Evidence and Program Guidance Unit, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
Elaborating and implementing health policies involves complex processes because of the different actors that are influencing the regulatory frameworks. To date, the impact on health determinants, status and outcomes is influenced by governments, international organizations and Non-State actors (NSAs). The latter are defined as ”entities that are not part of any State or public institution such as nongovernmental organizations, private sector entities, philanthropic foundations and academic institutions”(1). Engagement by the World Health Organization (WHO) with NSAs has been identified as essential for global health policies implementation for enhancing nutrition and tackling undernutrition, obesity and other diet-related health conditions. However, this interaction can also present challenges in terms of safeguarding global food and nutrition policy development against conflicts of interests(1). Development: Considering the call for action of the global nutrition targets and recognizing that the existing regulations and forms of governance must evolve to adapt to the global challenges, greater interest has been raised to enable participation of different actors in the inclusion of health matters leading to a plurality of opinions in policy discussions. (2) There are different levels of the policy making process where NSAs may interfere into the decision making process in global nutrition: agenda setting, policy formulation, policy implementation, and monitoring and compliance. NSAs are mainly involved into the agenda setting, information through expertise (e.g. highlighting health issues) and implementation (e.g. mobilization) However, they can also interfere directly or indirectly in the decision-making process through lobbying, advocacy, monitoring, protest or participation (3). While acknowledging the necessity of multisectoral approach to conduct nutritional programmes with strategic collaborations, there is a need to protect at all levels the public health policies from undue influence by any form of real, perceived or potential conflict of interest that. This is particularly the case when associated with power differentials between actors and intellectual biases can compromise public health advice, research and policy-making(1). In order to tackle this issue, ongoing global initiatives on conflict of interest safeguards such as the WHO Framework of engagement with Non-State actors (FENSA) or the establishment of the commission on Ending Childhood Obesity (ECHO) and the Scaling Up Nutrition (SUN) provide guidance for conflict of interest management by focusing on multilateral institutions and national governments. Despite these challenges, the current double burden of malnutrition needs to be managed with a broadened approach and joint collaboration with all stakeholders, including NSAs. Indeed, the role of the different NSAs into the global health political arena provides a variety of resources such as finance, knowledge, technologies, mobilization and support to help inform and implement the various nutrition policies (3). In this light, WHO has been engaging extensively with the NSAs in major, from longerterm collaborations to smaller, briefer interactions in order to ensure protection and promotion of public health. One example is the Second International Conference of Nutrition (ICN2)-, a high level ministerial conference that proposed policy frameworks and identified priorities to address today’s nutritional global challenges, organized jointly by WHO and the Food and Agriculture Organization of the United Nations (FAO) who developed a road map for NSAs to contribute to the process. The outcome of this meeting was an invitation to strengthen and facilitate contributions and actions by all stakeholders to improve nutrition and health and to promote collaboration within and across countries around the world. (4) Moreover, the WHO Comprehensive Implementation Plan on maternal, Infant and Young Child Nutrition endorsed in the 2012 by World Health Assembly (WHA) promotes the need to create and strengthen partnerships between states and NSAs for a financial commitment and to support implementation of nutrition-sensitive and nutrition-specific actions in order to achieve the global nutrition targets to address the double burden of malnutrition. (5) Essentially, WHO engages with NSAs, to improve their positive contribution and also to limit negative effect that private interest may have on public health. In line with this, the organization’s engagement with NSAs is guided by the following principles: to demonstrate benefit to public health, to respect the environmental nature of the organizations, to support evidence-based approach, to protect WHO’s process, to promote transparency, to manage conflict of interest, and to protect WHO’s integrity(1). Conclusions: A global health policy will only be successful if it encourages the committed participation of the different players in the international arena. However, the role of each player in the policy making process should be carefully defined. With regards to WHO, the role of NSAs is to promote global health and to support implementation of the WHO’s policies and recommendations agreed by the governing bodies in a transparent manner in order to safeguard nutrition governance (1). References: 1. WHO. Advance draft .Framework of engagement with non-State actors. Draft resolution submitted by Argentina as Chair of the Open-Ended Intergovernmental Meeting and the informal consultations on the draft Framework of engagement with non-State actors. Agenda item 11.2 Sixty-Eighth World Health Assembly A68/A/Conf./X 2015. 2. FAO, WHO. Concept Note on Non-State-Actors participation in the ICN2. Second International Conference on Nutrition 19 -21 November 2014. Rome:Food and Agriculture Organization of the United Nations2014. Available from: (http://www.fao.org/3/a-i3994e.pdf, accessed 18 June 2015). 3. Dodgson R, Lee K, Drager N. Global Health Governance. A conceptual review.Discussion paper 1. London: London School of Hygiene and Tropical Medicine: 2015. 4. FAO, WHO. Second International Conference on Nutrition. Rome, 19-21 November 2014. Conference Outcome Document: Rome Declaration on Nutrition Rome: Food and Agriculture Organization of the United Nations 2014. Available from: (http://www.fao.org/3/a-ml542e.pdf, accessed 18 June 2015). 5. WHO. WHA Global Nutrition Targets 2025: Policy Brief Series Geneva: World Health Organization 2014. Available from: (http://www.who.int/nutrition/topics/globaltargets_overview.pdf, accessed 18 June 2014).