World Health Organization Tool Research Articles

PREVALENCE OF WORKPLACE PHYSICAL VIOLENCE AGAINST HEALTHCARE PROFESSIONALS IN HOSPITAL

Background: Workplace violence (WPV) is defined as ‘violent acts, including physical assaults and threats of assault, directed toward the persons on duty or at work’. Growing public-health concern among Healthcare Workers (HCW’s) is WPV. The purpose of this study was to estimate prevalence of healthcare-associated violence. Methods: This cross-sectional study was conducted at Nishtar Hospital, Multan from June to August 2020. World Health Organization tool was used to collect quantitative data on different aspects of workplace violence after taking informed consent from universally selected 164 healthcare professionals working in the Emergency Department. Results: Out of 164 healthcare workers, 97 were males while 67 were females. More than 70% (115) had 1–5 years experience and 41 (25%) had more than 5 years experience. Sixty percent of the participants reported any form of violence during their careers, 57 (34.75%) reported physical violence while 41 (25%) reported verbal abuse. When talking about frequency of physical violent events, 84.2% reported more than once a month. All participants who reported physical violence and verbal abuse responded that the place of the incident was inside in the hospital/facility and could have been prevented. Conclusion: Violence inside workplace is at a higher note and is preventable. Academic institutions should teach the necessary skills also for responding to acts of violence. Pak J Physiol 2024;20(3):81-3, DOI: https://doi.org/10.69656/pjp.v20i3.1738

Rethinking Health Systems Responsiveness in Low- and Middle-Income Countries: Validation Study.

Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries. We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L&MICs). This study is designed to (1) run the Delphi technique to validate the upgraded conceptual framework of HSR, (2) modify and upgrade the WHO measurement tool for assessing HSR in the context of L&MICs, and (3) determine the validity of the upgraded HSR measurement tool by pilot testing it in Pakistan. The Delphi technique will be run by inviting global public health experts to provide suggestions on the domains and subdomains of HSR specific to L&MICs. Cronbach ɑ will be calculated to determine internal consistency among the participants. The upgraded HSR conceptual framework will serve as a beacon to modify the measurement tool by the research team, which will be reviewed by subject experts for refinement. The modified tool will be pilot-tested by administering it to 1128 participants from primary, secondary, and tertiary care hospitals in Rawalpindi district, Pakistan. Additionally, an "observation checklist" of HSR domains and subdomains will be completed to objectively measure the state of HSR across health care facilities. HSR assessment will be further strengthened by incorporating the perspective of hospital managers, service providers, and policy makers (ie, the supply side) as well as community leaders and representatives (ie, the demand side) through qualitative interviews. The study was started in January 2024 and will continue until February 2025. A multidimensional approach will yield significant quantifiable information on HSR from the demand and supply sides of L&MICs. This study will provide a conceptual understanding of HSR and a corresponding measurement tool specific to L&MICs. It will contribute to global public health literature and provide a snapshot of HSR in Rawalpindi district, Pakistan, with concrete action points for policy makers. DERR1-10.2196/59836.

Results of a pilot project of microbial therapy management at the children’s hospital

