Public-Private Partnerships in Mexico: Implications for Public Health Nutrition Governance
About WPHNA
The World Public Health Nutrition Association is an individual membership organisation. Membership is open to anyone who supports, and is committed to, the aims and purpose of the Association. The Association also offers a professional certification track for members who work in public health nutrition.
Our members, from more than 65 countries, form a global network and have created a dynamic forum to exchange views to support each other in our work. We welcome members at all stages in their careers and from all parts of the world.
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Acknowledgements
We want to thank our President, Margaret Miller, and our Secretary of External Affairs, Claudio Schuftan, for their editorial support. Also, we want to thank our peers, Melissa Mialon and Eric Crosbie, for their contribution to the research that supports our publication and their thorough review of this report.
How to cite the report:
Carriedo A., Ojeda E., Crosbie, E. Mialon, M. Public-Private Partnerships in Mexico: Implications for Public Health Nutrition Governance, World Public Health Nutrition Association (WPHNA), 2023.
Executive summary
Introduction
Obesity and diabetes in Mexico and public policy approaches
The issue: Normalization of the private sector as part of “the solution”
Public Private Partnerships for public health as a global phenomenon and their emergence in Mexico
Objectives
Methods
Results
Objectives, scope, and impact of programs conducted under PPPs
Discrepancy in objectives
Indicators to monitor and evaluate programs
and evaluation
Impact and effectiveness of programs
Conflicts of Interest, ethics and
Power dynamics
Risks and benefits of PPPs
Private partner framing the problem and the solution
PPPs promote brands, have unclear results, and have limited liability
Changes in food policymaking within PPPs
Changes in food and nutrition governance in Mexico
Public awareness on COI and of industry interference in food policy
Acronyms
ACRONYMS
ANSA
CONADE
CONAGUA
CONDEBA
CONEVAL
CSR
DIF
ENPCSOD
F&BI
FEMEXFUT
FEMSA
FOI
FOPL
GISAMAC
IDB
INIFED
MOVISA
NCDs NFL
OGP PRODI
SSA
ENGLISH
National Agreement for Healthy Eating
National Commission for Physical Culture and Sports
National Water Commission
National Council for the Development of Physical Education and Sports in Basic Education
National Council for the Evaluation of Public Welfare Policy
Corporate Social Responsibility
System for Integral Family Development
National Strategy for the Prevention and Control of Overweight, Obesity, and Diabetes
Food and Beverage Industry
Mexican Soccer Federation
Freedom of information
Front-of-package labelling
Inter-agency Group on Health, Food, Environment, and Competitiveness
Inter-American Development Bank
National Institute of Educational Physical Infrastructure
Movement for a Healthy Life
Noncommunicable diseases
National Football League
Open Government Partnership
Program for the Integral Development of Water and Sanitation Operating Organizations
Public-Private Partnership
Ministry of Public Education
Ministry of Health
Sugar-Sweetened Beverages
Transnational corporations
United Nations
World Health Organization
Executive summary
The aim of this qualitative study is to critically examine the risks and benefits of public-private partnerships (PPPs) and their role in the nutrition policy agenda. We studied four PPPs devoted to the prevention and control of obesity, increasing levels of physical activity, and expanding access to drinking water and sanitation in Mexico.
Trends in noncommunicable diseases (NCDs) are a serious concern globally. One strategy promoted at the global level to prevent and control them is to engage in PPPs. Evidence suggests that programs conducted under PPPs not only are often ineffective in improving public health but are used as a corporate strategy to interfere with public health policy and protect and further the economic interests of sponsoring corporations by neutralizing potential government efforts to improve health policy. Under the previous administration (2012-2018), the Mexican government adopted public health policies to tackle NCDs, particularly the obesity epidemic and rising rates of diabetes, which are largely driven by unhealthy dietary habits. Simultaneously, PPPs were formed between the government and the food and beverage industry (F&BI) aiming to reduce the healthcare burden of these diseases.
This report summarizes the results of a qualitative study conducted in Mexico in 2020, based on interviews with key actors, publicly-available documents, and freedom of information (FOI) requests regarding four PPPs in Mexico. The aim was to determine whether such partnerships constitute effective ways to design, implement, evaluate, and organise public health nutrition programs aimed to prevent and control obesity and improve access to drinking water and sanitation in Mexico and to explore their main governance challenges, risks, and benefits. We discuss key issues for PPPs, which private partners frame as actions of corporate social responsibility (CSR) and as a key tool for public institutions to implement their policies. Also, we discuss how public interest groups have progressed to scrutinize the F&BI’s influence on the nutrition public policy agenda across two different presidential administrations.
Study results show that all four PPPs examined were found to have minimal public information available on their duration, impact, and governance models. Also, programs conducted under these partnerships have fairly clear objectives, but their success was not measurable, challenging any existing or potential process evaluation and effectiveness to be accurate. Governance around such PPPs was found to be weak in relation to good governance principles as defined in the literature. No clear principles are established or followed transversally among partners, such as accountability, transparency, fairness, participation, integrity, and credibility, among others. Some actors perceive F&BI “support” as an important economic aid to the government, while others perceive it as a risk to the public health agenda or see PPPs as a mechanism that is diluting public health actions or shaping the agenda in the service of commercial interests. Framing problems and solutions for public health nutrition programs in ways that portray the industry as a solutions-oriented partner is part of a strategy that seeks to perpetuate the use of PPPs. Government (federal or local) relies on private sector support to accomplish its goals. This study confirms that PPPs have produced minimal gains for public health while boosting the credibility of the F&BI. Engaging in PPPs with food industry actors should be carefully assessed, particularly if such partnerships lack clear governance principles and the means to ensure transparency and public accountability.
