I recently attended the conference convened by the Centre on Global Health Security at Chatham House on “The Role of the Private Sector in Global Health Security”1. The event gathered industry leaders to foster dialogue about responsibilities and partnerships for health. The need for this dialogue exists due to health emergencies such as the Ebola outbreak in West Africa, but also the more recent series of storms that hit the Unites States and the Caribbean. These events remind us how interconnected and interdependent the world is. No country or company, acting alone, can adequately protect and promote the health of its citizens or of its workforce. But what does global health mean for the private sector within the context of sustainability?
Health is both a pre-requisite and a result of sustainable development2. It goes beyond the mere absence of illness to include a “state of complete physical, mental and social wellbeing”3 and as such, an essential component of a productive and fulfilling life. Health is also determined by environmental, social, cultural, behavioural, and institutional factors which are outside the control of the health sector. Therefore, health is shaped by the conditions in which we work and live. These considerations are important when discussing the place of health within sustainability. Sustainable Development Goals (SDG)4 are the new global agenda that articulates the commitments of national governments as well as the private sector to make our world more prosperous, inclusive, sustainable and resilient.
The role of the private sector
Every industry is capable of creating both a positive and damaging effect on health. Companies might have programmes protecting the health and promoting the wellness of their employees but by engaging in partnerships, they can together contribute to reduce risks and health improvements. Simultaneously the products or services that companies produce have a direct or indirect health impact on local communities and society at large. A key message of the event was that collaboration for global health is not only desirable, it is necessary. There are however many issues that raise concerns among public health stakeholders about the role of the private sector in global health, starting with possible conflicts of interest and ending with governance structures and financing models that underpin collaborative efforts. These concerns are well founded and need to be tackled in order to progress collaborations.
The key messages I brought back home from the event are consistent with the questions I always pose to organisations when talking about their approach to sustainability and how important is health for them:
1. What do you do to protect and promote the wellbeing of your workers? 2. How many health related issues are on your risk register? 3. Do you assess the health impacts on society of your projects or company? 4. Are you involved in any public private partnerships for sustainable development?
Protecting and promoting wellbeing
The private sector has a vested interest in accessing a healthy and productive workforce. According to a joint study by the World Economic Forum and Harvard University5, Non Communicable Diseases (NCDs) will result in a cumulative lost output of $47 trillion USD over the next two decades, equivalent to 75% of the global GDP in 2010. For the private sector this means an increase in medical costs, insurance premiums, absenteeism, and loss of productivity. In response, many companies worldwide have developed wellness programmes for their workers. It is our experience that the most successful wellness programmes are those that create a structural change in the workplace and embrace local and community efforts rather than those that act as standalones.
To better understand how to maximise the value of workplace wellness to companies, the International SOS Foundation and Sancroft have developed a new practice guide. Click here to download a copy.
Both society and organisations come out better when they work together, share priorities and combine resources/budgets for activities. Healthy and safe workplaces are one of the most important determinants of wellbeing and it is a space where the private sector has a clear opportunity for direct cost-effective interventions.
Identifying health related issues
It became very evident that health related issues do not often make it on to company or project risk registers. Participants highlighted with several examples how we are not globally prepared for the next health threat. For example, when Zika first re-emerged in Brazil the world scrambled to respond. The International Health Regulations (IHR) is an international binding agreement articulating the capabilities needed at country level to address serious public health threats. Many State Parties are not compliant yet with the IHR; however most private companies operating globally do not know if the countries where they have operations are complaint with the IHR. One speaker highlighted how diseases are now spreading more quickly, making quarantine more challenging, but at the same time creating new opportunities for containment if we get the transport system involved in the process. The Infectious Disease Risk Assessment and Management (IDRAM) initiative6 managed by Chatham House is one of the initiatives bringing different stakeholders together to address these global health risks.
The recommendations for organisations were:
Assess the vulnerability of your operations and remember that these are country specific;
Consider the possible diseases and how health systems can deal with them;
Update your risk registers regularly and ensure a health expert has been consulted; and
Coordinate your emergency response plans with the competent authorities.
