Private Sector and Global Health: Bridging the Gap
By Maahir Shah
“When public and private sectors combine intellectual and other resources, more can be achieved”
- Gro Harlem Brundtland, Former Prime Minister of Norway
As I delved deeper into learning global health this semester, I was surprised to learn of the inequities that are prevalent in the field of global health, a field that promotes and focuses on equity as a key foundational pillar. One article that illustrates these inequities and their root causes is an article on soft drink consumption in a state in Mexico, published in Mexico Daily News.
The article outlines how residents of Chiapas, a state in Mexico, consume approximately 821.25 liters of Coca-Cola per person per year, even though clean drinking water is difficult to find. Because of this, diabetes has become a major health problem in the state. Reading this astonished me as it made me realize the impact that private corporations can have on our lives and our health. In Chiapas, while several interventions can be used to reduce Coca-Cola consumption, these will not be very effective if Coca-Cola continues incentivizing the community to purchase its products. We need to use a different approach.
Private organizations around the world can play a significant role in changing the landscape of prevalent health disparities, whether they work within the health sector or not. However, apart from organizations directly involved in healthcare, very few organizations participate in global health initiatives. In an opinion piece, Peter Sands, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, talks about the lack of private corporations’ involvement in global health. Martin Short, the CEO of The Power of Nutrition, also discusses why businesses need to join forces with the public sector in his article.
We need to first understand why private companies are not largely involved in global health. Some of the reasons include:
Businesses in other sectors often consider contributions towards public health as charity and generosity, not part of their core action plan.
Many of the efforts made today to improve health often realize benefits after several years – since these benefits are observed in the long term, companies are not incentivized to work towards them today.
Corporations that want to work in global health are often held back due to the stakeholders involved, who equate compassion with financial loss. Private companies are solely rewarded for their profits and financial gain. This discourages them from adapting their operations and reducing the negative health impacts of their actions. This is seen with private healthcare and pharmaceutical companies too, where the focus is on increasing profits, not health equity.
Global health advocates are hesitant to partner with private organizations due to the conflicts of interest that arise from such discussions. They believe that they have opposing interests and will not be able to reach common ground. But current approaches in global health, which include implementing community awareness programs and public policy changes, can only go so far in reducing health inequities. For example, public engagement for improving diet cannot be effective in a low-income community if food stores in the region supply low-nutrient processed goods that are cheaper than healthier alternatives. To tackle global health problems, one needs to address the underlying social determinants that cause them, and for this to happen effectively, the conversation needs to include private businesses.
So, how can private businesses and global health organizations work together?
Scaling Up Health Services
Global health organizations and the private healthcare industry can combine resources and expertise to scale-up health services in a region. Private organizations can help increase manufacturing capabilities, improve resource delivery, and provide funding to improve access to diagnoses and treatments. Global health organizations partnering with private organizations outside the health sector can also be very beneficial. They can provide new technologies, innovations, and financing to improve the efficiency of health interventions implemented at local, national, and global levels. One example is the Global Fund’s partnership with Google Cloud, which aims to use artificial intelligence and data analytics to detect previously unidentified regions in India with a high burden of Tuberculosis.
Advocacy and Communicating with the Public
Private companies and global health advocates can work in unison to advance advocacy campaigns and increase public awareness of diseases. Through their marketing capabilities, the private sector can reach large segments of the population that public organizations cannot. These advocacy efforts could vary in content - be it communicating health information to the public or encouraging customers to get treated for diseases. Several examples of this were seen during the Covid-19 pandemic. Unilever’s handwashing campaign with the UK government used various media channels to promote regular handwashing with soap across countries in Africa and Asia, thus promoting effective hygiene practices. Such collaborations help increase public awareness of health issues while also improving public perception and awareness of the companies, thus benefitting both parties.
Improving Access to Better Health
Private healthcare companies can reduce health inequities in LMICs by improving access to diagnostics, medications, and treatments. Currently, by providing costly medications and treatments to individuals in LMICs, these companies largely cater to the higher income market segments. This is because they believe that the lower-income market is not profitable. However, this is not the case. The book ‘The Fortune at the Bottom of the Pyramid’, by C.K. Prahalad, contests this belief and provides business models that companies can adopt to help lower-income communities while remaining profitable. It focuses on using a ‘high-volume, low-margin’ strategy, where profits are driven by volume rather than margins. Global health advocates should work with businesses to implement this approach in LMICs, to help improve access to health services, while maintaining the profits of companies.
Adapting Corporate Strategy
The private sector plays a major role in determining the lifestyle and economic status of a community - they lay the foundation for the factors that cause health problems. In turn, these health problems negatively impact the economic output of the private sector. According to the World Economic Forum, Non-Communicable Diseases (NCDs) will produce a USD 47 trillion loss in global output between 2010 and 2030. Thus, companies can face significant losses if health burdens are not reduced. Therefore, rather than making charitable donations, businesses must acknowledge the health impacts of their operations and modify their business models to reduce them. All businesses must work towards improving the determinants (eg., nutrition, education, water, sanitation) that have a major impact on one’s health. Companies selling products that exacerbate health problems (e.g., cigarettes, fast food) should reinvent their product lines to introduce healthier and more sustainable alternatives. Companies in the health sector must work towards improving health equity by making health services and treatments more affordable and accessible. One such example is the partnership between Chemo Group (a pharmaceutical company), Mundo Sano (a non-profit drug development organization), and DNDi (Drugs for Neglected Diseases initiative, a non-profit R&D organization) to increase access to benznidazole, that can help treat Chagas disease. As part of their agreement, the medication will be sold at an affordable price to ensure equitable access to the drug. Global health organizations must work with corporations to facilitate such change and identify avenues to improve health outcomes while maintaining the companies’ ability to be profitable.
One major avenue where global health advocates can look to is climate action. Today, several companies have modified their operations to incorporate a climate action and sustainability plan, despite potential conflicts of interest. I strongly believe that, as with climate action, global health advocates must work with businesses to include a health equity action plan into their overall strategy. The potential impact and benefits of doing this are substantial but remain largely unexplored.
Bridging this gap may be a path that requires concerted effort but is crucial for global health equity to become a reality. We need to focus on building more avenues for collaboration to achieve global goals as listed under the Sustainable Development Goals (SDGs), such as Universal Health Coverage or Health for All. Without meaningful collaboration with the private sector, these goals will continue to remain out of reach, thus costing more lives and affecting the quality of life of more individuals, primarily in LMICs. Hence, let us approach effective collaborations with the private sector with a sense of urgency – as our goal of health for all depends on it.
Acknowledgement:
This article was inspired by the coursework of PPHS 511 (Fundamental of Global Health) at McGill University taught by Professor Madhukar Pai. I also want to thank Professor Pai for his guidance when drafting this article.
About the Author
Maahir Shah is a 4th-year undergraduate student at McGill University, pursuing an Honours in Biology and a Minor in Biotechnology. He is currently working with the McGill Center for the Convergence of Health and Economics. He is also a Global Health Scholar for 2021-2022 and a Design Editor for the McGill Global Health Journal. Maahir is interested in identifying novel approaches that can help tackle the challenges faced in global public health.