The key recommendations and changes needed to improve programs conducted under PPPs include: i) avoid partnerships at any level of government with domestic or transnational businesses, particularly when conducting public health, food, and nutrition interventions; ii) develop tools to shield public policy from conflicts of interest and corporate capture of policy implementation; iii) ensure governance and financial transparency in public health
interventions); iv) raise involvement of civil society groups supporting the human right to adequate food and water; v) enable external, non-conflicted evaluators to assess program design, implementation, and evaluation; vi) distinguish between promising rhetoric and action; and vii) hold both private and public partners accountable.
These recommendations are important when conducting health or nutrition interventions regardless of civil society involvement, especially when supporting the human right to adequate food and water and children’s rights. Civil society involvement will enable external evaluators to assess program design, implementation, and evaluation without conflicts of interest and distinguish between rhetorical commitments and concrete action. In the context of a PPP, this ultimately will help hold both private and public partners accountable. PPPs between the F&BI and government were found to have risks. The greatest risk identified in the partnerships studied is the F&BI’s use of its influence to neutralize possible government actions to strengthen health policies that are contrary to corporate interests and its efforts to steer the design and implementation of public health policies in its favour.
Summary of Findings
The objectives, scope, and impact of programs conducted under PPPs are:
• Although third-party assessments of the impact and achievements of PPPs may exist, in general monitoring and evaluation of all aspects of the PPPs is inadequate.
• None of the programs provide information on their impact in relation to their stated objectives, so there is no means of assessing their effectiveness.
• There are various weaknesses and problems in program execution, such as uncoordinated efforts and arbitrary decision making at the local level (by schools, directors, or municipalities), without considering any national guidelines.
• Public information available on most PPP programs leaves most of the relevant information, indicators, and results needed to assess programs’ impact unclear.
• Despite the state’s obligation to report on public programs, the information public partners make available to the public, including their finances, is poor. The main manager of data and financial resources is the private partner.
• In the descriptions of PPPs, beneficiaries are meant to be actively involved in the programs and processes conducted under PPPs. However, beneficiaries lack agency. They do not participate actively and continuously in decision-making and program operation or in any particular phase of the program.
The key issues of good governance identified in PPPs are:
• Inconsistencies and violations of principles of accountability, transparency, and ethics are presented in reports and accounts of their programs and among the public and the private partners involved.
• Transparency and accountability are issues for most PPPs. A few have external evaluators but almost none have complete public information available on how they were conducted or their effectiveness. We encountered contradictions and delays and were denied access to public information.
• Although some PPPs are subject to greater scrutiny by civil society, others have no incentive to change the status quo, especially if corporate financing is not contingent on any accountability from the public partner.
• For most programs conducted under PPP arrangements, health-related outcomes are not measurable; therefore, the integrity of such partnerships is questionable. Their practices are inconsistent with their stated goals and with what they undertake to achieve.
• The risk to public health of having the F&BI as designers, implementers, or evaluators of PPP programs was not considered problematic.
• The public health gains and the autonomy of programs conducted under the PPPs studied are not evident from the public information available, and therefore their adherence to ethical standards should be questioned.
Risks and benefits of the PPPs studied:
• The PPPs studied here provided benefits for the private partners and eased the net financial burden of public programs, without any clear impact on program recipients.
• A strategy commonly used to perpetuate PPPs is framing the problems of and solutions to public health nutrition problems in terms that align with the private sector’s narrative, regardless of the nature of the actors’ affiliation.
• Some actors perceive F&BI “support” as an important economic aid to the government, while others see it as a risk to the public health agenda. The latter criticize PPPs as diluting public health actions and serving commercial rather than public interests.
• The power of decision-making and control of the agenda in PPPs, especially those related to schools, is strongly controlled by the F&BI, limiting government institutions’ stewardship and control over their programs.
• Promotion of the participating private entity’s brand occurred directly or indirectly, without being perceived as a negative practice by most implementers or beneficiaries.
• Although a partnership may appear laudable, there is scant evidence that the partnerships studied have accomplished the goals policymakers hoped to achieve with their programs.
• PPPs’ efforts to address public problems of obesity or drinking water and sanitation fail to show a positive impact on water drinking habits, physical activity levels, or access to drinking water or show (based on the information available) a measurable impact on obesity.
Introduction
PPPs constitute a hybrid form of governance, in which non-state actors co-govern with state actors for the provision of collective goods, and in so doing adopt functions of governance that have historically been the sole purview of sovereign states.1 This transition from public to private regulation and policy implementation gives rise to important new theoretical and political concerns of legitimacy2 and challenges existing conceptualisations of regulation.3, 4 These governance issues have also arisen in national and sub-national contexts, and with local programs and policies, as in the cases that we describe in this report.
However, there is also growing recognition in the literature that the health agenda is too complex for any single sector or organization to tackle alone.5,6 While some literature has identified the limitations of hybrid governance, another body of literature argues that no single sector can overcome its challenges alone and emerging health problems require a range of responses beyond the capacity of either the public or private sector working independently, and consequently that relationships need to be built between the two.31
The United Nations (UN) and the World Health Organization (WHO) have called on their member states to build strong coalitions as a key means of combating NCDs through policy change.7-9 This mandate is part of Sustainable Development Goal (SDG) No. 17, and is also mentioned in the UN Decade of Action on Nutrition.10 Although great emphasis has been placed on promoting PPPs to further development and improve health, some potential risks arise from this approach. In the field of public health nutrition, partnerships to achieve better nutrition for all, including the right to adequate food (Rtaf), have been compromised by the powerful economic interests of the F&BI getting in the way of achieving better, healthier, and sufficient food for all.11 Corporations, including transnationals in the F&BI, through multiple practices, have obstructed public health efforts in countries worldwide.12 The experience of tobacco control serves as a cautionary tale for those developing nutrition policy, and in particular policies aiming to prevent and control obesity and diabetes, regarding the need to be aware of and protect such efforts from F&BI interference. One of many tactics the F&BI applies to delay, deflect, or obstruct policy involves taking part in the policymaking process.13 Participating in public debates and lobbying is one key means of shaping policy design and influencing agenda setting, but a more subtle way of influencing it is during the implementation and evaluation of policy. At times the F&BI acts as a legitimate participant on
committees or advisory boards, and at other times as a good-faith partner in interventions aimed at improving community health and access to food or water or promoting behavioural change.14 This report focuses on the latter: PPPs between several F&BI corporations and the government. We examine four case studies where such arrangements have influenced programs aimed at prevention and control of obesity and improvement of water sanitation in Mexico. We discuss key issues around PPPs, sometimes framed as a CSR action by private partners and as a key method for public institutions to impleme nt public policy.
