WHO forum 2005: Making partnerships work for health

The WHO Forum was a dynamic, interactive three-day discussion of how we can make partnerships work for health. During the Forum, representatives from WHO Member states, NGOs, foundations, academia, the private sector, UN agencies, and finance institutions explored questions that are key to the establishment and support of partnerships.

Partnerships are especially critical to the prevention of the chronic disease pandemic. As K. Srinath Reddy, MD, observed, "Chronic diseases involve multiple risk factors with multiple determinants-so multisectoral action is imperative. Partners can bring different but complementary strengths, unite diverse constituencies, increase pathways of action, and create a synergy of effect."

There are many kinds of partnerships, each with its unique set of benefits and challenges. One of the most necessary and complex partners with which we now must work is industry. Rather than combating industry, as was the case in tobacco control, chronic disease prevention requires engaging with industry in positive action. Representatives from industry attending the Forum affirmed their commitment to promoting health and noted that private sector partners want to be engaged at every stage, from defining the problem to identifying and implementing solutions, rather than being engaged in a piecemeal manner.

Questions posed at the Forum, which we can continue to discuss here, include: What works? How can we engage effectively with civil society, the private sector, UN agencies, WHO Member states, to make partnerships work? How can partnerships help move policy to practice? How can partnership help mobilize resources at country level?

The power and potential of networks Richard Horton, editor of the Lancet, challenged participants in WHO's Forum last week to "begin a global conversation on how we can deal with chronic disease. Why has it been so hard to act about the burden of chronic disease? How might we begin to mobilize our interests, engagement, and commitment to the goal of reducing chronic disease by 2% annually worldwide over the next 10 years?"

A participant from Cuba responded, "It's the partnerships among everybody, where everyone can make a contribution, that will encourage progress. We can use our experiences to achieve our aims."

Another participant noted, "There are 50 years of mistakes and successes that we all can learn from."

Together with Ruben Israel of Globalink, and K. Srinath Reddy of Initiative for Cardiovascular Health Research in Developing Countries (IC Health), I participated in a panel discussion on "Enhancing partnerships through better knowledge sharing" which was moderated by Gauden Galea, Regional Office for the Western Pacific, WHO. Many members of the ProCor network were present and it was gratifying to meet them and learn more about them.

Repeatedly in this session and throughout the three-day forum, participants voiced the need for best practices and data to guide policy decisions. It's urgent that knowledge be translated into action. Many of those contemplating action, however, lack the information they need in order to make decisions or elicit the necessary support.

Communication networks like ProCor, AMICOR, Globalink, and others, whether local, regional, national or global, provide quick, easy, informal ways of sharing information that "makes the case" for policy and promotes best practices that can inspire, empower, and provide templates for local adaptation and application. Networks provide the opportunity for a "global conversation."

"Networks must collaborate among themselves to create a cascading effect," Dr. Reddy urged. ProCor seeks to link strategically with other networks of all sizes. AMICOR Brazil, the product of Dr. Aloyzio Achutti, provides a model of an active, relevant regional network that circulates information from ProCor and other sources to local members, and simultaneously provides content from Brazil and Latin America that can spiral out into a global context. Similarly, Globalink and ProCor work together to share relevant information with each others' constituencies.

Collectively we have amassed much data and experience, but it is unavailable to those who seek it. People in a geographic region or specific area of expertise are often limited to communicating with others in the same sector or setting. Researchers are most apt to share their knowledge with other researchers, clinicians to converse with other clinicians, and policymakers to discuss issues with other policymakers. But communication among these groups is what's needed. Language and technology barriers must be overcome.

Networks work because they meet the specific informational needs of the network's members. And networks can easily connect with other networks, and information can be passed from sector to sector, language to language, country to country, and ultimately from person to person. If we do this, we can avoid repeating mistakes others have made, and build upon solid foundations that others have laid. In order to achieve an integrated and effective response to the chronic disease epidemic, we need to connect, share, support, and collaborate. Networks provide a low-cost, accessible, responsive way to connect with others for the knowledge sharing that is essential to global health.

As our Cuban colleague said, "We can use our experiences to achieve our aims." Dr. Achutti expressed the same goal last week: "If a small sample of people could exchange their opinions or impressions, we could build a real huge collective mind."

I suspect that part of the problem may be that we each need to convince ourselves that we have something to share, that our experiences are of value, our questions are not ours alone, and that we will not be judged or criticized. How can networks empower individuals to engage?

Examples of successful partnerships Here is a brief summary of some partnerships with industry that were discussed during the WHO Forum or that are highlighted in WHO's "Preventing Chronic Disease: A Vital Investment."

Partnership with the food industry to address childhood obesity: Dr. Jean-Michel Borys described France's EPODE (Ensemble, prévenons l'obésité des enfants/Together let's prevent childhood obesity), a public/private partnership of communities, the food industry, and insurance companies. The food and insurance companies contributed their expertise in consumer behavior and marketing, as well as funding support, to this partnership addressing childhood obesity. While industry partners benefited from the program's highly visible and positive public recognition, there was no product or brand promotion. (EPODE http://www.villesante.com/epode/).

This partnership also demonstrates that while strategies must be customized to a specific locale in order to be effective, they can often be adapted and adopted in greatly different settings. The EPODE strategy was subsequently adapted in Mexico to address childhood diabetes. The program that was developed and implemented in Mexico was very different from the French program, but EPODE provided a template for the process as well as valuable learnings.

--Partnership with the hospitality industry to address tobacco: Michael Boland, Chair of the Office of Tobacco Control in Ireland, discussed a partnership that included the hospitality industry, Ministry of Health, parliamentary committee, trade unions, health professionals, NGOS, and WHO. Workers in the hospitality industry are a high-risk group, and trade unions are committed to promoting worker health. (Office of Tobacco Control http://www.otc.ie/)

--Inter-country partnership to increase fruit and vegetable consumption: A partnership among eight Portuguese-speaking countries in Europe, Asia, Africa, and Latin America was presented by Jose Pereira Miguel, High Commissioner for Health for Portugal. The goal of the partnership was to develop and implement country-specific action plans to promote fruit and vegetable consumptions with each country. The countries' shared language allowed representatives to share experiences during a workshop in Lisbon. The partnership also is reaching out to industry-producers and distributors of fruits and vegetables-because populations can only increase consumptions when foods are available.

--Partnership with industry to reduce salt: WHO's Preventing Chronic Diseases: A Vital Investment, which was presented at the Forum, describes efforts to reduce salt intake in the UK and in China.

UK: After the government set a target of reducing salt consumption in the population, a "Salt Summit" was convened in November 2003 which included food retailers, producers, and caterers as well as departmental health ministries, the Food Standards Officer, and health and consumer groups. Discussion and meetings continued, and by February 2005, 65 key food industry organizations had met with government officials to discuss salt reduction plans, resulting in 52 commitments from across all sectors of the food agency. The next stage of the programme of work with industry includes establishing targets for specific categories of foods, obtaining further long-term plans, and working with the catering sector and public procurers of food to establish guidelines for salt reduction.

China: A community-based project in China's third largest city, Tianjin, was launched in 1984. Health workers were trained to increase their knowledge about the relationship between salt intake and blood pressure, and were taught how to counsel patients. Special measuring spoons for monitoring salt consumption were provided and low-sodium salt was introduced, with salt manufacturers and retail shops ensuring that the low-sodium alternative was available in the project area. Average salt intake was significantly decreased, especially among men, as was systolic blood pressure.

Date Posted: 30 October 2005