Category: APHA IH Section

Overview of CAPE Conference – Conference Note 3 – Investing in Private Enterprises

Since the private sector has been highlighted as having a significant role to play in reaching the Sustainable Development Goals (SDGs), there have been growing efforts to integrate it into international development financing activities. In my last post, an overview of DE principles used to guide key players in official development assistance (ODA) was provided. This post will focus on development finance institutions (DFIs)  and similar entities that invest public funds into private enterprises.

Public international development agencies make up the majority of donors. Now that donors are able to contribute to DFIs through ODA routes, the claim can be made that DFIs should also be required to follow DE principles as they invest in private enterprises.  Although DFIs are able to operate similarly to ODA, the overall goals and methods of these streams of funding are not perfectly aligned. One reason for this is that DFIs are focused on creating jobs and receiving a return on investment, while ODA focuses on poverty-alleviation. Additionally, each DFI has individual operating guidelines and procedures. The chart below includes items that were discussed at the 2016 CAPE Conference as DE supporters considered whether DFIs should be required to adhere to DE principles:

As a result of this discussion, the recommendations below were compiled and will be presented at the Second High-level Meeting of the GPEDC on November 28th:

• DFIs and other donor-backed investment vehicles should commit to supporting national development strategies. The GPEDC should track whether donors incorporate country preferences into their investment strategies. Attempts to achieve wider ownership of investment decisions would be impractical.
• Countries and donors should commit to harmonising the relevant elements of country results frameworks with those used by DFIs and other donor-backed investment vehicles. No indicator is necessary.
• Donors should commit to putting in place rigorous procedures for identifying groups at risk, consulting affected communities and handling grievances. Monitoring could be based on an independent rating of these.
• Donors should commit to a process that will establish shared transparency requirements when investing public money in private enterprise (PPP). Indicators could include the percentage of PPPs that conform to Open Contracting Partnership data standards, and the percentage of investments where: full beneficial ownership information is available; the upfront investment case is public; some indication of the degree of concessionality is stated.
• Partnership and accountability should apply when formulating investment strategies and monitoring their execution, and in ensuring that those making day-to day investments take full account of the consequences of their decisions on local communities.

The results of the recent U.S. elections have thrown many Americans for a loop.  While we work to unpack a lot of feelings about a Trump presidency, I thought it might be better to talk about another result from last Tuesday.  Colorado became the sixth state to pass a bill that allows terminally ill patients to seek life-ending medication.  Supported by 65% of the constituency, the measure applies to individuals with 6 months to live or less who can self-administer the lethal dose.

The measure requires that people “make two oral requests, separated by at least fifteen days, and a valid written request to his or her attending physician.” It also requires that people be capable of taking the medication unassisted, and stipulates that patients can rescind a request for life-ending medication at any time during the process.

Oregon – along with Washington, Vermont, Montana, California, and most recently Colorado – has had an aid-in-dying measure since 1997.  Winner of a Grand Jury Prize at the 2011 Sundance Film Festival, How to Die in Oregon, an HBO documentary tells the stories of people impacted by this law.  To date, 1,327 prescriptions have been filled with 859 deaths.  The most commonly cited reasons for requesting the prescription include loss of autonomy, decreasing ability to participate in activities that made life enjoyable, and loss of dignity.

So-called aid-in-dying and Death with Dignity measures are highly controversial, perhaps due in part to Dr. Jack Kevorkian’s unabashed commitment to “physician-assisted suicide.”

Forms of assisted suicide are legal in the Netherlands, France, Germany, Switzerland, and Belgium.  While the laws in France, Germany, and Switzerland are more passive, the Netherlands and Belgium are anything but.  Passed in 2002, Belgium law allows doctors to prescribe life-ending drugs to individuals suffering “intractable and unbearable pain.”  This includes pain caused by mental illness.  The Economist produced a documentary about a 24-year-old Belgian woman on her journey to euthanasia due to severe and chronic depression.  In February 2014, Belgium became the first country to allow minors to request euthanasia with parental consent.  To qualify, children must give informed consent, be terminally ill, and beyond all hope of medical intervention.  The first case of physician-assisted suicide of a minor occurred earlier this year.

Of course, euthanasia is fraught with controversy.  The act alone conflicts with the ethical and professional codes of the medical profession:

A physician’s assistance in suicide can indeed be construed as helping the patient: helping in the sense of being an ally in the patient’s quest to fulfill personal goals, or helping by buttressing individual autonomy. However, there are also features of such action that can be qualified as harmful: harmful by sowing confusion in trainees about the conceptual core of traditional clinical methods, or harmful by eroding respect for absolute moral values such as “do not kill.”

Others argue that the Hippocratic Oath is irrelevant including its oft misquoted tenet: “First do no harm.”  In the case of physician-assisted suicide, isn’t harm avoided by allowing patients autonomy and freedom from painful, protracted deaths?  Patients with Amyotrophic lateral sclerosis (ALS), called Lou Gehrig’s disease, remain cognizant while the rest of their body shuts down.  Though progression differs from person-to-person, an individual with ALS can expect to lose mobility, use of hands and arms, the ability to chew and swallow, and finally the ability to breathe without assistance.

