Table 2 Criteria, conditions and safeguards to govern commercial drivers of NCD risk: An agenda for the public health community

Self-regulation

Self-regulation will persist into the foreseeable future. With stronger consumer demand for healthier products, the tremendous leverage of industry could have a substantial impact on reducing population risk exposure. Private regulation can be anticipated particularly where states have weak oversight of transnational determinants of such risk. Nonetheless, as this paper has argued, the approach has proven to carry significant challenges to public health goals. Consequently, the public health community should advocate for, encourage and demand that such regulation exhibit the following four characteristics:

1) appropriate targets: ambitious targets/standards that are evidence-informed and rights-based, in the interest of public health, have been developed in a transparent manner (be they on product reformulation, promos, product placements, endorsements, marketing etc) and are SMART in nature (ie specific, measurable, attributable, realistic and time bound);

2) independent monitoring: review of compliance, progress and public health impact;

3) transparent reporting: with remedial action as necessary and an independent oversight body to ensure accountability;

4) sufficient scope for impact: include the leading corporate players and cover a significant proportion of the risk of exposure and the market—ideally applied globally to reduce cross border spillovers.

As such, self-regulatory regimes should have inputs from governments, scientists and civil society, particularly in target and standard-setting and ensuring accountability. Where these four conditions are not met, or where monitoring reveals low standards and lax enforcement, the public health community should seek to ensure that those risks are governed through hybrid or public regulation if at all possible.

Hybrid regulation

There is strong and widespread support for public-private partnership to address the overarching Agenda 2030 development framework and interest in leveraging such partnerships in health, including in the prevention of NCDs. We can only expect such cooperation to grow at country and global levels. But safeguards must be put in place to ensure public health concerns receive adequate attention. Consequently, the public health community should advocate for:

1) appropriate targets: ambitious targets/standard that are evidence-informed and rights-based, in the interest of public health and have been developed in a transparent manner (be they on product reformulation, promos, product placements, endorsements, marketing, etc) and are SMART in nature (ie specific, measurable, attributable, realistic and time bound);

2) independent monitoring: provide for an independent third party monitoring of compliance, progress and public health impact;

3) transparent reporting: with remedial action as necessary and an independent oversight body to ensure accountability;

4) sufficient scope for impact: include the leading corporate players (and should certainly not exclude firms were this to create an uneven and uncompetitive playing field) and cover a significant proportion of the risk of exposure and the market—ideally globally;

5) manage conflicts of interest: ensure that safeguards are in place to avoid potential or actual conflicts of interest or reputational threats to the public sector through partnership with firms or industries which do not conform to minimum acceptable standards (such as the principles set out by the United Nations Global Compact [113]); and

6) assess alternatives: ensure that the same objectives can’t be achieved more quickly and effectively through other means, and that the interests pursued by private partners would not threaten the longer-term public health objectives.

Public regulation

Public regulation is the favoured approach of many public health experts as they consider that experience with self- and hybrid-regulation has had insufficient public health impact on the prevention of NCDs. In the case of public regulation, the public health community should advocate for and advance the following conditions:

1) appropriate targets: ensure evidence-informed, rights-based targets for NCD risk mitigation that conform to international standards and laws, free of undue private sector influence—ones that stretch industry but are realistic and attainable and recognize that changes to industrial practices can take time;

2) inclusive target setting: ensure the mechanism to set and review targets and apportion roles and responsibilities including non-state actors and all relevant sectors of government so that regulation and action is focused on the fundamental drivers—it could be led by the Ministry of Health or through leadership in an overarching ministry such at the office of the Prime Minister, or the Ministry of Planning, etc.;

3) safeguards: ensure that measures and procedures are in place to manage apparent or real conflicts of interest and reputational risks and ensure a level playing field for non-state actors;

4) accountability: ensure independent monitoring, reporting and remedial action on progress as part of national efforts to report on implementation of Agenda 2030.