAN works for universal and full implementation of the International Code of Marketing of Breast-Milk Substitute and Resolutions. Contact Point in New York City: Patti Rundall at prundall@babymilkaction.org; mobile: 44-0778-6-523493. website: http://info.babymilkaction.org/node/458

National Heart Forum (NHF-UK) is a leading charitable alliance of 70 national organisations working to reduce the risk of avoidable chronic diseases—coronary heart, disease, stroke, diabetes, obesity, respiratory disease, and cancer. Our purpose is to co-ordinate public health policy development and advocacy among members drawn from professional representative bodies, consumer groups, voluntary and public sector organisations. Contact in New York: Paul Lincoln mobile +44 7946 433215; paul.lincoln@heartforum.org.uk Skype: paul.lincoln; Modi Mwatsama: mobile +44 7941 694995; modi.mwatsama@heartforum.org.uk ; Skype: modi.mwatsama Follow me this week on twitter at ModiMwatsama

World Cancer Research Fund International (WCRF International) Working with leading research scientists, policy makers and health professionals, WCRF International is committed to making cancer prevention a reality. It is the not-for-profit umbrella association that leads and unifies our WCRF global network of cancer charities dedicated to funding research and education programmes into the link between food, nutrition, physical activity, weight maintenance and cancer risk. The national charities are based in the US, UK, Netherlands, Hong Kong and France. WCRF International was created to maximise the potential of each national member, and by building a network of cancer charities, strengthen the global cancer prevention message. With the belief that greater impact can be achieved when allied organisations work together, WCRF International operates to ensure that each of its charities is in a stronger position than if it were operating in isolation. Contact Point in New York: Kate Allen, PhD at k.allen@wcrf.org; mobile: 44-07766-600-940. Follow us on Twitter at WCRFInt

Friday, September 16, 2011

Reuters reports on Lancet letter

The COI Coalition's letter to the Lancet has been picked up by the Reuters newswire.

Health groups warn business could hijack UN disease meeting

Nestle, Glaxo Lobby UN

Report on the Bloomberg Businessweek site on 16 September 2011:

Nestle, Glaxo Lobby UN Over Biggest ‘Epidemic’ Battle Since AIDS

Guardian article 16 September 2011

The COI Coalition statement is reported in The Guardian on 16 September 2011. The Coalition is described as a 'vocal movement to address conflicts of interest':

Concerns at behind-the-scenes lobbying have led to a vocal movement to address conflicts of interest at the summit and within any global strategy against NCDs. More than 100 organisations, led by those who have fought the marketing of the baby milk corporations in the developing world but including those working on food, alcohol, tobacco and essential medicines issues, called on the UN to recognise the difference between such campaigners and groups representing industry, and develop a code of conduct for engaging with those who had a commercial interest in the outcome.
---extract ends

Letter in the Lancet - 16 September 2011

A letter from the COI Coalition has been published in the Lancet, 16 September 2011:

Conflicts of interest and the UN high-level meeting on non-communicable diseases


Thursday, September 1, 2011

Statement of Concern

This statement can be downloaded as a pdf - in English - in French.

This Statement of Concern has been developed by the Conflicts of Interest Coalition*. It focuses on the lack of clarity regarding the role of the private sector in public policy- making in relation to the prevention and control of non-communicable diseases (NCDs).

It calls for the development of a Code of Conduct and Ethical Framework to help protect the integrity of, and to ensure transparency in, public policy decision-making, by safeguarding against, and identifying and managing conflicts of interest.

The Statement of Concern has been sent to the President of the United Nations General Assembly and the co-facilitators of the United Nations High Level Meeting on the Prevention and Control of Non-Communicable Diseases.

As of September 2011, the statement has been endorsed by 143 national, regional and global networks and organisations working in public health, including medicine, nutrition, cancer, diabetes, heart disease, lung disease, mental health, infant feeding, food safety and development.