The vast majority of deaths in ALS are the result of respiratory failure, a process that progresses slowly over months. Medications can relieve discomfort, anxiety and fear caused by respiratory insufficiency.

Given this prognosis, it is plain to see why an increasing number of ALS patients in Oregon are seeking a death with dignity.  Do you think physician-assisted suicide has a place in public health discourse?

The American Beverage Association’s Let’s Clear It Up site is a one-stop shop for all your burning beverage, marketing, and health questions:

MYTH

High Fructose Corn Syrup (HFCS) causes obesity and diabetes.

FACT

Actually, the American Medical Association has concluded that HFCS, a common liquid sweetener made from corn, is not a unique contributor to either obesity or type 2 diabetes. In fact, HFCS is so similar to sucrose (table sugar) that your body can’t tell the difference between the two, and processes both in the same way.

Despite its name, HFCS it is not high in fructose and, just like sucrose, it is a combination of two simple sugars – glucose and fructose.

Source: American Medical Association

While the argument that Let’s Clear It Up makes is valid – HFCS is indeed not a unique contributor to either obesity or type 2 diabetes – over-consumption of HFCS and sugar does contribute to both.  The issue with the above “fact” is that it seeks to obfuscate the argument by citing the American Medical Association.

Dr. Sandra Fryhofer is the source in question.   Past Chair of the American Medical Associations Council on Science and Public Health, Fryhofer has also served as President of the American College of Physicians and as a committee member with the Centers for Disease Control and the Institute of Medicine.  She’s also a spokesperson for Coca-Cola.

MYTH: In the above video, Fryhofer claims that HFCS is simply half glucose – brain fuel – and half fructose – found in fruits, honey, and root vegetables.  Sometimes, she concedes there is a smidge more fructose in HFCS than in sugar, 55% vs. 50%, but hardly worth reporting.

FACT: A study published in Nutrition found that fructose in beverages sweetened with HFCS can reach 65% of total sugar with an average of 59%.  Per the third National Health and Examination Survey (NHANES) adults and children consume a lot of fructose.  Mean consumption of fructose stood at 54.7 g/day or 10.2% of total calories.  Adolescents consumed the most fructose at 12.1-15% of daily calories.  Sugar-sweetened beverages were the largest, single source (30%) of fructose in the diet.  Consuming a diet high in fructose can contribute to insulin resistance and obesity.

As reported by Dr. Yoni Freedhoff’s Weighty Matters blog, Dr. Fryhofer’s affiliation with Coca-Cola runs counter to the American Medical Association’s Conflict of Interest Policy:

To ensure that the Trustee or Member is not placed in the difficult position of serving organizations with conflicting overall goals and objectives, a Trustee or Member shall disclose his or her participation in other organizations. If the overall goals and objectives of the AMA and the other organization do not conflict, participation is permitted. If a conflict exists, the Trustee or Member shall choose between the conflicting organizations, and shall resign from one of the positions.

Rather than violate the policy, a recent study found that Fryhofer isn’t alone in her patent endorsement of the beverage industry within the ranks of public health.

The study, published by Boston University researchers, found that the American Beverage Association sponsored 96 public health organizations between 2011 and 2015.  Organizations that received funding from PepsiCo and Coca-Cola include the American Center Society, American Diabetes Association, Centers for Disease Control, and National Institutes of Health.  The Academy of Nutrition and Dietetics and the American Academy of Pediatrics did not renew contracts with the American Beverage Association after 2015.

Along with paying organizations that support public health initiatives, the American Beverage Association uses its vast monetary and political sway to trump public health bills, including those that propose restrictions on purchases made within the Supplemental Nutrition Assistance Program, voluntary guidelines for marketing to children, and soda taxes.  A Center for Science in the Public Interest analysis found that the American Beverage Association spent $106 million since 2009 in opposition of local, state, and federal public health initiatives.

When the city of Philadelphia proposed a soda tax in 2010, the American Beverage Association offered to donate $10 million to Pew Charitable Trusts on one condition: drop the proposal.  Philadelphia chose not to comply, the tax is in effect, and a lawsuit against the tax was filed by the American Beverage Association.

Tomorrow, 4 cities in California and Colorado will vote on measures to introduce 1 to 2 cent soda taxes.  Shy of 100,000, these voters are contending against a barrage of the American Beverage Association’s best offense.  In San Francisco alone, $9.5 million worth of air time has been dedicated to opposition of the tax.  In neighboring Oakland, California, those in favor of the tax have spent $23,000, around 3% of what the American Beverage Association has spent in the same community.

The American Beverage Association also hires dietitians to tweet false statistics and retweet articles in support of bans on soda tax.  Tweets include #partner, #advisor, and @cartchoice but do not specifically disclose the partnership.  @Cartchoice refers to the American Beverage Association’s blog Your Cart Your Choice where many tweeters are also contributors.  Ninjas for Health, “a network of innovators who have big ideas for keeping health out of the hospital,” maintain public lists of twitter accounts sponsored by Coca-Cola.  You can read them here, here, and here.

See anyone you know?