Obesity and diabetes in Mexico and public policy approaches
Obesity and diabetes were declared a public health emergency in Mexico in 2016. More than 200,000 people die each year of causes related to noncommunicable diseases, including obesity and diabetes. 15 According to the latest Mexican Health and Nutrition Survey, the combined prevalence of overweight and obesity was 75%, and the prevalence of previously diagnosed diabetes was 10%.16 Also, the national nutrition survey showed more that 35% of children between 5 and 11 years of age and 38% of children between 12 and 19 were overweight and/ or obese. 9 Also, 80% of the population, regardless of age, are regular consumers of sugary drinks. Moreover, 64.6% of children between 5 and 11 and 35.4% of adults are reported to consume snacks and desserts every day. Evidence has confirmed how rising rates of obesity and diet-related diseases are linked to high consumption of sugary drinks and ultra-processed foods.17
In an effort to reduce the high burden of obesity and diabetes in Mexico, the National Strategy for the Prevention and Control of Overweight, Obesity, and Diabetes (Spanish acronym ENPCSOD) was launched in 2013 within months of the new government taking office. 18 It included a front-of-package labelling (FOPL) strategy based on an industry proposal;
The
an excise tax on sugar-sweetened beverages (SSBs) and foods high in fat, sugar, and salt (HFSS) or “junk food;” and some food and beverage marketing restrictions.12 Ample research has been conducted on the involvement of the food industry in the policy process in Mexico, including in the ENPCSOD, underscoring how closely the F&BI has worked with policymakers in framing the agenda and seeking to provide solutions to Mexico’s current obesity and diabetes epidemics that serve private interests.19-22
Exposing and discussing the F&BI’s influence over the public health policy agenda in the academic literature has supported efforts by health advocates to call attention to it and shift patterns away from such corporate influence. Nevertheless, this influence persists through different means and actions.21 Some methods of influence have been amply described in the literature and compared with the practices of the tobacco and alcohol industries.23, 24 One of the many strategies the transnational F&BI uses is to engage in PPPs as part of government policies and programs, often on issues related to food, nutrition, and health. Producing unhealthy products consumption of which contributes to the development of NCDs is inherently incompatible with public health goals, but because these PPPs have been framed as CSR actions they often are not perceived as a threat to public health or a rights-based agenda.
issue: Normalization of the private sector as part of “the solution”
Evidence has shown how powerful the negative impacts of transnational food corporations and their ultra-processed foods are on the obesity epidemic and on our current unsustainable food systems12, 25 they have compromised
health, land, ecosystems, and food sovereignty.21 Systematic reviews have shown that collaborations with F&BI have failed, mainly because the private partners do not comply with the public partners’ requests when it comes to modifying products or practices, in particular to promote healthier foods.26, 28
Transnational F&BIs, particularly in the soda industry, have exercised their power to challenge numerous attempts to regulate and implement policies to reduce consumption of ultra-processed foods to lower rates of obesity, diabetes, and other diet-related non-communicable diseases.29, 31 This has been the case in many countries and for many years. In Mexico, for example, just after the national soda tax came into effect in 2014, some beverages were granted tax exemption, closed-door negotiations with the government prevented the soda tax from being progressive, health policy advocates were threatened using spyware, and soda producers and the federal government negotiated on public-private initiatives.19, 32 Spyware attacks on Mexican advocates were motivated by commercial interests.33 Many public officials had close links to the soda industry, giving the government a possible incentive to purchase and use spyware on soda tax advocates.33
In the past, private sector participation in public health policy, in particular by the F&BI (both national and transnational corporations), was well perceived and received, particularly under the National Agreement for Healthy Eating (Spanish acronym ANSA) launched by former president Felipe Calderon in 2010.34 In the ANSA, the federal government assigned specific strategic obesity prevention actions directly to the private sector, as in the case of product reformulation, which was adopted as a key directive but not a statutory mandate. Nevertheless, the perception of corporate participation in public policy as a net positive contribution has shifted. In Mexico, the first controversies about the industry’s interference in the food policy agenda emerged with the collaboration between the Ministry of Public Welfare and PepsiCo for the National Crusade Against Hunger in 2013. This was followed by the clear influence the food industry exercised in designing the 2014 FOPL strategy outlined in former president Pena Nieto’s anti-obesity strategy, where the F&BI took part in policy design, resulting in the adoption of an industry-proposed FOPL system using Guideline Daily Amounts (GDA).35, 37 Since then, civil society and academia have worked to raise awareness of such influence and its impact on the policymaking process and on ultra-processed food availability and promotion.21, 38
Public Private Partnerships for public health as a global phenomenon and their emergence in Mexico
There is growing evidence on how PPPs and collaborations may take any of the forms we have described, being framed as CSR initiatives, PPPs, or multi-stakeholder platforms (MSP). They are a strategy the F&BI uses to protect and advance its economic interests by neutralizing possible government actions to improve health policies.39, 41 Nevertheless, some global examples have shown how private partners’ power exceeds that of others involved and favours their interests by permeating regulatory efforts in the areas of public health and health policy, both locally and globally.