Introduction. In multidisciplinary pediatric hospitals in Russia, the prerequisite for the formation of principles of antimicrobial therapy management as a medical technology, implemented with the participation of a clinical pharmacologist became possible on the basis of updated clinical and pharmacological tools proposed by the World Health Organization (WHO) in 2019. 
 Purpose. The project goal is to show the possibilities of control of antimicrobial therapy, as a medical technology in multidisciplinary children’s hospitals to improve adherence to domestic clinical recommendations in the actual clinical practice of implementing antibiotic therapy management programs in children on the profile of «Pediatrics». 
 Material and methods. The pilot scheme was implemented from 2019 to 2021 on the basis of the Morozov Children’s Clinical Hospital by methods of WHO AWaRe and points estimation of prevalence of antibiotic use according to WHO tool checklist in dynamics. Regulatory documents of medical organization (MO) were formed, which ensured transition from traditional to new approaches within 3 years from 2019 to 2021 to maintain clinical practice of antibiotic use based on clinical guidelines. 
 Results. A comparative study of clinical antibiotic use in children “before” the project in 2019 and “after” in 2021 showed a 2.7-fold decrease in antibiotic use by absolute DDDs from 65.99 in 2019 to 24.34 in 2021. DDDs per 100 p/d. By WHO AWaRe method for absolute values of antibiotics in the “Tolerance” category, a 2-fold decrease in consumption and a 5-fold decrease in consumption for absolute values of antibiotics in the “Control” category: in 2019. — 41.13% (abs. 27.55 PDT per 100 p/d) and in 2021. — 60.1% (abs. 4.64 PDT per 100 p/d). Consumption of “Reserve” category antibiotics by absolute values has not changed.
 Limitations. This publication describes one medical institution in which this project was implemented, which somewhat reduces the value of the results obtained.
 Conclusion. As a result of the implementation of the principles of managing antimicrobial therapy, this pilot project was able to reduce the irrational use of antibiotics in the pediatric hospital.

Obstructive Sleep Apnea and a Comprehensive Remotely Supervised Rehabilitation Program: Protocol for a Randomized Controlled Trial.

Obstructive sleep apnea (OSA) is characterized by recurrent, intermittent partial or complete obstruction of the upper respiratory tract during sleep, which negatively affects the patient's daily quality of life (QoL). Middle-aged and older men who smoke and have obesity are most at risk. Even though the use of continuous positive airway pressure (CPAP) during sleep remains the gold standard treatment, various rehabilitation methods, such as exercise, respiratory therapy, myofunctional therapy, and nutritional lifestyle interventions, also appear to be effective. Moreover, it is increasingly recommended to use alternative or additional therapy options in combination with CPAP therapy. This study aims to evaluate if a comprehensive home-based, remotely supervised rehabilitation program (tele-RHB), in combination with standard therapy, can improve OSA severity by decreasing the apnea-hypopnea index (AHI); improve objective parameters of polysomnographic, spirometric, anthropometric, and body composition examinations; improve lipid profile, maximal mouth pressure, and functional capacity tests; and enhance the subjective perception of QoL, as well as daytime sleepiness in male participants with moderate to severe OSA. Our hypothesis is that a combination of the tele-RHB program and CPAP therapy will be more effective by improving OSA severity and the abovementioned parameters. This randomized controlled trial aims to recruit 50 male participants between the ages of 30 and 60 years with newly diagnosed moderate to severe OSA. Participants will be randomized 1:1, either to a 12-week tele-RHB program along with CPAP therapy or to CPAP therapy alone. After the completion of the intervention, the participants will be invited to complete a 1-year follow-up. The primary outcomes will be the polysomnographic value of AHI, Epworth Sleepiness Scale score, 36-Item Short Form Health Survey (SF-36) score, percentage of body fat, 6-minute walk test distance covered, as well as maximal inspiratory and expiratory mouth pressure values. Secondary outcomes will include polysomnographic values of oxygen desaturation index, supine AHI, total sleep time, average heart rate, mean oxygen saturation, and the percentage of time with oxygen saturation below 90%; anthropometric measurements of neck, waist, and hip circumference; BMI values; forced vital capacity; forced expiratory volume in 1 second; World Health Organization's tool to measure QoL (WHOQOL-BREF) score; and lipid profile values. Study recruitment began on October 25, 2021, and the estimated study completion date is December 2024. Analyses will be performed to examine whether the combination of the tele-RHB program and CPAP therapy will be more effective in the reduction of OSA severity and improvement of QoL, body composition and circumferences, exercise tolerance, lipid profile, as well as respiratory muscle and lung function, compared to CPAP therapy alone. The study will evaluate the effect of a comprehensive tele-RHB program on selected parameters mentioned above in male participants. The results of this intervention could help the further development of novel additional therapeutic home-based options for OSA. ClinicalTrials.gov NCT04759456; https://clinicaltrials.gov/ct2/show/NCT04759456. DERR1-10.2196/47460.

