Correspondence
Open letter to WHO DG
candidates: keep policy
and priority setting free
of commercial influence
In May, 2017, WHO Member States
will meet in Geneva for the 70th
World Health Assembly (WHA) and a
new WHO Director-General (DG) will
be elected. As public-interest non-
government organisations (NGOs)
involved in global health governance
and the prevention and treatment
of chronic diseases, we believe that
a fundamental consideration for
Member States when electing the DG
will be how the new leadership will
ensure appropriate interactions with
alcohol, food, pharmaceutical, and
medical technology industries. We
invite the three candidates to describe
what steps they commit to take to
ensure greater transparency, rigor, and
public scrutiny of WHO’s policy and
regulatory and norm-setting activities
so that they are adequately protected
from undue commercial interests.
In May, 2016, WHA adopted the
Framework of Engagement with
Non-State Actors (FENSA), a policy
due to be fully operational by May,
2018. While FENSA envisages that
WHO will “exercise particular caution…
when engaging with private sector
entities…whose policies or activities
are negatively affecting human
health.. ”,1 the rhetoric and direction
of WHO’s reform process as well as
WHO’s chronic funding challenges
have left us deeply concerned rather
than reassured. We fear that instead
of protecting WHO’s mandate, FENSA
risks relegating WHO to a limited role,
unable to stand up for human rights
and democratic decision making.
We draw attention to the conflict of
interest statement signed by more than
175 NGOs and networks representing
more than 2000 groups and first
launched at the UN High-Level Meeting
on Non-communicable Diseases
in 2011: “The policy development
stage should be free from industry
www.thelancet.com Vol 389 May 13, 2017
involvement to ensure a ‘health in
all policies’ approach, which is not
compromised by the obvious conflicts
of interests associated with food,
alcohol, beverage and other industries,
that are primarily answerable to
shareholders.”2
Alcohol, food, pharmaceutical, and
medical technology industries should
comply with policies developed by WHO
and its Member States. Their role is not
in public health policy formulation,
risk assessments, risk management,
or priority setting, nor in determining
normative quality standards and legally
binding regulations to protect and
promote public health. These processes
must be undertaken in an environment
free of commercial influence.
We believe that only a WHO that
protects its independence and integrity
of decision making will have the ability
to fulfil its constitutional mandate, and
look forward to your response to our
request.
PR holds shares in Nestlé SA, for the purpose of
attending the Annual General Meeting. All other
authors declare no competing interests.
*Katherine Brown, Patti Rundall,
Tim Lobstein, Modi Mwatsana,
Bill Jeffery, on behalf of 61 signatories;
a full list of signatories is available in
the appendix
kbrown@ias.org.uk
Institute of Alcohol Studies, London, SW1H 0QS, UK
(KB); International Baby Food Action Network,
Cambridge, UK (PR); World Obesity Federation,
London, UK (TL); UK Health Forum, London, UK
(MM); and Centre for Health Science and Law,
Ottawa, ON, Canada (BJ)
1 Sixty-ninth World Health Assembly.
Framework of engagement with non-state
actors. Agenda item 11.3. May 28, 2016.
http://apps.who.int/gb/ebwha/pdf_files/
WHA69/A69_R10-en.pdf?ua=1 (accessed
April 21, 2017).
2 Conflict of Interest Coalition. Statement of
concern. 2011. http://info.babymilkaction.org/
sites/info.babymilkaction.org/files/
COIC150_0.pdf (accessed April 21, 2017).
Health economics
Joseph L Dieleman and colleagues
(June 18, p 2521)1 should be con­
gratulated for their study on health
spending prediction. However, this is
a multifactorial and complex prob­
lem. The ongoing global financial
crisis, rapid development of novel
technologies that can increase or
reduce total health expenditures,
the emergence of often unexpected
diseases such as the Zika virus, chang­
ing population genetics and epi­ gen­
etics, and environmental changes
and disasters are key parameters that
impede the accuracy of spending
prediction models. Policy-makers and
global leaders need to work together
iStock
in order to achieve a balanced health
spending among countries. Ever- Published Online
increasing and accelerating global­ April 27, 2017
http://dx.doi.org/10.1016/
isation and materialism, along with a S0140-6736(17)31146-7
decline in medical humanities train­
ing, contributed to the loss of empathy
among medical students and resi­
dents.2 On our way to evolution of
humankind beyond current biological
limitations through the use of science
and technology, new philosophical
movements have emerged, such as
transhumanism and posthumanism,
with strong moral, conceptual, and
religious dimensions.3,4 Such move­
ments and their effect on political
parties5 might decisively modulate
future health policies.
We declare no competing interests.
See Online for appendix
*Theodore G Papaioannou,
Marianna Karamanou,
Manolis Vavuranakis,
Dimitrios Tousoulis
thepap@med.uoa.gr
Biomedical Engineering Unit, First Department of
Cardiology, Hippokration Hospital, Medical School,
National and Kapodistrian University of Athens,
Athens 11527, Greece (TGP, MV, DT); and Institute
of History of Medicine and Public Health, CHUV,
University of Lausanne, Lausanne, Switzerland (MK)
1 Dieleman JL, Templin T, Sadat N, et al. National
spending on health by source for 184 countries
between 2013 and 2040. Lancet 2016;
387: 2521–35.
2 Jones DS. A complete medical education
includes the arts and humanities. Virtual Mentor
2014; 16: 636–41.
3 Koch T. Enhancing who? Enhancing what?
Ethics, bioethics, and transhumanism.
J Med Philos 2010; 35: 685–99.
4 Tomkins J. Developing theological tools for a Submissions should be
strategic engagement with Human made via our electronic
Enhancement. New Bioethics 2014; 20: 141–52. submission system at
5 Transhumanist Party. http://www.transhuman­ http://ees.elsevier.com/
istparty.org (accessed June 27, 2016). thelancet/
1879