The soda industry has taken part in several countries’ social and poverty relief programs.42,43 Often its engagement takes the form of PPPs and is framed under the banner of CSR actions.43, 44 PPPs and CSR initiatives raise questions about the power dynamics
among public actors and transnational corporations (TNCs), which are discussed extensively in the global health literature.45
In Mexico, some PPPs with the transnational F&BI emerged in the field of nutrition after the launch of Mexico’s national overweight, obesity, and diabetes strategy (ENPCSOD) in 2013, and mainly concurrent with the introduction of the soda tax in 2014. Some of them have existed and evolved for a long time, but they have changed names and undergone minor modifications over time, often in response to changes in public administration. Changes in the country’s obesity policy agenda have led PPPs between the transnational F&BI (hereinafter F&BI or the private partner) and different government agencies to evolve over time. The F&BI has stayed deeply involved in the country’s nutrition policy, from complex synergies (explained below) to finance social policy programs to the implementation of programs related to water access and interventions to change dietary behaviour. This not
Objectives
only has shaped the policy agenda but has also helped to frame CSR actions within public health interventions and vice-versa.
In this study we aim to examine four different PPPs and analyse them, to answer the following questions: How are PPPs between the F&BI and the Mexican government that aim to prevent and control obesity or improve water sanitation in Mexico working in achieving their goals? What are the main challenges for their governance and what are some risk and benefits of such partnerships?
We explore the socio-political context in which these PPPs with the F&BI have emerged in Mexico and critically examine them from a public health perspective. We explore the perceived risks and benefits of such arrangements for partners, programs, and local populations and their impact on the nutrition policy agenda. Also, we present some recommendations based on our findings.
Critically assess the objectives, scope, and impacts of public health nutrition programs conducted under publicprivate partnership (PPP) arrangements in Mexico.
• Explore the key issues around governance of these PPPs, including their role in the nutrition policy agenda, public participation, and program impact.
• Explore the risks and benefits of some public health nutrition PPPs as perceived by actors and experts on PPPs, including industry, government, civil society organizations, and operational personnel.
• Offer recommendations for the public health community, civil society, and policymakers based on our findings.
Methods
This is an exploratory study using a qualitative methodology. We use a combination of theories and frameworks to better understand the phenomenon using the “complementary approach” to policy analysis defined by
Cairney (2012), which uses multiple concepts or theories to produce a series of perspectives with which to explain empirical outcomes.46 Theoretical approaches to studying PPPs have looked at their structure (the persons and institutions involved), mechanisms of engagement, transparency and accountability issues, and other social responsibility actions taken by the private sector.47, 53 We use several theoretical approaches to build our analytical framework, as well as the principles of good governance54, 55 identified in the literature. Principles of good governance are helpful to understand the purpose or rules that guide partnerships in the context of public health initiatives,56,58 and defined in Box 1. As with any action where a government institution is involved, some rules/laws are expected to be drafted and followed. Likewise, and according to literature, PPPs should have rules, action plans, and indicators.50 We operate on the assumption that the stated aim of all the PPPs studied here is to provide a public service as a mean to improve nutrition and health. Accordingly, we consider the principles of good governance key points to address in our analysis
Efficiency and effectiveness: Processes and institutions should produce results that meet population needs and influence health outcomes while making the best possible use of resources.55
Accountability: Decision-makers in government, the private sector, and civil society organizations are beholden to the public, as well as to institutional stakeholders, especially when engaging in public health matters. This accountability differs depending on the organization and whether the decision is internal or external to that organization.55
Transparency: Transparency is built on the free flow of information. Processes, institutions, and information should be directly accessible to those concerned with them, and enough information should be provided to understand and monitor matters of public interest, including health.55
Fairness: is characterized by equity, respect, justice, and stewardship of shared goods, both among people and in their relations with other living beings.
Participation: All men and women should have a voice in decisions that affect their livelihood and wellbeing, in areas like health, either directly or through legitimate intermediate institutions that represent their interests. Such broad participation is built on freedom of association and speech, as well as capacities to participate constructively. Good governance of the health system mediates divergent interests to reach a broad consensus on what is in the best interests of the group and, where possible, on health policies and procedures.55
Integrity: Integrity exists when there is consistency “among what an institution does, what it says it does, and what it is obliged to do.”52 Consistency is needed between the practices of an institution, its mission, and its purpose.
Credibility: Credibility includes trust and trustworthiness. Trustworthiness relies on the institution and on the public perception of the institution.52
Stewardship: Stewardship is defined as the government function responsible for the welfare of the population and concerned with the trust in and legitimacy of its activities, and how the citizenry perceives them.56, 58
Ethics: The commonly accepted principles of PPPs include beneficence (should lead to public health gain); non-maleficence (must not lead to ill health); autonomy (should not undermine each partner’s autonomy); and equity (benefits should be distributed to those most in need).4
We selected four PPPs purposely. The PPPs selected had to include a government (federal or regional level) partner, either the Ministry of Health or Education, as the agencies that have been directly involved in the obesity policy agenda. Also, they had to have the aim of providing a service to vulnerable populations such as children or communities living in poverty. The PPPs selected and the criteria we used are listed in Figure 1 and were defined after conducting a review of the literature. We specifically selected private partners that are transnational, as they have similar arrangements, both globally and regionally, that may be comparable with our case study. We conducted a systematic search, selection, and analysis of 199 documents related to the selected PPPs and the Mexican context at the time. These documents included existing peer reviewed literature and grey literature including press releases and government and industry documents. An initial systematic search with Google Scholar and Google Search using key terms was conducted to obtain them. We conducted a snowball search and forward referencing of the documents identified. Such documents include organizational reports, press releases, and financial reports. Additional secondary data was considered, as available and necessary, including newspapers, opinion columns, and social media (Twitter, Facebook). Also, to gather additional information about the selected PPPs, information requests were submitted to public agencies through the transparency platform. In total, we submitted 50 information requests. Of those, 48 received an answer (29 without information, 19 with information attached) and 2 were unanswered.