The economic burden of RSV-associated illness in children aged < 5 years, South Africa 2011–2016

BackgroundData on the economic burden of RSV-associated illness will inform decisions on the programmatic implementation of maternal vaccines and monoclonal antibodies. We estimated the cost of RSV-associated illness in fine age bands to allow more accurate cost-effectiveness models to account for a limited duration of protection conferred by short- or long-acting interventions.MethodsWe conducted a costing study at sentinel sites across South Africa to estimate out-of-pocket and indirect costs for RSV-associated mild and severe illness. We collected facility-specific costs for staffing, equipment, services, diagnostic tests, and treatment. Using case-based data we calculated a patient day equivalent (PDE) for RSV-associated hospitalizations or clinic visits; the PDE was multiplied by the number of days of care to provide a case cost to the healthcare system. We estimated the costs in 3-month age intervals in children aged < 1 year and as a single group for children aged 1–4 years. We then applied our data to a modified version of the World Health Organization tool for estimating the mean annual national cost burden, including medically and non-medically attended RSV-associated illness.ResultsThe estimated mean annual cost of RSV-associated illness in children aged < 5 years was US dollars ($)137,204,393, of which 76% ($111,742,713) were healthcare system incurred, 6% ($8,881,612) were out-of-pocket expenses and 13% ($28,225,.801) were indirect costs. Thirty-three percent ($45,652,677/$137,204,393) of the total cost in children aged < 5 years was in the < 3-month age group, of which 52% ($71,654,002/$137,204,393) were healthcare system incurred. The costs of non-medically attended cases increased with age from $3,307,218 in the < 3-month age group to $8,603,377 in the 9–11-month age group.ConclusionsAmong children < 5 years of age with RSV in South Africa, the highest cost burden was in the youngest infants; therefore, interventions against RSV targeting this age group are important to reduce the health and cost burden of RSV-associated illness.

Determinants of Maternal Near Miss among Women in Northeast Iran: A Facility-Based Case-Control Study.

The investigation of Maternal Near-Miss (MNM) risk factors is important for the global reduction of maternal mortality. This study aimed to identify the determinants of MNM among pregnant women in northeastern Iran. A prospective case-control study was conducted on 250 women referred to the maternity ward of Nohom-e-Dey hospital in Torbat-e Heydarieh, Iran, from June 2018 to May 2020. Applying the criteria of the World Health Organization tool, near-miss mothers were taken as cases, and mothers with normal obstetric outcomes were selected as controls with convenience sampling. Logistic regression models using Stata version 14.0 and odds ratios (95% confidence intervals) were reported. A total of 123 MNM cases and 127 controls were included in the study. The multiple logistic regression represented that having had previous abortion, living in rural or urban areas, whether the mother went through C/S or vaginal delivery and level of prenatal education were associated with MNM. Besides, having experienced chronic medical diseases during pregnancy had the strongest association with MNM, and next were complications during childbirth and neonatal outcomes which were associated with MNM, although in terms of statistical association, only the first two mentioned factors were statistically significant. Determinants of MNM could be experiencing chronic medical disorders during maternal complications. Health providers need to carefully manage past medical history and adverse perinatal outcomes, especially in pregnant women who live in rural areas. Encouraging mothers to attend pregnancy training classes is effective in reducing MNM.

Eye health for all in Aotearoa New Zealand: summarising our situation using a WHO tool

On 27 July 2022, Aotearoa New Zealand became the first high-income country to launch a report of its eyecare situation using the Eye Care Situation Analysis Tool (ECSAT) recently revised by the World Health Organization (WHO).1 This launch sees Aotearoa join other countries from the Western Pacific region that have long been leaders in efforts to improve eye health nationally and globally. Examples include Australia, Singapore, Tonga and China that led or co-sponsored initiatives that saw resolutions on eye health adopted by the World Health Assembly (WHA73.4, 2020) and the United Nations Resolution on Vision (A/RES/75/310).

Evaluation of Essential and Emergency Surgery Provide in Primary Hospitals of Gedeo Zone and Sidama Region, South, Ethiopia, 2020.

