A Partnership for Public Health: Branded Food Products Database

Background: Voluntary food and beverage product reformulation is a prominent example of how self-regulation and public-private partnerships have become part of the public health nutrition policy landscape. This thesis aims to understand the emergence of reformulation in the nutrition policy system in order to provide insights into nutrition policymaking dynamics in the US. Methods: The methods of this study were based in applied policy research. It focuses on how stakeholders influence the nutrition policy process, including by shaping the framing of reformulation and nutrition policy. The methods consisted of a literature review and qualitative analysis of documents, including submissions to a government-led consultation on reformulation, in-depth stakeholder interviews, and the media. Results: Reformulation’s rise to prominence as a public health approach was the result of a confluence of factors, three of which were particularly important: (1) the consultation analysis revealed that it is a component of the food and beverage industry’s corporate political strategy to avoid and pre-empt public health regulations, (2) the interviews identified that reformulation has the support of a cross-sector coalition, and (3) the media analysis found that reformulation is a chameleonic idea with multiple frames and meanings. Specifically, the framing of reformulation shifted from 1980-2015 to encompass business, health and political frames, and to embody a range of underlying values and beliefs. Synthesising the media analysis with the consultation analysis and interviews showed that the political emphasis of reformulation became common in the early 2000s, when the food and beverage industry was responding to increasing pressure from governments and public health advocates as part of their political strategy. The interviews also found that non-industry stakeholders were fractured in their support for reformulation because they questioned the belief of ‘working with industry’ and whether nutrition policies should be formulated based on nutrients or foods. These fractions, and the lack of a unified counter policy agenda, also contributed to the industry’s ability to promote a voluntary reformulation approach. Conclusion: Voluntary reformulation initiatives form part of the food and beverage industry’s political strategy by building collaborative relationships and establishing a participative role in policymaking. This research therefore points to the need to study the dynamic interactions of stakeholders within the nutrition policy system, rather than conceptualizing industry involvement as an external influence.

At a Crossroads: Ada and Public Policy

COVID-19 Highlights Critical Need for Public Health Data Modernization to Remain a Priority.

Risk assessment of per- and polyfluoroalkyl substances (PFAS) in food: Symposium proceedings

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. 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. 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. 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.

Public-private partnerships (PPPs) in public health have gained great attention in the global health literature over the last two decades. Evidence suggests that PPPs could contribute to mitigating complex health problems. There is, however, limited knowledge about the process and specific conditions in which PPPs for healthy eating, in particular, can be developed successfully. To address this gap, this article first summarizes the literature, and second, using qualitative content analysis, identifies factors deemed to influence the process of building PPPs for healthy eating. The literature search was undertaken in two stages. The first stage focused on PPPs in public health to understand what constitutes a PPP, and the types and characteristics of PPPs. The second stage sought empirical examples and conceptual papers related to PPPs for healthy eating to identify critical elements that could facilitate or hinder partnerships between the government and the food industry. The search yielded 38 articles on PPPs in public health and 20 on PPPs for healthy eating. The analysis generated 23 individual elements that have the potential to influence a successful process of building PPPs for healthy eating (eg, endorsement from an individual champion, equal representation from partner organizations on board committees). The analysis also yielded five factors that appeared to well-represent the 23 individual elements of PPP formation: motivation, enablers, governance, benefits, and barriers. These results constitute an important step to understand critical factors involved in the formation of PPPs in public health and should inform additional empirical research to validate them.

To explore the economic costs and sources of financing for different public-private partnership (PPP) arrangements to tuberculosis (TB) provision involving both workplace and non-profit private providers in South Africa. The financing required for the different models from the perspective of the provincial TB programme, provider, and the patient are considered. Two models of TB provider partnerships were evaluated, relative to sole public provision: public-private workplace (PWP) and public-private non-government (PNP). The cost analysis was undertaken from a societal perspective. Costs were collected retrospectively to consider both the financial and economic costs. Patient costs were estimated using a retrospective structured patient interview. Expansion of PPPs could potentially lead to reduced government sector financing requirements for new patients: government financing would require $609-690 per new patient treated in the purely public model, in contrast to PNP sites which would only need to $130-139 per patient and $36-46 with the PWP model. Moreover, there are no patient costs associated with the treatment in the employer-based facilities and the cost to the patient supervised in the community is, on average, three times lower than in public sector facilities. The results suggest that there is a strong economic case for expanding PPP involvement in TB treatment in the process of scaling up. The cost to the government per new patient treated could be reduced by enhanced partnership between the private and public sectors.