a) Inclusion criteria
a) Participation of a private partner that is a transnational food or beverage corporation based in Mexico.
b) An explicit aim to provide or improve a nutrition and health service (obesity prevention, physical activity, nutrition education, water sanitation) to vulnerable populations such as children and/ or communities living in poverty.
c) Established or operating for at least 6 years, having emerged during or after the launch of the ENPCSOD (2013), at a time when industry increasingly wanted to show themselves as part of the solution to the obesity epidemic, and when the Pena Nieto administration’s agenda included a plan to combat the obesity and diabetes epidemic.
d) Existence of sufficient documentation (reached by consensus of four investigators) to allow a thorough analysis from the perspective of both private and public partners.
e) With a substantial number of beneficiaries and breadth of scope. This is defined as > 5,000 beneficiaries per program in the selected timeframe of analysis (2 to 5 years – see Figure 2).
b) PPPs selected
a) “Centros de Hidratación,” a program led by Escuelas Sustentables A.C., an NGO sponsored nationally by Coca-Cola and in collaboration with the Ministry of Education, mainly through INIFED.
b) “Agua Saneamiento y Salud” [Water Sanitation and Health], a project promoted nationwide by PepsiCo, the IDB, and the Mexican water agency CONAGUA.
c) “Ponte al 100” launched by Coca-Cola with the Ministry of Health and the National Commission of Physical Culture and Sports.
d) “Nestlé por niños saludables” (previously “Nutrir”) [Nestlé for Healthier Kids] and the local departments of education and health.
We also conducted 26 interviews with key informants. Eight were experts in the topic of PPPs, 5 were operational personnel, and 13 were involved in some way with the PPPs under study, either from civil society (or private sector front groups), private sector, or public partners.
The selected documents and interviews were transcribed verbatim and imported to NVivo qualitative analysis software. We followed an initial coding framework informed by the chosen theoretical frameworks, discussed by the team (AC, EO, MM, EC) and conducted a thematic analysis. Emerging themes were incorporated in the coding frame and discussed among the team members. Two researchers (AC & EO) coded the information and FOI requests and a third researcher checked 10% for quality ass urance.
Triangulation of the information provided by the private partner was carried out by requesting public information from the corresponding public partner whenever it was not publicly available on their website, through the application of laws on transparency and access to public information. The public entities responded to 48 of the 50 requests made. Of their replies, 19 included the information requested and 29 did not, stating that the entity is not responsible for that information or indicating that the requested information does not exist. Either the lack of response to our requests was attributed to the extension of the deadline due to the Covid pandemic or no reply was given. Several PPPs were at the state or municipal level, so not all actors knew about such PPPs. When the response was incomplete or there was no answer and no regulatory measure extending the period to reply, complaints were filed (six in total).
We compared available reports written by both public and private entities to detect discrepancies and consistencies between parties. A contextualization of each of the programs established by PPPs was conducted through a historical narrative and by mapping all actors involved in the PPPs. Details about this exercise are available (on request).
Results
Objectives, scope, and impact of programs conducted under PPPs
This section describes the main type/style of arrangements detected and provides some insights about the programs’ objectives, indicators, monitoring and evaluation, and impact. As programs conducted under the PPP arrangements we identify how they are presented by both partners. The objectives, partners and beneficiaries involved in each of the PPP programs studied are presented in Figure 2.
FIGURE 2. PPPs studied, the private and public actors involved, related programs, and aims and scope of their programs
Centros de Hidratación/ Programa Nacional de Bebederos Escolares (2011-2018)
Partners Arca Continental
Coca-Cola México
Coca-Cola FEMSA
Escuelas Sustentables A.C.
Fundación Bepensa
Fundación Coca-Cola
State school construction institutes (INIFED local authorities)
Ministry of Education (SEP local authorities)
Geographical Areas
Objectives
Several states throughout the country including: Mexico City, Coahuila, Durango, Guanajuato, Jalisco, Nuevo Leon, and Quintana Roo
Programa Centros de Hidratación
Provide safe and potable water to schools by installing water fountains in preschools and primary and secondary schools, mainly in rural and indigenous communities, helping to improve health of students, teachers, and community members. The program’s priority focus has been on the poorest areas of the country.
Programa Nacional de Bebederos SEP/ INIFED
(Part of the Education Reform, before 2016 as part of “Escuelas Dignas” and after 2016 as “Escuelas al CIEN,” executed and evaluated by INIFED). One of the specific objectives of the national Educational Reform is to install and maintain school drinking fountain systems that provide a continuous supply of drinking water in schools, in accordance with the guidelines issued by the National Institute of Physical Infrastructure for Education (INIFED)
Beneficiaries and impact
Evaluation
Programa Centros de Hidratación has installed 1,711 water fountains (Escuelas Sustentables website). According to INIFED they installed 13,326 water fountain systems, 2,000 of which were provided by “alternative sources of funding.” (INIFED accountability report 2012-2018)
Only some reports by INIFED were available. Some numbers are provided.
Partners
CONAGUA
IDB
PepsiCo (INIFED accountability report 2012-2018)
Geographic area
Objectives
Beneficiaries and impact
Evaluation
Pilot project: Initially the program identified rural communities in 4 municipalities in the State of Mexico, Michoacan, San Luis Potosi, and Veracruz. We did not find information for other states.