BackgroundSurgical services at level referral hospitals were an essential part of overall health care. The surgical uhservice was approximated to account for 11% of the worldwide load of disease, with a large percentage of that burden being uncovered in resource-constraint settings. Even though the surgery service is significant and growing across all economic sectors, the majority of resource-limited countries have been unable to provide essential surgical services.ObjectiveTo investigate the capacity of essential and emergency surgical services in primary hospital facilities in the Gedeo zone and Sidama region.MethodologyIn the Gedeo zone and Sidama region, a cross-sectional study was undertaken in eight district hospitals. By looking at four areas of data: infrastructure, human resources, interventions available, and equipment, a World Health Organization tool for conditional analysis was used to assess a health set-up competence to perform essential surgical and anesthetic procedures. The tool looked for eight different categories of healthcare giving 35 surgical procedures, and 67 different pieces of instruments.ResultsThis research found that 48.57% of the 35 essential interventions counted in the test, including cesarean section, were available at all hospitals. Prior to admission, each hospital reported a total of 53 beds, with an average travel distance of 28 kilometers. There were 189 healthcare providers in the eight facilities. According to the research, basic instruments were not always present at all of the sites.ConclusionInfrastructure, health profession, service supply, and key instruments and supplies deficiencies reveal major inadequacies in hospitals’ capacity to perform EESC and efficiently treat the growing surgical load of disease and damage in primary care.

WHO method for estimating congenital syphilis to inform surveillance and service provision, Paraguay.

ProblemIn Paraguay, incomplete surveillance data resulted in the burden of congenital syphilis being underestimated, which, in turn, led to missed opportunities for infant diagnosis and treatment.ApproachThe prevalence of congenital syphilis, as defined by the World Health Organization (WHO), was estimated for Paraguay using the WHO congenital syphilis estimation tool. This tool was also used to monitor progress towards the elimination of mother-to-child transmission of syphilis.Local settingThe burden of syphilis in Paraguay has historically been high: its prevalence in pregnant women was estimated to be 3% in 2018.Relevant changesThe incidence rate of congenital syphilis estimated using the WHO tool was around nine times the reported prevalence. Subsequently, Paraguay: (i) provided training to improve diagnosis and case reporting; (ii) strengthened information systems for case monitoring and reporting; and (iii) procured additional rapid dual HIV–syphilis and rapid plasma reagin tests to increase syphilis testing capacity. In addition, the Ministry of Health prepared a new national plan for eliminating mother-to-child transmission of syphilis, with clear monitoring milestones.Lessons learntHealth-care providers’ reporting and surveillance procedures for congenital syphilis may not adequately reflect national and international case definitions. Use of the WHO congenital syphilis estimation tool in Paraguay drew attention to congenital syphilis as a national public health problem and highlighted the importance of comprehensive national surveillance systems and accurate data. Ongoing use of the WHO tool can track progress towards the elimination of mother-to-child transmission of syphilis by helping improve syphilis service coverage and national surveillance.

Transparency in public pharmaceutical sector: the key informants\u2019 perceptions from a developing country

BackgroundPolicymaking in the pharmaceutical sector plays a pivotal role in achieving the health systems’ goals. Transparency in the pharmaceutical policy could increase confidence in decision-making processes. This study aims to assess transparency in the public pharmaceutical sector of Iran.MethodsThis qualitative study with a content analysis approach was conducted in 2017 using the World Health Organization tool to explore pharmaceutical transparency. The perceptions of the various stakeholders of the health system through semi-structured interviews with a maximum variation of stakeholders were obtained in eight functions, including registration, licensing, inspection, promotion, clinical trials, selection, procurement, and distribution of medicines.ResultsThere are some problems in two main categories: (1) General problems, including lack of transparency, conflict of interest, centralization, and monopoly. (2) Ethical problems include illegal payments, gifts, bribes, conflicts of interest, hidden power, hoarding, relationship-oriented behavior, medicine trafficking, and counterfeit medicine. Suggested solutions include evidence-based decision-making, the use of transparent and accountable processes, standardization, needs assessment, declaring a conflict of interest, skilled human resources, and tracking prescription.ConclusionDespite the development of effective pharmaceutical policy in the health care system and government interventions for the control of the market, in some functions, reviewing the pharmaceutical policy is essential. Additionally, declaring a conflict of interest statement must be at the core of policy development to provide greater transparency.