The informal governance of public-private partnerships in UK obesity policy: Collaborating on calorie reduction or reducing effectiveness?

Chapter 1 - Nutrient Composition of Foods: The First Step in Precision Nutrition

Investigating the most Important Advantages, Disadvantages and Obstacles of Public-Private Sector Partnership in Providing Primary Health Care Services from the Viewpoint of Health Managers

Agriculture and food systems are important determinants of nutrition and consequent public health. However, an understanding of the links among agriculture, food systems, nutrition, public health and the associated policy levers, is relatively under-developed. A framework conceptualizing these key relationships, relevant to a range of country contexts, would help inform policymakers as to how agriculture and food policy could improve nutrition and public health, particularly in low- and middle-income countries (LMIC). The objectives of this paper are: to present a conceptual framework, relevant to a range of country contexts and focused on the policymaker as the user, which depicts the key relationships among agriculture, the food system, nutrition and public health; and to describe how the framework can be used for understanding the impacts of agriculture and food system policies on nutrition outcomes. Existing conceptual frameworks, highlighting the relationships among agriculture, the food system, nutrition and public health (n = 37) were identified, reviewed and categorized, based on the key themes they address. Building on this analysis and synthesis a conceptual framework was developed that assists in identifying associated policy levers and their effects on elements of the framework. The end product is a conceptual framework that presents key domains linking agriculture and food systems to nutritional outcomes and public health. The framework is relevant to a range of contexts, for example low-, middle- and high-income settings; and to policymakers wishing to examine the potential direct and indirect impacts of agriculture and food system policies.

Economic, political, and social changes prompted the evolution of our current food system. Studying the historical context of these changes helps us to better understand and devise nutrition policy and programs today. This chapter begins with the roots of the modern U.S. food system at the dawn of the 20th century, isolating four key aspects that have shaped nutrition and public health: food production, processing, and consumption, along with state nutritional policy. To begin, government subsidies, in tandem with shifts in farming demographics and business models, have significantly determined what food is available to consumers at what prices. Next, an examination of food processing complicates this story, exploring the growing number of intermediaries between farmers and consumers over the 20th century. In addition, federal dietary advice and resources have sought to guide what and how people eat. At the same time, the consumer culture has influenced eaters through cookbooks, home economics, advertising, and a host of food media, from magazines and radio to blogs and social media. The Example in Practice addresses the history of the National School Lunch Program, combining the themes of production, processing, consumption, and policy in a single case study. This chapter provides readers with key landmarks and a basic historical context to understand the origins of and potential futures for today’s food, nutrition, and public health policy problems.

Partnership and fragmentation in international health: threat or opportunity?

Introduction: Public-private partnerships (PPPs) have become a preferred global policy in healthcare. In India, PPPs have gained momentum over the past two decades but remain contentious. Most Indian research focuses on PPPs in primary rural healthcare. This study examines clinical and diagnostic PPPs in secondary and tertiary public hospitals in urban Maharashtra, analysing public-private relationships, decision-making processes, functionality, challenges, and their impact on health service delivery. Methods: An exploratory, qualitative multiple-case study approach was employed. Forty hospital-based PPP projects active between 2017 and 2023 were mapped, and six diverse projects were selected for detailed case studies. Data collection included 25 qualitative interviews with stakeholders, review of technical documents, and a comparison of rates for 20 health services between PPPs and public hospitals. The study applied principal-agent theory to analyse public-private relationships and assessed PPP performance using the publicness criteria developed by David MacDonald and Greg Ruiters. Results: The study revealed significant challenges in PPPs, including politicisation, lack of transparency, and governance inefficiencies. Local political influence often prioritised commercial interests over public health goals, with bureaucratic support addressing issues like doctor shortages and budget constraint. Decision-making for public hospitals was confined to municipal levels, with no involvement from the state health department. Of the 40 PPPs, 24 involved for-profit agencies and contracts lasting 10 to 30 years. Monitoring mechanisms were inadequate, leading to issues like non-compliance with contracts, underqualified staff, and inconsistent service delivery. Despite adequate resources, many projects had low utilisation rates. While some projects improved access, their services remained unaffordable for marginalised populations, with prices 3 to 15 times higher than those in public hospitals. Conclusion: Addressing a critical knowledge gap, this study offers empirical insights into hospital-based clinical and diagnostic PPPs in municipal settings in India. Theoretically, PPPs can improve healthcare access by leveraging the private sector, however, structural reforms, robust governance frameworks, effective monitoring, and stricter regulation are critical to improving PPP performance in public interest. The study emphasizes the importance of strengthening the public health system to ensure comprehensive and equitable healthcare, raising concerns about the long-term viability of PPPs in addressing the complex challenges of urban healthcare.