Programa de Desarrollo Integral para Organismos Operadores de Agua Potable y Saneamiento (PRODI) transnational CONAGUA/IDB
The objective is to seek development schemes aimed at providing drinking water to dispersed populations.
5 million USD from PepsiCo for 850,000 beneficiaries (in total through 2025), initially. 2011-2016 – 7 million USD for 772,181 beneficiaries.
Yes, bi-annual reports are available on the IDB website; nevertheless, a report on the impact of the program is not available either on the IDB portal or provided in response to an FOI request filed with CONAGUA.
Partners
CONADE
CONDEBA
Ministry of Health
Ministry of Education (national and sub-national level)
Industria Mexicana Coca-Cola
Fundación Coca-Cola
Fundación Movimiento es Salud A.C.
Federación Mexicana de Medicina del Deporte
Fundación Azteca
Fundación Carlos Slim
Instituto Mexicano del Seguro Social
Instituto de Salud Pública de la Universidad Anáhuac
Instituto Politécnico Nacional
Movimiento por una Vida Saludable (MOVISA)
Federal Police
Tecnológico Nacional de México
The Aspen Institute
Geographical area
Objective
Beneficiaries and impact
The State of Mexico for the first 3 years with 105 schools, and many others thereafter. Operation in 29 states by 2014 (SEP Progress Report, September 1, 2015) reducing its scope to 22 states in 2018.
The objective of Ponte al 100 is to guide the general population in three main areas: measure how the body is doing (diagnoses), evaluate how fit a person is, and prescribe exercise and diet individually to modify habits.
According to Coca-Cola, more than 4 million diagnoses have been conducted on more than 2.6 million people.
According to Coca-Cola, 900,000 pupils at 4,700 schools have been served through the program.
According to the Fundación Movimiento es Salud A.C. website, they have evaluated 2,569,393 boys and 2,601,032 girls.
Evaluation
Partners
Geographical area
Objectives
Yes, a performance evaluation was conducted by CONEVAL and a process evaluation by consultants for CONADE on “Programa de Cultura Física.” Also, CONADE and the General Directorate of Policy Evaluation of SEP conducted a diagnosis report of “Programa S269 de Cultura Física y Deporte”
Nestlé por niños saludables (previously Nutrir)/ Nestlé (2006-2020)
DIF (local authorities)
Nestlé
Ministry of Education (local authorities)
Ministry of Health
State of Mexico, Guanajuato, Mexico City, and Veracruz.
Nestlé por Niños Saludables (Nestlé for Healthy Kids) seeks through programs and tools, to promote the adoption of healthy living habits in children from 0 to 12 years of age. (Nestlé Report 2016-2018)
Beneficiaries and impact Evaluation
Every year they train 650,000 children and 6,000 schools and 1 million parents. According to Nestlé, they have reached 5 million children, 60 thousand parents, and 10,000 teachers in 6,000 schools. (Nestlé website https://www.nestle.com.mx/csv/ iniciativas_globales/nxns consulted 11 Feb 2020).
Qualitative study by the private partner evaluating the change in knowledge after the intervention. No information provided through FOI requests in the states where the program operates.
Discrepancy in objectives
We found discrepancies in how the objectives were presented by public and private partners from most of the PPPs analysed. Setting a goal with clear objectives is essential for any program to have an adequate impact on its public health goals.48, 59 As suggested by the UN SDGs, a distinction between binding and non-binding objectives and whether or not any of the cases studied had binding objectives needs to be established. Box 2 provides some examples of the differences in how the public and private actors of the PPPs studied present their objectives, actions, and indicators.
We identified two ways in which the objectives of the PPPs were defined and presented throughout the documents analysed. The first is when the government has an action plan and the private sector joins that action plan for a specific phase or component. The second is when the private sector presents a project or an idea on its own terms and manages implementation jointly with the public sector, with the latter having minimal involvement in the details (design) of the proposal but with freedom of action (implementation).
For instance, the program Ponte al 100 was designed and presented to the government by Fundación Movimiento es Salud, an organization sponsored by several F&BIs including Fundación Coca-Cola (see Annex 1), to aid the national program to promote physical activity.60 The aim of the program was to measure the body’s “functional capacity index” (as mentioned in the documents),
referring to a person’s ability to engage in physical activity and fitness level. The government, through CONADE, had to implement and manage it in schools or measurement centres and coordinate evaluation sessions with beneficiaries. The objectives were not clear regarding what exactly the impact of such an intervention would be. Some informants pointed out that, although it was expected to increase physical activity levels among children or improve obesity rates, such outcomes were not reported. Also, discrepancies between the written objectives (see Box 2) and informants were captured regarding the program’s objectives. Contrary to the objectives described in Box 2 for Ponte al 100, one informant affirmed:
“We changed the objective and converted it into a program of physical activity, aiming to make people healthier. We sought authorization with [Minister of Health] Mercedes Juan, but [UnderMinister of Health] Pablo Kuri spoke with us and didn’t like the program, because we were not an [obesity] prevention program as it is strictly defined in NOM-008 for obesity prevention.” (CSO-FG interviewee.)
In the Agua Saneamiento y Salud and Nestlé por Niños Saludables partnerships, the private sector was the main designer, implementer, and decision maker. Under these partnerships, the government becomes an instrument to implement corporate/private
objectives. Discrepancies between the information provided by the public and the private partners were found for Nestlé por Niños Saludables. The geographical areas in which it actually operates were different. The
company reported activities in schools nationwide, with a special focus of the program in 5 states. Agreements or documentation supporting such claims were found for only two states.61,62
Box 2. Examples of objectives, actions, and indicators presented by the private partner (or through front groups) and the public partner in the various case studies.