Assessing the health impacts on society
The UN estimates that by 2050 almost seven out of ten people will live in cities, the Asia-Pacific region will experience the fastest urbanization compared with other regions, and the majority of the infrastructure that this new population will need has yet to be built. It is therefore imperative that health is strategically addressed in the planning and construction phases. Prospective assessments, such as Environmental Impact Assessment (EIA) are carried out globally to identify and therefore manage the impacts on society of such projects. However, health is poorly considered in these assessments7. Unfortunately, the result is that 23% of deaths worldwide are attributable to living and working in unhealthy environments8. We need in-country coordination which ensures that projects and services delivered are designed and built in a way that maximise health gains. The main recommendation from the UN Global Compact regarding the role of private sector for the SDGs is, “act responsibly and identify opportunities”9. Companies need to map where they generate negative impact, how to combat these impacts and then identify areas where possible contributions can be generated.
Engaging in partnerships to achieve sustainability
Public Private Partnerships (PPPs) occur when a public and a private entity enter in an agreement for the construction of infrastructure or delivery of a service. This is just one type of partnership available and evidence about their effectiveness towards Universal Health Coverage (UHC) are still weak. We are often reminded that only public financing will achieve universal health coverage, therefore other forms of collaboration in global health are needed. There is still a tendency to perceive the private sector exclusively as a source for funding; although the private sector brings knowledge, strategy and management value as observed during the Ebola outbreak in West Africa10. Target 17.16 of the SDGs recognises multi-stakeholder partnerships as important vehicles for mobilizing and sharing knowledge, expertise, technology and financial resources. To achieve this we need to invest in structured partnerships with long term objectives, paying more attention to the local challenges.
It is recommended to:
Establish a steering committee of committed members
Develop clear and articulated plan of activities
Work in a complementary manner and avoid duplication
Select partners with strong political will and commitment
Allocate capable staff and enough resources to deliver measurable results
Leverage the existing international frameworks like SDGs
Considering the challenges ahead, innovation is not enough. We need disruption and to move away from short-termism. We need to learn from previous and present mistakes and successes in order to move ahead with building sustainably. We need to address political, economic, and structural drivers of insecurity and inequality at the international level. Global health is a collective responsibility and the private sector needs to be part of the solution. In order to do so, there is a need to understand health more broadly than the absence of disease and realise the importance of well-functioning health systems. Organisations need to better understand their business sustainability risks and opportunities in workplace wellbeing. Finally, measuring and reporting the societal impact of companies across the economic, social and environmental dimensions brings value at a strategic and operational level and will soon be considered best practice.
For further information, click here to download a copy of our practical guide entitled, ‘Maximising the value of Occupational Health & Safety and workplace wellness reporting for a global workforce: A practical guide for internationally operating employers’.
1https://www.chathamhouse.org/event/role-private-sector-global-health-security 2Resolution A/RES/66/288. “The future we want”. In: Sixty-sixth United Nations General Assembly, New York, 11 September 2012. Available from: http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/66/288&Lang=E 3WHO (1948) “Constitution of the World Health Organization” 4Resolution A/RES/70/1. “Transforming our world: the 2030 agenda for sustainable development”. In: Seventieth United Nations General Assembly, New York, 21 October 2015. Available from: http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E 5https://www.weforum.org/reports/global-economic-burden-non-communicable-diseases 6https://www.chathamhouse.org/about/structure/global-health-security/extraction-industry-infectious-disease-risk-assessment-and-management-idram-project 7P. Harris, F. Viliani and J. Spickett “Assessing Health Impacts within Environmental Impact Assessments: An Opportunity for Public Health Globally Which Must Not Remain Missed” Int. J. Environ. Res. Public Health 2015, 12, 1044-1049 8http://www.who.int/quantifying_ehimpacts/publications/PHE-prevention-diseases-infographic-EN.pdf?ua=1 9UN Global Compact. Available from: https://www.unglobalcompact.org/sdgs/about 10World Economic Forum (2015) “Managing the Risk and Impact of Future Epidemics: Options for Public-Private Cooperation”. Available from https://www.weforum.org/reports/managing-risk-and-impact-future-epidemics-options-public-private-cooperation
Francesca Viliani, Group Manager - Public Health Programs