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D. Sessions Report

Saturday: Opening presentation from CEO of Novo Nordisk A/S. Panel discussion with key stakeholders, followed by table discussions on key issues identified by the panel. Further table discussions for participants to raise issues in health and stakeholder citizenship and prerequisites for effective stakeholder collaboration and identify common ground for action.

Sunday: Break out group discussions of issues in health (at the environmental / systemic level and with a separate group dedicated to diseases) and stakeholder citizenship and identification of conditions for effective stakeholder collaboration. Report to group and discussion.

Initial Presentations

Lars Rebien Sørensen, CEO of Novo Nordisk A/S introduced some of the challenges facing his company. In ‘Lifestyle/ Health’, great progress has been made over the last 50 years, but we dwell on the problems that we still face. Much of health is in the hands of governments: around the world are great disparities in this provision: ie. states with well developed welfare versus inadequate provision, usually by undemocratically governed regimes.

Within the pharmaceutical industry, companies face the dilemma of making sufficient financial returns on investment and ensuring that their drugs are accessible to all that need them. Additionally, social investment and philanthropy into developing countries may run against local (eg anti-dumping) regulations in developing countries put in place to support local industry.

A video and presentation of how Novo Nordisk is tackling Diabetes (their main revenue stream, globally): they operate within the stated WHO guidelines, alongside national health strategies, enhancing the capacity of those national strategies and offering drugs at subsidised prices to developing countries. A foundation has been set up to provide additional funding for the very poor.

Being a good corporate citizen appears to conflict with shareholder value maximisation. However, not engaging as a responsible citizen exposes the pharmaceutical company to reputation risks, particularly where they invent a new highly effective drug; their pricing decisions (if too high) can lead directly to (poor) people dying. While not maximising profits in the short term, the creation of trust underpins their continued licence to operate. The ability to attract and retain staff and shareholders with these values is consistent with longer term corporate objectives, and reflects the history of Novo Nordisk as a responsible corporate citizen.

Andreas Seiter of Novartis International AG endorsed Novo Nordisk’s approach and added that the challenge Novartis faces is to be a good corporate citizen alongside imperfect governments, and that this led to a negative public response from factors outside their domain. He mentioned two initiatives: they are working towards the achievable aim of leprosy eradication, and they have a tiered pricing structure for malaria prophylactics ($40 for a treatment sold to tourists, $2 for the same treatment sold by local hospitals in developing countries). They have developed a cure for leukaemia, sales to developing countries are subsidised by higher price sales in the developed world. They have recently established a Tropical Disease Research Centre in Singapore (with 50 researchers) aiming to develop drugs specifically targeting developing country diseases and to build local R&D capacity. He concluded with the comment that pharmaceutical companies have a difficult balance to strike when it comes to pricing their drugs – giving them away for free takes them into a political role, when this is not necessarily appropriate.

Christine Durbak presented the role of World Information Transfer: to increase health (including environmental health) literacy and knowledge through multiple media, and presented some of the cultural challenges of spreading knowledge effectively and appropriately across the globe. She stressed that access to information was crucial for all citizens, and that such information must be scientifically reliable and easily understandable.

Yasmin von Schirnding of WHO discussed the central role of health in sustainable development, identifying the inadequate attention given since Rio to health and poverty alleviation, health risks and determinants beyond communicable diseases, health impacts of development policies and practices and the new implications of globalisation. WHO’s approach towards the Earth Summit 2002 is to have broad measurement of data and definition and agreement of strategy, with stated immediate goals of raising the priority of ‘health’ at the Earth Summit 2002, renewing Agenda 21 commitments and supporting them with agreed action plans / global initiatives. Specific focus is on intersectoral action, as well as new partnerships and alliances.

Laura Williamson of UNEP DTIE talked of their role in monitoring health / environmental health and promoting transparency among participants. They support the work that GRI is undertaking in agreeing a set of measurable guidelines.