Quality of maternal and newborn hospital care in Brazil: a quality improvement cycle using the WHO assessment and quality tool.

Increasing efforts toward quality improvement (QI) are necessary in low- and middle-income countries (LMICs) to reduce maternal and perinatal mortality and morbidity and to promote respectful care. In Brazil, perinatal health indicators are below targets in several states despite universal access to perinatal services and very high rates of institutional births, indicating poor quality of care (QoC) as a key issue to be addressed. However, research efforts to develop and test QoC improvement interventions are scarce. We assessed the effects of a 1-year comprehensive QI cycle using a World Health Organization (WHO) assessment and quality tool on maternal and newborn care at hospital level and documented QIs obtained after a 1-year comprehensive QI cycle. Uncontrolled, unblinded, pre-post study carried out in six maternity hospitals in Pernambuco, Brazil, accounting for 29 128 live births in 2014. A standards-based and participatory approach based on a WHO quality assessment and improvement tool for maternal and neonatal care at hospital level was used. A national team of assessors supervised by international experts carried out baseline and final assessments. An action plan was developed and implemented to address key quality gaps emerging from the baseline assessment and from two supportive supervision visits. At baseline, hospitals presented a variety of quality gaps, the majority common to all participating centers. Gaps in case management of normal and complicated deliveries and in respectful and holistic care were predominant, in both teaching/tertiary and secondary care hospitals. After one year, several improvements were observed, particularly in respectful care during labor and at delivery, in case management of normal labor and delivery and in neonatal care. A systematic participatory approach based on a WHO tool produced important QIs in a relatively short time and should be considered for use for large-scale QI programs in Brazil and other LMICs. Its comprehensive, peer-to-peer and action-oriented nature and its capability to document QI over time and to build a QI culture represent important comparative advantages over other QI interventions.

Conflict of Interest in Nutrition: Where's the Power? Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

Actual or perceived conflict of interests (COIs) among public and private actors in the field of nutrition must be managed. Ralston et al expose sharply contrasting views on the new World Health Organization (WHO) COI management tool, highlighting the contested nature of global debates. Both the WHO COI tool and the Ralston et al paper are largely quiet on aspects of power among different actors, however, which we argue is integral to these conflicts. We suggest that power needs to be acknowledged as a factor in COI; that it needs to be systematically assessed in COI tools using approaches we outline here; and that it needs to be explicitly addressed through COI mechanisms. We would recommend that all actors in the nutrition space (not only private companies) are held to the same COI standards, and we would welcome further studies such as Ralston et al to further build accountability.

WHO’s Attempt to Navigate Commercial Influence and Conflicts of Interest in Nutrition Programs While Engaging With Non-State Actors: Reflections on WHO Guidance for Nation States Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool"

This commentary situates the comments submitted in response to the World Health Organization (WHO) draft guidance on conflicts of interest in national nutrition programs in light of: (1) WHO policies to protect WHO integrity; (2) the Framework of Engagement with Non-State Actors (FENSA); (3) WHO’s attempt to seek funds due to cuts in member contributions; and (4) attempts—often by corporate entities—to redefine conflicts of interest to avoid oversight of conflicts of interest and increase corporate influence. The WHO guidance defines conflicts of interest in ways that deviate from standard legal usage which confuses its analysis and facilitates the creation of conflicted public-private partnerships. The guidance suggests that nations can allow engagement with non-state actors when the benefits are greater than risks without separate check due to conflicts of interest. Instead, the WHO should have recommended that nations seek alternative ways to achieve their goals when non-state actors have significant institutional conflicts of interest.