Objectives Ponte al 100
“Ponte al 100 evaluates people’s physical state, analyses it, and prescribes an appropriate diet and exercise regime.” (Movimiento es Salud Foundation website)
“Ponte al 100 is an educational initiative to empower children, young people, teachers, and families to take responsibility for their physical health, structuring the school community as the axis of action and incorporating physical exercise, nutrition, and school infrastructure” (Capacidad Funcional website)
Agua, saneamiento y salud
Actions Centros de Hidratación
“PepsiCo and the Inter-American Development Bank (IDB) joined forces to address the imbalance between supply and demand for water with the Hydro-BID Technical Support Centre, a revolutionary centre for water resources where local water managers in cities throughout Latin America can find help to administer their water resources.” (PepsiCo Sustainability Report 2018)
“In collaboration with the nonprofit Escuelas Sustentables, we continue expanding the Hydration Centres program with the aim of supplying communities with safe drinking water and promoting responsible use of water among young people.”
(Mexican Coca-Cola Industry Sustainability Report, 2015 P. 21)
“The objective of the Ponte al 100 pilot program was to help fight sedentary lifestyles and lower rates of overweight and obesity by engaging in physical activity and adopting personalized nutritional recommendations made available to the population based on Functional Capacity Assessments (Ponte al 100), and encourage people to play an active role in preserving their health.” (CONADE Reply to Senators, December 6, 2017)
The private partner is prescribing what individuals should do about obesity for them to take responsibility for it.
The public partner aims to engage people in physical activity and adopt recommendations.
“The objective of the Integral Project of Water and Water Treatment Operating Organizations (Spanish acronym PRODI) is to help the National Water Commission (Spanish acronym CONAGUA) improve the quality of water and water treatment service in localities, preferably with 50 to 900 thousand inhabitants.” (Loan Agreement No. 3591/OC-ME, May 12, 2016
“Article 11 of the General Law on Physical Infrastructure for Education states that the existence of sufficient drinking water fountains with a continuous supply of drinking water will be guaranteed on all premises for school use in accordance with the guidelines issued by the Ministry of Health in coordination with the Ministry of Public Education.” (General guidelines for drinking water fountains, DOF 12/23/2015)
The private partner aims to help administer water resources.
The public partner aims to improve the quality of water in several localities.
The private partner aims to supply communities with safe drinking water and promote responsible use of water.
Indicators used
Nestlé por niños saludables Centros de Hidratación
“In collaboration with local education and health authorities, we develop materials, which include school kits, cookbooks, songs about nutrition, stories in Spanish and indigenous languages, etc., for preschool and elementary school children.” (Nestlé Report 2016-2018)
“Nutrir, Unidos por Niños Saludables promotes nutritional knowledge in school age children through nutritional orientation sessions with options for games and recreational activities, which can be implemented in classrooms, cafeterias, community centres, or at home in a progressive and flexible manner.” (Guanajuato Government Bulletin, December 10, 2017)
The public partner aims to guarantee that schools have a continuous supply of drinking water and use it in accordance with SEP guidelines.
“Through partnerships with NGOs and local departments of education, we provide didactic material for schools and train teachers to offer nutritional orientation sessions for children using games and recreational activities.” (Nestlé Report 20162018)
Ponte al 100
Water fountains installed (Fundación Escuelas Sustentables, A.C., and Mexican Coca-Cola Industry Sustainability Report, 2016 P. 22)
Overall number of personal “functional capacity” evaluations performed (Mexican Coca-Cola Industry Sustainability Report, 2014 p. 19)
Number of schools with water fountains (regardless of whether they are operational or not) by the end of the evaluation period (INIFED) and number of water fountains installed. (INIFED accountability report 20122018)
Number of schools with water fountains (regardless of whether they are operational or not) by the end of the evaluation period (INIFED) and number of water fountains installed. (INIFED accountability report 20122018)
The private partner’s aim is to provide material for schools and teachers, for them to direct sessions at school on healthy eating.
The public partner aims to promote (not clear exactly how) nutritional knowledge in schools through orientation sessions.
The private partner’s indicator is the number of water fountains installed.
The public partner’s indicator is the number of schools with water fountains.
The private partner’s indicator is the number of “functional capacity” assessments performed.
The public partner’s indicator is the same, although the objective was slightly different.
Goals and/ or impact Nestlé por niños saludables
Agua, saneameinto y salud
“We have impacted 2.3 million children and more than 1,000 teachers in more than 6,000 schools nationwide.” (Nestlé Report 2016-2018)
“For 13 years, the program “Nestlé por Niños Saludables” has been implemented successfully in different parts of the country, impacting more than 4.5 million children in more than 6,000 public and private schools throughout Mexico, with a special focus on Mexico City, the State of Mexico, Guanajuato, and Veracruz.” (Nestlé Press Release, March 14, 2019)
“The Program “Nestlé por Niños Saludables” will benefit 650 thousand children and young people at 6 thousand schools at the federal and state levels, from preschool through junior high, and will also serve indigenous and special education schools.” (Veracruz Government Newsletter, March 2, 2019)
The private partner says they have impacted 2.3 million children and teachers, and previously 4.5 million children (not clear how they measure impact).
The public partner says they will reach 650,000 children in 6,000 schools (not clear how they measure impact).
“As the first private sector donor to contribute to the IDB fiduciary fund in 2011, the PepsiCo Foundation’s 7 million-dollar investment in the AquaFund (made between 2011 and 2016) helped catalyse 547 million dollars in total funds through April 2019 and provided new or improved access to safe water and sanitary services to more than 765 thousand people.”
(PepsiCo Sustainability Report 2018)
Indicators to monitor and evaluate programs
“The Program for Sustainability of Drinking Water and Water Treatment Services in Rural Communities IV” was financed by means of a 450 million dollar IDB loan to the Mexican government, which will eventually benefit 600 thousand people with new access to drinking water, and around 390 thousand people with new access to sewerage and basic water treatment in rural areas in 31 states throughout Mexico.”