In the face of mounting healthcare challenges, developing countries grapple with resource constraints, underfunded health systems, and a growing burden of infectious and non-communicable diseases. The question is no longer whether healthcare systems can sustain themselves under these pressures—the evidence says they cannot—but how they can adapt and evolve to meet these needs. One promising approach lies in establishing and strengthening public-private partnerships (PPPs) [1]. PPPs are collaborations in which governments and private entities collaborate to achieve common health goals, leveraging the strengths of both sectors. The public sector offers reach, regulatory frameworks, and an understanding of population health needs, while the private sector contributes innovation, efficiency, and financial resources. Together, they can address healthcare access, quality, and affordability gaps [1]. In many developing countries, healthcare access remains unequal. Rural and underserved populations often lack essential services, while urban areas face overcrowded and overburdened public hospitals. By pooling resources and expertise, PPPs can deliver sustainable solutions, such as building health facilities in remote areas, funding community health programs, or providing cutting-edge technology and training to public hospitals. Initiatives like the African Access Initiative have brought affordable medicines and diagnostic tools to low-income countries by fostering collaborations between governments and pharmaceutical companies. These partnerships ensure the availability of life-saving medications for conditions like cancer and diabetes [2]. In countries like India, PPPs have been instrumental in building state-of-the-art hospitals in rural areas, combining public funding with private expertise. For example, the Karnataka state government’s partnership with private hospitals expanded tertiary healthcare access to previously underserved populations [3]. Partnerships with multinational corporations and NGOs have facilitated training for healthcare professionals, enabling them to provide higher-quality care. In Kenya, PPPs have focused on improving maternal and child health outcomes through community-based education programs [4], in 2010, the Kurdistan Regional Government (KRI) asked for assistance from the RAND Corporation, a U.S.-based nonprofit policy think tank specializing in research and development across various fields, to support the reform of the healthcare system in the Kurdistan Region of Iraq. The primary goal of the reform was to establish a health system that could efficiently provide high-quality services to all individuals, with the support of Public-Private Partnerships (PPPs) [5]. Despite their promise, PPPs are not without challenges. Critics argue that these arrangements can lead to the privatization of public health assets or create inequities in service delivery. For instance, poorly regulated PPPs may prioritize profitability over the needs of vulnerable populations, leaving rural or low-income communities underserved. Transparency, accountability, and robust legal frameworks are essential to mitigate these risks. Governments must ensure that PPP agreements prioritize public health outcomes with clear success metrics and oversight mechanisms. As the global health landscape evolves, developing countries have an opportunity to harness PPPs as a tool for resilience and equity. By fostering inclusive partnerships that align public and private incentives, countries can mobilize resources, improve service delivery, and ensure sustainable healthcare financing. The need for innovation and collaboration in healthcare has never been more urgent. Governments, private entities, and civil society must work together to create partnerships that prioritize the well-being of all citizens, particularly the most vulnerable. With the right frameworks, public-private partnerships can move beyond being a stopgap solution and become a cornerstone of sustainable health systems. Let us embrace the potential of PPPs and work toward a future where healthcare is a right, not a privilege, for everyone, everywhere.