Should Public Health and Policy Communities Interact With the Food Industry? It Depends on Context Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

The issue of public health and policy communities engaging with food sector companies has long caused tension and debate. Ralston and colleagues’ article ‘Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool’ further examines this issue. They found widespread food industry opposition, not just to the details of the World Health Organization (WHO) tool, but to the very idea of it. In this commentary we reflect on this finding and the arguments for and against interacting with the food industry during different stages of the policy process. While involving the food industry in certain aspects of the policy process without favouring their business goals may seem like an intractable problem, we believe there are opportunities for progress that do not compromise our values as public health professionals. We suggest three key steps to making progress.

Purveyors of the Commercial Determinants of Health Have No Place at Any Policy Table Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

With public health attention on the commercial determinants of health showing little sign of abatement, how to manage conflicts of interest (COI) in regulatory policy discussions with corporate actors responsible for these determinants is gaining critical traction. The contribution by Ralston et al explores how COI management has itself become a terrain of contestation in their analysis of submissions on a draft World Health Organization (WHO) tool to manage COI conflicts in development of nutrition policy. The authors identify two camps in conflict with one another: a corporate side emphasizing their individual good intents and contributions, and an non-governmental organization (NGO) side maintaining inherent structural conflicts that require careful proscribing. The study concludes that the draft tool does a reasonable job in ensuring COI are avoided and policy development sheltered from corporate self-interests, introducing novel improvements in global governance for health. At the same time, the tool appears to adhere to a belief that private economic (corporate) and public good (citizen) conflicts can indeed be managed. I question this assumption and posit that public health needs to be much bolder in its critique of the nature of power, influence, and self-interests that pervade and risk dominating our stakeholder models of global governance.

Tackling NCDs: The Need to Address Alcohol Industry Interference and Policy Incoherence Across Sectors Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

Ralston et al highlight the ways that different actors in global nutrition governance conceptualise and frame the role of non-state actors in governance arrangements, including the potential for conflict of interest (COI) to undermine global health efforts. The authors argue that the World Health Organization (WHO) draft tool on managing COI in nutrition policy is an important innovation in global health, but that further research and refinement is needed for operationalising the management of COI with diverse actors in diverse contexts. In this commentary, reflecting on strategic framing and industry interference in policy-making, we argue for the urgent need for states and intergovernmental organisations to prevent alcohol industry interference in the development of national and global alcohol policy. We argue that policy incoherence remains a key barrier, where governments pursue health goals in the health sector while pursuing exports and market liberalisation of health harmful commodities in the trade sector.

Television marketing of food and beverage targeted to children, Italy

Abstract Aim According to the World Health Organization (WHO), 40 million children aged &amp;lt; 5 and 131 million of children aged 5-9 are overweight or obese. Growing evidence is focusing on the association between number of hours spent watching television (TV) and children's food behaviour. Our aim was to assess the amount of TV food marketing targeted to Italian children, and to qualitatively analyse the ads. Methods The 5 most viewed TV channels were selected and recorded for 20 days (non-consecutive, both week and week-end days) and analysed through the WHO's tool to asses food -beverage multimedia marketing targeted to children. The analysed exposure variables were: type of product, viewing time, channel's target and broadcasting company (for all types of ads), duration of each food ad, type of programme, and target of the advertised product (only for food and beverage). Power of persuasion variables were assessed only for food marketing. Lastly, for each food product showed, the food category and if it was a core vs non-core product was assessed. Differences between groups were assessed using the chi-square test and t-test. Results During 320 hours of broadcasting TV, a total of 9,069 ads were identified, (51.7 hours). Food products were the second most frequently advertised (19.4%). On average, 5.4 food ads were displayed during non-peak viewing time/hour (6 during peak). The time slot of 3 pm had the highest rate of food ads (23.8%). Channels targeted to the general public had a higher rate of food ads compared to channels targeted to children (p = 0.000). Private channels transmitted a higher number of food ads compared to public channels (p = 0.000). Humour was the most frequently persuasive technique used in food ads and in ads targeted to whole population (14.3%). Conclusions Children usually watch TV programs that have a high rate of food ads, mainly promoting unhealthy products with captivating techniques. Legislators should advocate for a healthier food marketing. Key messages Children are exposed to a high amount of TV food commercials daily. Food marketing should be strictly regulated in accordance with the WHO Nutrient Profile model.