To add your organisation’s support for this crucial issue, please email

* The Conflicts of Interest Coalition comprises civil society organisations united by the common objective of safeguarding public health policy-making against commercial conflicts of interest through the development of a Code of Conduct and Ethical Framework for interactions with the private sector.

Our organisations strongly support the objective of raising the profile of NCDs globally.

We call on the UN to:
  1. Recognise and distinguish between industries, including business-interest not-for-profit organisations (BINGOs) and public interest non-governmental organisations (PINGOs), that are both currently under the ‘Civil Society’ umbrella without distinction.

  2. Develop a ‘Code of Conduct’ that sets out a clear framework for interacting with the private sector and managing conflicts of interest, and which differentiates between policy development and appropriate involvement in implementation.
Since the major causes of preventable death are driven by diseases related to tobacco, unhealthy diet, physical inactivity and alcohol drinking, we are concerned that many of the proposals to address NCDs call for ‘partnerships’ in these areas with no clarification of what this actually means.

Public-private partnerships in these areas can counteract efforts to regulate harmful marketing practices.

It is essential that a strong and clear policy on conflicts of interest is established by the international community to provide Member States with guidance to identify conflicts, eliminate those that are not permissible and manage those considered, based on thorough risk/benefit analysis, acceptable. Transparency, although an essential requirement and first step, is not a sufficient safeguard in and of itself against negative impacts of conflicts of interest.

We propose that the following framework be used as a basis for a ‘Code of Conduct’ for industry

The policy development stage should be free from industry involvement to ensure a “health in all policies” approach, which is not compromised by the obvious conflicts of interests associated with food, alcohol, beverage and other industries, that are primarily answerable to shareholders.

These industries should, of course, be kept informed about policy development, through stakeholder briefings for example, but should not be in an influencing position when it comes to setting policy and strategies for addressing public health issues, such as NCD prevention and control.

While it is important for these industries to be in dialogue during the policy development process, this should be as a means of informing the process relating to practical issues rather than as members of the policy development team.

Industries are both part of the NCD problem and the solution. It is vital therefore to engage them in the most appropriate way when implementing policy and not when developing policy, to ensure that public health policy is protected from commercial interests.

Without this approach, WHO’s principles of democratic policy-making for health, its constitutional mandate of the attainment of the highest possible level of health for all, and its independence, integrity and effectiveness will be undermined. Without such a policy, conflicts of interest can become institutionalised as the norm, impacting on the authority of governments. Industries with a strong interest in the outcome will increasingly assume greater roles in policy and decision shaping. This can fundamentally compromise and distort international and national public health priorities and policies.

The conflict of interest concern is not limited to the direct involvement of industry. UN agencies, including the WHO, are unanimous in recognising the important contributions NGOs make in the area of public health and are aware of the growth of these organisations in their numbers and influence in health at global, regional and national levels, including in the area of NCDs. However, WHO and others have so far not made a clear distinction between BINGOs (business-interest not-for-profit NGOs that are set up by, representing or closely linked to, business interests) and PINGOs (public-interest NGOs). This failure to distinguish between the two groupings exacerbates any existing lack of transparency and complicates implementation of any procedures which aim to manage the role of these actors in policy and standard-setting consultations. In the Civil Society Interactive Hearing on 16th June, there was no clear differentiation between groups within civil society. The voice of civil society ought to reflect only public health interests.

The safeguards in Article 5.3 of the Framework Convention on Tobacco Control, the WHO International Code of Marketing of Breast-milk Substitutes, the Resolutions on Infant and Young Child Nutrition and the Global Strategy on Diet, Physical Activity and Health can be used among other helpful tools to establish measures that go beyond individual conflicts of interests, and address institutional conflicts of interest.

