Engaging with the Private Sector for Noncommunicable Disease Prevention and Control: Is it Possible to Create "Shared Value?"

Noncommunicable diseases (NCDs) are the leading cause of premature mortality worldwide. Corporate interests are sometimes well-aligned with public health, but profiteering from the consumption of products that are known to be the major contributors to the noncommunicable disease burden undermines public health. This paper describes the key industry actors shaping the NCD landscape; highlights the unhealthy commodities' impact on health and the growing burden of NCDs; and outlines challenges and opportunities to reduce exposure to those risk factors. Corporations deploy a wide array of strategies to maximize profits at the expense of health, including sophisticated marketing techniques, interference in the policy-making process, opposition and distortion of research and evidence, and whitewashing of health-harming activities through corporate social responsibility initiatives. There can be no shared value for industries that sell goods that harm health irrespective of consumption patterns (such as tobacco and likely alcohol), so government actions such as regulation and legislation are the only viable policy instruments. Where shared value is possible (for example, with the food industry), industry engagement can potentially realign corporate interests with the public health interest for mutual benefit. Deliberate, careful, and nuanced approaches to engagement are required.

Landscape Analysis of Nutrition-sensitive Agriculture Policy Development in Senegal.

BACKGROUND: Unlocking the agricultural potential of Africa offers a genuine opportunity to address malnutrition and drive development of the continent. OBJECTIVE: Using Senegal as a case study, to identify gaps and opportunities to strengthen agricultural policies with nutrition-sensitive approaches. METHODS: We carried out a systematic analysis of 13 policy documents that related to food production, agriculture, food security, or nutrition. Next, we collected data during a participatory analysis with 32 national stakeholders and in-depth interviews with 15 national experts of technical directorates of the different ministries that deal with agriculture and food production. RESULTS: The current agricultural context has various elements that are considered to enhance its nutrition sensitivity. On average, 8.3 of the 17 Food and Agriculture Organization guiding principles for agriculture programming for nutrition were included in the policies reviewed. Ensuring food security and increasing dietary diversity were considered to be the principal objectives of agricultural policies. Although there was considerable agreement that agriculture can contribute to nutrition, current agricultural programs generally do not target communities on the basis of their nutritional vulnerability. Agricultural programs were reported to have specific components to target female beneficiaries but were generally not used as delivery platforms for nutritional interventions. CONCLUSIONS: The findings of this study indicate the need for a coherent policy environment across the food system that aligns recommendations at the national level with local action on the ground. In addition, specific activities are needed to develop a shared understanding of nutrition and public health nutrition within the agricultural community in Senegal.

Determinants of high vitamin A supplementation coverage among pre-school children in Mali: the National Nutrition Weeks experience.

OBJECTIVES: To assess vitamin A supplementation (VAS) coverage of children aged 6-59 months and the factors that favour or limit this coverage during the National Nutrition Weeks in Mali. DESIGN: Cross-sectional study. Interviews about demographic factors and children's adherence to the vitamin A capsule distribution programme were conducted. Professionals' knowledge of vitamin A and various aspects related to the supplementation strategy were assessed. SETTING: Five regions out of the eight regions in the country, in addition to Bamako District. Three rural communes were selected in three regions to represent rural areas. SUBJECTS: Parents or caregivers of children under 5 years of age, health agents who participated in the weeks, and community and administrative leaders. RESULTS: At least 80% of the children received the supplement. More 'traditional' communication channels (town criers, friends and family members) appeared to be more effective in reaching the target groups than modern methods, i.e. radio and television. Mothers' possession of a radio (Pearson chi2 = 5.03; P = 0.025) and fathers' education (Pearson chi2 = 19.02; P < 0.001), possession of a radio (Pearson chi2 = 8.93; P = 0.003) and listening to it (Pearson chi2 = 7.62; P = 0.006) all appeared to be statistically and significantly associated with children's coverage. In multivariate logistic regression analysis, only the study site (urban/rural) (P = 0.004), 'traditional channels' (P = 0.02) and fathers' education (P = 0.04) were significantly associated with children's coverage. Knowledge about VAS was high among community and administrative leaders, and health professionals. The planning and implementation of activities at the district level were found to be good in general. CONCLUSION: National Nutrition Weeks provide a successful example of a periodic VAS strategy with high coverage among children aged 6-59 months in Mali. Campaigns aimed at informing and sensitising populations during the Nutrition Weeks should also target children's fathers.