"Conflicted" Conceptions of Conflict of Interest: How the Commercial Sector Responses to the WHO Tool on Conflict of Interest in Nutrition Policy Are Part of Their Standard Playbook to Undermine Public Health Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

Managing conflict of interest (CoI) among the interested stake-holders in nutrition policy is a vexed and controversial issue. This commentary builds on Ralston and colleagues’ highly informative analysis of the 44 submissions to the World Health Organization (WHO) draft tool on preventing and managing CoI in national nutrition programs. The commentary proposes that the commercial sector actors are, by definition, too conflicted to objectively respond to the draft tool. The responses of the commercial sectors are predictable, as they mimic their positions during the prior negotiation for the development of the Framework for Engagement of Non-State Actors (FENSA). Their overall approach, and specific responses, are typical of the now standard methods of the ultra-processed food and beverage industry’s ‘corporate playbook.’ In addition, Ralston et al’s analysis raises a number of other issues, such as: why these corporations are so keen to be included in the world of multi-stakeholder partnerships, why so few member states responded to the draft tool, and problems with the term ‘private sector.’ The commentary ends with a suggestion for WHO to seek broader involvement from the 160+ member states who have yet to participate in the consultations regarding the draft tool.

Preventing and Managing Conflict of Interest in Nutrition Policy: Lessons for Alcohol Control Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".

Ralston et al present an analysis of policy actor responses to a draft World Health Organization (WHO) tool to prevent and manage conflicts of interest (COI) in nutrition policy. While the Ralston et al study is focussed explicitly on food and nutrition, the issues and concepts addressed are relevant also to alcohol policy debates and present an important opportunity for shared learning across unhealthy commodity industries in order to protect and improve population health. This commentary addresses the importance of understanding how alcohol policy actors – especially decision-makers – perceive COI in relation to alcohol industry engagement in policy. A better understanding of such perceptions may help to inform the development of guidelines to identify, manage and protect against risks associated with COI in alcohol policy.

Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool.

Background: With multi-stakeholder approaches central to efforts to address global health challenges, debates around conflict of interest (COI) are increasingly prominent. The World Health Organization (WHO) recently developed a proposed tool to support member states in preventing and managing COI in nutrition policy. We analysed responses to an online consultation to explore how actors from across sectors understand COI and the ways in which they use this concept to frame the terms of commercial sector engagement in health governance. Methods: Submissions from 44 Member States, international organisations, non-governmental organizations (NGOs), academic institutions and commercial sector actors were coded using a thematic framework informed by framing theory. Respondents’ orientation to the tool aligned with two broad frames, ie, a ‘collaboration and partnership’ frame that endorsed multi-stakeholder approaches and a ‘restricted engagement’ frame that highlighted core tensions between public health and food industry actors. Results: Responses to the WHO tool reflected contrasting conceptualisations of COI and implications for health governance. While most Member States, NGOs, and academic institutions strongly supported the tool, commercial sector organisations depicted it as inappropriate, unworkable and incompatible with the Sustainable Development Goals (SGDs). Commercial sector respondents advanced a narrow, individual-level understanding of COI, seen as adequately addressed by existing mechanisms for disclosure, and viewed the WHO tool as unduly restricting scope for private sector engagement in nutrition policy. In contrast, health-focused NGOs and several Member States drew on a more expansive understanding of COI that recognised scope for wider tensions between public health goals and commercial interests and associated governance challenges. These submissions mostly welcomed the tool as an innovative approach to preventing and managing such conflicts, although some NGOs sought broader exclusion of corporate actors from policy engagement. Conclusion: Submissions on the WHO tool illustrate how contrasting positions on COI are central to understanding broader debates in nutrition policy and across global health governance. Effective health governance requires greater understanding of how COI can be conceptualised and managed amid high levels of contestation on policy engagement with commercial sector actors. This requires both ongoing innovation in governance tools and more extensive conceptual and empirical research.