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Participants Presentations


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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

The opportunity for open debate

Openness to partnerships and willingness to listen

Honesty of the process and participants and ease / transparency of information transfer

The four chosen issues for IC

Companies appear serious about engaging / thinking / acting on the issues

Possibility of a profitable business case using tiered pricing

Value based presentation, honest presentation of Andreas’ “dilemmas” with regard to governance

Sentiment that maximising shareholder value leads to raised social value

Raised awareness of key health issues and corporate action addressing them

Raised profile of WHO and the progress made by them and UNEP

Acceptance of Corporate Social Responsibility as part of working in society

Evidence of social investment, rather than one-time giveaways.


Concerns Raised by the Presentations

Missing a framework for purpose and discussion; Need a clear focus for effective action; Lack of coherence re partnerships’ purpose

Complexity of system of Sustainable Development indicators

Jargon – beware lack of understanding of each others’ positions, data and goals; need for common language

How this process links into Earth Summit 2002 is not clear. Feeling of elitism (in Earth Summit 2002 process); need for new leaders?

Debate is focused on specific issues already. Unclear through which processes it got this far. Who determines priorities? What about prevention / education / population?

Unknown boundaries in governance: Citizens? Companies? Governments?

Number of missing groups (eg consumers; youth, grassroots groups); question of representation in general

Many pilots, but are business cases replicable?

Call to action, but no movement yet

Fear that you risk stakeholders' independence by engagement in partnerships

Excessive strength of markets (and companies) over values in decision-making in health

Uncertain accountability

‘Local solutions to local problems’ is being overlooked

Rights and responsibilities must be appreciated, in adequate framework, with respect.

Flexibility needed in the process and recognition of different groups

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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

Poverty eradication (globally)

Improving living conditions, esp. water, food, sanitation, energy

Equitable distribution of resources

Economic development with equity and sustainability

Increase integration of economic, social and environmental aspects in (corporate) policy to serve the goal of sustainable development and not solely profit; life-saving drugs are "public goods"

Political desire for certainty when only probability is possible (esp. environmental health)

Risk assessment of developments – need for the scientists to step in

Getting government / industry to commit to environmental standards

Implementation – what countries do versus what they say

New equity / incentive structures

Need for collaboration on HIV/AIDS R&D, education and delivery

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Key Health Issues

Preventative healthcare and promotion of healthy lifestyles

Education – on Public health, HIV, health and environmental protection

Integrate traditional and 'modern' approaches

Differentials in access to care for marginalized groups (gender, cultural issues)

Increase R&D and delivery of preventables (vaccines): HIV / AIDS, malaria, TB

Improve ecosystem health (community involvement)

Understanding of and education regarding links between environment and health, eg regarding pesticide poisoning

Incommunicable diseases (eg diabetes)

Making critical drugs available

Need for an international framework / policy on bio-ethics

Building local capacity, eg training of doctors and nurses

Improve health / environment assessments

Public health and health care must be patient focused and value based

Reliable, consistent, accessible and user-friendly communication, in local languages

Distribution of HIV drugs in Sub-Saharan Africa

Structuring incentives innovatively to protect environment / promote healthcare at local level

Support the recommendations of the Commission on Macroeconomics and Health

MSF / Novartis example (malaria pilot in Tanzania): disseminate lessons learnt

Environment and health equity and incentives

Environmental health issues don't exist in isolation – eg trade agreements

Ecosystem health – need for community involvement

Limits between entitlement and health

Violence and environmental collapse, stress and human health impacts

Lack of economic incentives or international health standards on environment and health

National frameworks: Do they exist? How to enforce them? Target strategic intervention and lobbying.

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Corporate Stakeholder / Citizenship

Engender trust in your partners, without compromising values, on equal footing

Agreed, shared understanding of the issue / problem

Follow bottom up principles

Creation /adoption of a new framework / leadership model


Prerequisites for Effective Collaboration

Provide BASIC NEEDS: Clean water, Adequate food, Safe shelter, Safe workplace, Health

Build trust

Build equitable basis for partnerships, including formal mechanism for community participation, especially in ecosystem health (linked to water management)

Use a rights-based approach: responsibilities and accountability

Include questions of scale and ecosystem context

Create new equity and incentive structures in R&D

Include gender considerations, eg regarding access to care

Define and identify health priorities and limits to research

Mobilise communities; promote local capacity

Poverty and inequitable distribution of resources; economic empowerment programmes for poverty eradication

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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.

Information and accountability:

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

Clarification of the problem:

“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

Key initial areas of focus:

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.

Factors to achieving local partnerships for progress:

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

Dow Chemical, Merrill Lynch and “Silicon Valley” companies identified as being responsible corporate citizens. Promote peer group understanding and pressure?

Work with the WHO towards Earth Summit 2002; support their initiatives through stakeholder collaboration.

Action? Potential group task to help countries (starting with just one) towards implementation of national action strategies under the Global Fund (TB, Malaria, HIV funding). The group could specify targets, approaches and engagement at the appropriate levels, starting with a framework for discussion / implementation at and around August 2002 and the Earth Summit 2002.

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Corporate and Stakeholder Citizenship

Q1 What are the key elements of corporate citizenship?

Accountability (but how to standardise / enforce?)

Confidence building

Across the full spectrum (from prevention to reaction)

Good governance
Beware free-riders
Responsibilities regarding public goods
Identify a sensible baseline / framework / foundation?
Work with government (trade rules, corruption, etc)

Q2 What are the roles and responsibilities of other stakeholders?


Structuring of incentives



Will to reframe problems and engage in new kinds of partnerships

Challenges and Dilemmas

What is the unit of analysis (many sectors, actors and local variations)?

Role of Power?

Independence and rightful roles of different stakeholders?


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