Transcript Document

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 8 2013
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
Civil Society Sectors
Human &
Economic
Development
& Growth
Government Sectors
WoS: Individuals, Families and Communities are also Actors
9
WoS Approach for 21st Century Convergence of Human and
Economic Development/Growth
Private Sectors –
Agriculture, Agri-Food and
Other Economic Sectors
Private Sector – Bio-tech,
Pharma, Medicine, Health,
Healthcare, Education &
other Human Sectors
Civil Society Sectors
Human &
Economic
Development
& Growth
Government Sectors
10
Polycentric Governance of
Polycentric Governance in WoS
Regulator
Provide
of Public
Goods
and
Services
Steward of
Pulbic
Resoures &
Investmens
Partner
in multisector
collabora
tion
Enabler of
social and
business
innovation
Enabler
of Whole
of
Society
Action
GOVERNMEN
T
Government & Public Policy in its many roles
Consume
rs
Grassroo
ts
Communi
ty
Small &
Medium
Businesses
Cooperat
ives
Large
NGO’s
(Global &
Nat’l)
Large
businesses
(Global &
Nat’l)
PRIVAT
E
SECTO
R
COMMUNITY
Many Stakeholders in Gov’t and Public Policy
11
Polycentric Governance : 3 Society Arenas with Different
Exchange Mechanism
(Lifetime work of Elinor Ostrom, Economic Nobel Laureate)
Polycentric Governance in WoS
GOVERNMENT
PRIVATE
SECTOR
COMMUNITY
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
Regulator
Provide
of Public
Goods
and
Services
Steward of
Pulbic
Resoures &
Investmens
Partner
in multisector
collabora
tion
Enabler of
social and
business
innovation
Enabler
of Whole
of
Society
Action
Government & Public Policy in its many roles