In summary, we call on the UN to recognise and distinguish between BINGOs and PINGOs that are currently under the ‘civil society’ umbrella and to develop a ‘Code of Conduct’ framework for industry engagement that differentiates between policy development and appropriate involvement in implementation that complies with existing regulations and the principles established in the Code of Conduct. We ask for the UN to consider our comments and take them into account for the UN High Level Meeting in September.
  1. Access to Essential Medicines Campaign - Médecins Sans Frontières (Global)
  2. Active – sobriety, friendship and peace (Europe)
  3. Affaires Européennes et Internationales (France)
  4. Aktionsgruppe Babyhahrung (Germany)
  5. Alcohol Action Ireland
  6. Alcohol Focus Scotland
  7. Alcohol Health Alliance (UK)
  8. Alcohol Policy Youth Network (Europe)
  9. All India Drug Action Network (India)
  10. Alliance Against Conflict of Interest (AACI) (India)
  11. Alliance for the Control of Tobacco Use (ACT) Brazil
  12. Arugaan (Philippines)
  13. Association for Accountancy and Business Affairs (UK)
  14. Association for Consumer's Action on Safety and Health (India)
  15. Association Nationale de Prévention en Alcoologie et Addictologie (ANPAA) France
  16. Australian Breastfeeding Association (Australia)
  17. Baby Feeding Law Group (UK)
  18. Baby Milk Action (UK)
  19. Bangladesh Breastfeeding Foundation (Bangladesh)
  20. Biomedical Research Centre for Maternal and Child Healthcare (IRCCS) (Italy)
  21. Birthlight (UK)
  22. Berne Declaration (Switzerland)
  23. Blue Cross Norway
  24. Brazilian Institute for Consumers Defense (IDEC) (Brazil)
  25. Brazilian Front for the Regulation of Food Advertising (Brazil)
  26. British Liver Trust (UK)
  27. Borstvoeding vzw (Belgium)
  28. Breastfeeding Network (UK)
  29. Breastfeeding Promotion Network of India (India)
  30. British Society for the Study of Liver Disease (UK)
  31. Calgary Breastfeeding Matters Group Foundation (Canada)
  32. Campaign for Development and Solidarity (FORUT) Norway
  33. Cancer Research UK
  34. Caroline Walker Trust (UK)
  35. Canterbury Breastfeeding Advocacy Services (New Zealand)
  36. Centre for Counselling Nutrition and Health Care (Tanzania)
  37. Centre for Science in the Public Interest (Canada)
  38. Consensus Action on Salt and Health (CASH)
  39. Consumers Korea (Korea)
  40. Consumer Organization of South Sulawesi (Indonesia)
  41. Consumers International (Global)
  42. Corporate Accountability International (USA)
  43. Corporate Europe Observatory (Europe)
  44. Diabetes Association Norway
  45. Earth Dharma Farm (USA)
  46. Ecowaste Management Coalition (Philippines)
  47. European Alcohol Policy Alliance – Eurocare (Europe)
  48. European Heart Network (Europe)
  49. Europe Third World Centre (CETIM) (Europe)
  50. Food Ethics Council (UK)
  51. Geneva Infant Feeding Association (Switzerland)
  52. Global Action Against Poverty (GAAP) (Global)
  53. Global Alcohol Policy Alliance (GAPA)
  54. Handicap International Federation (Switzerland)
  55. Health Action Information Network (Global)
  56. Health Action International Africa
  57. Health Action International Asia Pacific
  58. Health Action International Global
  59. Health Action International Europe
  60. Health Action International Latin America
  61. Health Care Without Harm (Global)
  62. Health Consumer Protection (Thailand)
  63. Health Innovation in Practice (Switzerland)
  64. Health Poverty Action (UK)
  65. Heart of Mersey (UK)
  66. INFACT Canada
  67. Indian Alcohol Policy Alliance
  68. Indian Medico-legal & Ethics Association (IMLEA)
  69. Initiativ Liewensufank (Luxembourg)
  70. Initiative for Health & Equality in Society (India)
