The Perils of Public-Private Partnerships

by Jonathan H. Marks

Imagine, for a moment, that you are a local public health official.  Budgets are tight.  Childhood obesity is on the rise.  And there is no playground in the heart of your city.  When a story appears in the local paper about the need for such a playground, a fast food company comes to the rescue.

Their vice-president for nutrition and public policy calls you, and offers to give you $100,000 for the construction of a playground.  The VP emphasizes that the money will not come directly from the company, but from a charitable foundation the company recently established.  There are only two conditions, the VP assures you, and neither is onerous.  There will be a bronze plaque at the gate to the playground saying that it has been constructed with a donation from the foundation and with the support of the company.  And you have to smile for a photograph with the VP while you each hold a corner of a large blown-up image of the donation check.

You are a thoughtful public health official.  You’ve read the literature on childhood obesity.  You know exercise is important and that a playground is likely to be beneficial for the city’s most vulnerable children.  But you also know that many public health experts believe that fast food is a major contributor to the rise in childhood obesity.  You feel uncomfortable about the proposed partnership, but you also find it hard to resist.


What do you do?

This is not just a hypothetical question—one that ethics professors like me pose to their students in order to promote class discussion.  (And, yes — it does prompt a great discussion!)  It is also the kind of question faced by many public officials — particularly at the local level, in city governments and public school systems.  When these officials look to leaders at the national level for guidance, they see that the partnership model has been embraced by the federal government.  Most notably, U.S. Secretary of Agriculture Tom Vilsack has said that “[b]y partnering with USDA, corporations win, USDA wins, and the American consumer wins. That's a win-win-win situation!”1

I believe that such a characterization downplays the significant ways in which the missions of potential public and private partners diverge.  These tensions create serious potential perils for the public partner, and they should not be glossed over or ignored.  

In my recent working paper for the Edmond J. Safra Center for Ethics at Harvard,2 I push back against the partnership as a default paradigm for interactions between government and industry, and offer some guidance to public health officials contemplating public-private partnerships related to food and health.  In the paper, I don’t provide a definitive answer to the kind of question posed above.  Rather, I offer some tools that might help public officials as they grapple with this challenge.

I invite these officials to think systemically about potential partnerships, and with sensitivity to the threats they present not only to integrity and trustworthiness (often described as attributes or properties of an individual or institution), but also to trust and confidence (often described as attitudes toward individuals or institutions.)

When you adopt such an approach, the potential perils become readily apparent.  Will the construction of the playground burnish a brand that the food company uses to market the kinds of energy-dense foods and beverages that public health experts believe play a significant role in rising levels of childhood obesity?  Worse still, might the partnership confer a “health halo”—or positive health association—that increases consumption of those products?   (This is sometimes described as a “secondary” gain or benefit for the industry actor, even though this partner may have intended to achieve precisely that effect.)  Such a partnership might rightly be considered to undermine the mission and integrity of the public official for whom the promotion of public health should be the primary goal.  But even absent these effects, the arrangement might undermine trust and confidence in the official and his or her agency.  A loss of trust and confidence in one area might undermine an agency’s work in other areas too.  

In my paper, I explore a couple of examples at the local and national level that vividly demonstrate these hazards.  One involves a $10 million donation to the Children’s Hospital of Philadelphia from a foundation established by the American Beverage Association, just as the city council was considering a soda tax proposal.3  The other involves the USDA and its role in a series of partnerships with fast food chains that were designed to increase the amount of cheese on several menu items.  This led to a headline in The New York Times: “While Warning About Fat, U.S. Pushes Cheese.”4

These examples underscore the importance of looking for tensions first, rather than synergies, when public health officials are considering public-private partnerships.  Such officials should think not only about the systemic effects of such partnerships, but also the cumulative effects of their relationships with industry.  (In my paper, I offer further guidance about how they might begin to conduct such an assessment.)  

Partnerships with industry will be most tempting for public officials when they are designed to achieve a goal that is central rather than peripheral to the official’s mission.  But if a public health official has insufficient resources to achieve a core objective, s/he should be both frank and vocal about the lack of public funding.  I recognize that, in the current economic and political climate, legislators are likely to resist calls for additional funding.   But it would be a mistake to downplay the perils of public-private partnerships in order to avoid those conversations, no matter how difficult they may be.

 

1 U.S. Department of Agriculture, “National Strategic Partners,” http://www.choosemyplate.gov/partnering-program/national-partners/partner-list.html (last accessed May 21, 2013)

2 Jonathan H. Marks, "What’s the Big Deal?: The Ethics of Public-Private Partnerships Related to Food and Health," Edmond J. Safra Research Lab Working Papers, No. 11,  http://ssrn.com/abstract=2268079

3 Jeff Fields, “Big Beverage Gives $10 Million to CHOP,” Philadelphia Inquirer, March 16, 2011, http://www.philly.com/philly/blogs/heardinthehall/118077483.html (last accessed January 31, 2013).

4 Michael Moss, “While Warning About Fat, U.S. Pushes Cheese Sales,” The New York Times, November 6, 2010, http://www.nytimes.com/2010/11/07/us/07fat.html?pagewanted=all (last accessed, March 1, 2013).