Polycentric Governance of Whole of Society (WoS) Prevention of Obesity and NCDs: On Conflict of Interests, Multi-Stakeholder Partnerships, Competition and Cooperation Laurette Dube & Nii A. Addy Third American Conference on Obesity-PACO3 Aruba, June

Agenda The Challenge The Present Public Health Prevention Context Whole-of-Government Approach to Health and Economic Convergence Polycentric Governance of WoS Prevention of Obesity and NCDs – A Path from Dogmatic to Pragmatic Approach to Conflict of Interest and Multistakeholder Engagement and Partnership

The Challenge Cross-sectoral and multi-level/scale approaches needed in WoG and WoS prevention are “wicked problems” – actors from state, market and civil society – actors from health, food, nutrition, other domains – Policy and action at local, state/province, national, and global levels Defining and managing conflict of interest vs collaborative interdependency and trust needed for impact, scale and resilience

The Public Health Context Sectoral approaches – Health agencies deal with health problems within health systems-TYPICALLY FOCUS ON CLINICAL Damage limitation: trade and health – E.g. United States–Central America Free Trade Agreement (CAFTA) reduced access to drugs in some countries – more dialogue and joint fact-finding by actors from health and other sectors -> better understanding of the implications of CAFTA

Recent approaches Health in All Policies (HiAP) – Focus on health within non-health sectoral policies, including agriculture, industry, trade policies – multiple levels - individual, intermediary, and social – One-way direction in spite of much Win-Win talks Whole of Government (WoG) Prevention – Earlier and deeper integration of health in non-heath budgets, activities and program – Formal and/or informal networks across the different agencies within that government

Present WoG and WoS in Public Health Health strategy – involves stakeholders in all sectors promoting health priorities Mutual Gains or Win-Win strategy – actors outside the health sector are also convinced that their concerns remain as priorities together with health concerns Cooperation strategy – health sector experts seeking how to cooperate with colleagues in other sectors to achieve their respective goals Economic cost strategy – Estimating long term economic costs of obesity and NCDs

WoG Approach to Health and Economic Convergence

WoS: Actors in Multiple Sectors Private Sectors – Agriculture, Agri-Food and Other Economic Sectors Private Sector – Bio-tech, Pharma, Medicine, Health, Healthcare, Education & other Human Sectors Human & Economic Development & Growth Government Sectors Civil Society Sectors

WoS: Individuals, Families and Communities are also Actors 9

WoS Approach for 21 st Century Convergence of Human and Economic Development/Growth 10

Polycentric Governance of GOVERNMEN T COMMUNITY PRIVAT E SECTO R Polycentric Governance in WoS 11

Polycentric Governance : 3 Society Arenas with Different Exchange Mechanism (Lifetime work of Elinor Ostrom, Economic Nobel Laureate) GOVERNMENT COMMUNITY PRIVATE SECTOR Polycentric Governance in WoS

Introducing Polycentric Systems “ Polycentric” systems connote many centers of decision that are formally independent of each other and jointly affect collective –and sometimes individual-- benefits and costs Engaged in competition, cooperation, contract and many other forms of engagement and collaboration Rules-based governance and pragmatic trust need to completement traditional states and market mechanisms.

Exchange Mechanism in Community : Pragmatic Trust Source: Ostrom, 1998

Polycentric Governance Pragmatic Collaborative Rules Boundary rules are clear and locally understood boundaries between CI partners, and between them and collaborators; Position rules specify a set of positions in the consortia and how many partners hold each position; Choice rules specify which actions are assigned to a partner in a particular position; Information rules specify channels of communication among partners and what information must, may, or must not be shared; Scope rules specify the outcomes that are targeted and measures of success in terms of effectiveness, efficiency, and fairness; Aggregation rules (such as majority or unanimity rules) specify how the decisions of partners at a decision point are to be mapped to intermediate or final outcomes; Conflict resolution rules. Rapid, low-cost, local arenas exist for resolving conflicts among partners or with external organizations. For instance, sanctions for rule violations start very low but become stronger; Nested enterprises rules. CI activities being closely connected to social-political-economic systems of partners and society in general, governance activities are organized in multiple nested layers.

Path from Dogmatism from Pragmatism In Conflict of Interest and Multistakeholder Engagement and Partnership for Obesity and NCDs Prevention: Critical, Urgent but Clallenging