  71. International Association for the Study of Obesity
  72. International Association of Consumer Food Organisations
  73. International Baby Food Action Network (Global)
  74. International Baby Food Action Network Europe
  75. International Baby Food Action Network Latin America
  76. International Baby Food Action Network Asia
  77. International Baby Food Action Network Arab World
  78. International Baby Food Action Network Africa
  79. International Baby Food Action Network Oceania
  80. International Baby Food Action North America
  81. International Code Documentation Centre (Malaysia)
  82. International Federation of Blue Cross
  83. International Institute of Legislative Affairs (Kenya)
  84. International Insulin Foundation (UK)
  85. International Society for Behavioral Nutrition & Physical Activity
  86. International Union Against Tuberculosis and Lung Disease
  87. Institute of Alcohol Studies (UK)
  88. Institute of Nutrition of the Rio de Janeiro State University (Brazil)
  89. Institute for Development and Community Health – LIGHT (Vietnam)
  90. IOGT International
  91. IOGT-NTO (Sweden)
  92. Kikandwa Rural Communities Development Organization - KIRUCODO (Uganda)
  93. Lactation Consultants of Great Britain
  94. Malaysian Breastfeeding Association
  95. Medicus Mundi International Network (Switzerland)
  96. Midwives Information and Resource Service (MIDIRS) (UK)
  97. Nada India Foundation
  98. National Childbirth Trust (UK)
  99. National Heart Forum (UK)
  100. National Institute of Alcohol and Drug Policies (Brazil)
  101. Navdanya Research Foundation for Science Technology & Ecology (India)
  102. Nepal Breastfeeding Promotion Forum
  103. Network for Accountability of Tobacco Transnationals
  104. No Excuse Slovenia
  105. No grazie, pago io (Italy)
  106. Nordic Work Group for International Breastfeeding Issues (NAFIA)
  107. Norwegian Cancer Society
  108. Norwegian Health Association (Nasjonalforeningen for folkehelsen)
  109. Norwegian Heart and Lung Patient Organisation
  110. Norwegian Policy Network on Alcohol and Drugs (ACTIS)
  111. Oakland Institute (CA, USA)
  112. Osservatorio Italiano Sulla Salute Globale (Italy)
  113. People's Health Movement (Global)
  114. Prevention Institute (USA)
  115. Royal College of Midwives (UK)
  116. Royal College of General Practitioners (UK)
  117. Royal College of Paediatrics and Child Health (UK)
  118. Royal College of Physicians (UK)
  119. Research and Advocacy for Health, Education , Environment (Pakistan)
  120. Save babies Coalition (Philippines)
  121. Scottish Health Action on Alcohol Problems (Scotland)
  122. StopDrink Network (Thailand)
  123. Sustain Children’s Food Campaign (UK)
  124. Sweet Enough Network (Thailand)
  125. Swaziland Infant Nutrition Action Network (SINAN)
  126. Sumy Youth Regional NGO, Gender Agency on Consultation and Information (Ukraine).
  127. The Breastfeeding Centre (Thailand)
  128. The Corner House (UK)
  129. Trade Union of Nutritionists of the State of Sao Paulo (Brazil)
  130. Universities Allied for Essential Medicine
  131. Vereniging voor Begeleiding en Bevordering van Borstvoeding VBBB (Belgium)
  132. War on Want (UK)
  133. WEMOS (The Netherlands)
  134. Western Cape Dept. of Health and the School of Public Health, University of Cape Town
  135. Women Concern Forum of South Sulawesi (Indonesia)
  136. Women’s Environmental Network (UK)
  137. World Alliance for Breastfeeding Action (Global)
  138. World Cancer Research Fund International (Global)
  139. World Action on Salt and Health (Global)
  140. World Association of Clubs of Alcoholics in Treatment (Italy)
  141. World Lung Foundation
  142. World Public Health Nutrition Association (Global)
  143. Young Professionals Chronic Disease Network (Global)