Allen White of Global Reporting Initiative (GRI); they aim to provide a set of corporate reporting standards to encourage comparability and completeness in ‘three pillar’ (social, environmental and economic) reporting, as well as the tools to measure these, accountably.  Their initial focus has been to establish corporate reporting structure; over 150 companies have agreed to work with these voluntary standards, providing annual reports along the specified criteria. They expect to include governments and NGO reporting guidelines in the future. One project (funded by the Gates Foundation) is to develop a corporate HIV/AIDS reporting protocol on policies, practices and programmes, starting with Sub-Saharan Africa extractive industries, then agriculture and ground transportation. Guidelines to be determined in discussion with industry experts, human rights groups, labour, governments, academia, multi-lateral institutions and community groups.

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Table Discussions on the Presentations

Following the initial presentations, participants had table discussions around the questions: What did you like about the presentations? What concerns did they raise?

Positive Aspects of the Presentations

Concerns Raised by the Presentations

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Table Discussions on Priority Issues

Participants then had table discussions around the questions: What are the most important issues in health and stakeholder citizenship for collaborative action? What are the prerequisites for effective collaboration on these? Some identified topics (not in any order) were:

Health: Overarching Concerns

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Key Health Issues

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Corporate Stakeholder / Citizenship

Prerequisites for Effective Collaboration

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Breakout Groups Output (Sunday)

Health and Environment:

What are the processes required to ensure effective stakeholder collaboration?

Q1 Who needs to be involved?

This is context specific, the political context / enabling environment frames this issue, typically the affected community information providers, decision makers, independent experts, the government, NGOs, independent auditors/verifiers. Importance of choosing appropriate the unit of analysis.

Q2 What factors are to be considered?

Different roles for stakeholders in an effective collaboration: Independent monitors and experts, corporate stakeholders, governments, NGOs, small businesses, local communities, intergovernmental institutions, foundations and media.

Q3 What would critical success criteria be?

The partnership is sustainable, desirable and informative
Interests of various stakeholders discussed, reflected, agreed and documented
Establish collective trust, with open communication, so challenges can be overcome
Low tension and a sense of ownership of project by all participants

Strategies for action implemented

Negative consequences of ecosystem decline for human health are reversed – THINGS GET BETTER! Remember to target long term goals…

Q4 What critical things need to be addressed?

Respect different participants; particularly affected communities in initial consultation process.
Trust and listening; relationship building
Identifying barriers to trust; neutral facilitation
Maintain flexibility and acknowledge the value of informal processes
Mediation process and training
Expression and monitoring of outcome, with agreement.

May not exist, or may need to be verified for neutrality
Measure in terms of impact on health
Translate and disseminate formally

“What’s supposed to be different when we’re done”?
Acknowledge terms of reference and rules of engagement, limitations of process with openly stated rights and responsibilities
Recognise differences / power with sectors and communities
Identify achievable goals at outset, and acknowledge when they are or are not achieved. Recognition of the ‘end’ of a project or stage necessary to keep forward momentum.

Get to know the community (whether geographic or based on interest)
Involvement in and access for community
Bring cultural openness / respect different learning styles

Identify realistic expectations and clear points of commitment
Identify responsibilities of people beyond the immediate community
Responsibility to actually do something
Respect the outcome

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Communicable and Non-Communicable Diseases

Medical education and empowerment;
Linkages between traditional and conventional medicines;
Innovation processes targeting diseases prevalent in developing countries;
Linkages to occupational health; and
Health as a basic human right.

Involve all local stakeholders, and ensure a level power base of initial involvement (eg in African rural community: healers, educators, patient groups, NGOs, companies). Appreciate that much of health is outside the remit/responsibility of multi-national companies, and is environmental / agriculture, waste, sanitation, etc driven.
Ensure facilitation across cultures, languages; take time to build trust
Champion specific goal(s), and engage in issues that might represent ‘risk’, through addressing issues in a novel way, outside your predetermined role
Appreciate the dynamic nature of the process and its targets; structure incentives for stakeholders to participate (corporate, NGO, local community, etc); maintain a flexible framework

The ‘Power Triangle’ (collaboration only works if all 3 points are addressed)

Transparency (feedback, credit)

Accountability                                                              Power (financial, knowledge, institutional)

(qualitative assessment, with                                    

discussion, measurement and verification)

Possible examples / outcomes

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Corporate and Stakeholder Citizenship

Q1 What are the key elements of corporate citizenship?

Q2 What are the roles and responsibilities of other stakeholders?

Challenges and Dilemmas

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