(IDB Press Release, 2014)
The private partner has improved access to safe water and sanitary series for 765, 000 people.
The public partner says they will benefit 600,000 people with access to drinking water and 390 ,000 with new access to sewerage.
From a programmatic perspective, research indicates that interventions should have indicators for actions to be completed or outputs, outcomes of the intervention (e.g. changes in behaviour, using the knowledge, etc), and overall impact (e.g. changes in obesity).63, 64 In the PPPs studied these were not clear, neither in the private partners’ documents nor in the public documents. For instance, in Centros de Hidratación, while having very straightforward indicators to measure progress such as number of water fountains installed, it is unclear how they changed water drinking patterns in children. Likewise, Ponte al 100 provides information on how many evaluations were conducted (outputs of the intervention) but does not provide how many, or if any, people changed their physical activity patterns or improved their diet (outcome). The two other programs had similar issues, and while the aim of the program was well defined for Agua Saneamiento y Salud, the indicators the IDB used in its evaluation do not clearly show how the program was working. (ref=TABLE DELETED). For instance, Nestlé por niños saludables does provide different numbers on how many people they reached in the same time period (Box 2), but we do not know if those interventions truly changed children’s behaviours and health status.
Implementation and evaluation
In terms of implementation, several challenges were encountered. The most important issues our interviewees reported were a lack of coordination of activities. This problem was cited for all the PPPs studied. There was a lack of clarity regarding how and by whom the program execution was coordinated. Therefore, there was a lack of knowledge of any systematic reporting of actions and practices throughout the programs. Their monitoring or evaluation strategies were non-existent for either one or both of the partners involved in the PPP. For example, a representative of the CSO mentioned that they were primarily responsible for retaining and managing information on the Centros de Hidratación program: “Due to changes in administrations, the information changes, so we [the CSO] have the complete information.” These findings suggest that international recommendations on how to implement programs to reduce obesity and improve physical activity are partially achieved only due to the private sector’s collaboration, and contrary to the recommendations, with limited evaluations.65,67
Also, regarding Ponte al 100, in response to an FOI request, CONADE indicated that: “Fundación Movimiento es Salud was responsible for all the information” and “once the operation of the program concluded, [they] took all the information.” This claim reflects how data management and coordination were handled. It is particularly worrying that students’ personal data was not protected by the Ministry of Education, instead of
being accessible to the private entity with no clear restrictions on data management. (SSA interviewee)
As with the previous example, other private partners reported having records and results, but they are not publicly available or were not shared with the research team. For the public entity, operating rules of public programs exist, but some of them were written a posteriori,68, 71 were not followed properly (IDB Reports),72 or in some cases were non-existent.
In terms of evaluation and results, despite some of the programs having had external evaluations like those conducted by CONEVAL, or evaluations conducted internally by the IDB or SEP, there is a lack of consistency in objectives, indicators, actions, and results, as exemplified in Box 2. For example, while the private sector reports on achievements (impact), the public sector seems to report on goals rather than the impact of the interventions. None of the four PPPs studied seem to have ensured a public access archive or portal with complete information on the programs and their evaluations. For instance, some FOI requests were answered stating that the information requested was non-existent or indicating that another authority was responsible for it. The public entity either delayed or denied the answer. In some cases, they pointed out that it was the responsibility of the private sector. Box 3 provides an example.
Box 3. Examples of FOI replies for Centros de Hidratación and agreements with Fundación Coca-Cola
Text of the FOI request FOI request delayed FOI request delayed
The description of “Escuelas Sustentables” in the agreements says: “It has an agreement with FUNDACIÓN COCA-COLA AC who is the sole sponsor for the donation of the Coca-Cola Hydration Centres. The agreement
The information requested is in hardcopy, and therefore is not available in digital format; 31 contracts concluded in 2014, 2015, and 2016. The documentation is compiled in 38 folders with a volume of more than 8,600 pages.
In accordance with the provisions of Article 131 of the General Law of Transparency and Access to Public Information, a search was carried out in the archives […] and it is not in the power of this entity, nor is there any precedent of the
is intended to arrange collaboration, participation, and execution of the installation of Coca-Cola Hydration Centres in public educational establishments.” (Agreement for the donation and installation of 26 Coca-Cola Hydration Centres, INIFED Coahuila, April 2014)
(Answer to FOI REQUESTS from INIFED Coahuila, May 2020)
subject referenced in the INIFED. Therefore, since it is a matter that pertains solely to a private party, it is suggested to submit the matter to the consideration of the companies involved. (Answer to FOI REQUESTS from INIFED, Oct 2020)
Impact and effectiveness of programs
Our results show that the impact or results reported differed depending upon which partner was reporting. For example, whereas Coca-Cola’s 2015 report stated that “Ponte al 100” performed personalized functional capacity diagnoses on 1.6 million Mexicans and more than 2.6 million in 2016, CONADE reported a total of 1,364,891 personalized functional capacity diagnoses performed between 2013 and 2015.73,75
Most of the PPPs show no substantial effectiveness of the programs, as none of them provide information on their impact in relation to their stated objectives. This underscores the problems surrounding the evaluation and monitoring of government programs, including those implemented under PPP arrangements, as exemplified in Box 2. Other examples include the water fountains (which the private partner calls hydration centres) provided as part of the program “Centros de Hidratación” as an indicator of the program’s impact on improving water consumption among children. This outcome was not reported, but instead our interviewees shared some negative views of the program; for example, one beneficiary in a school stated that “kids don’t use them [water fountains]; instead, they bring their water containers from home.” Also, there is no information on how many of these hydration centres were working properly and were in use at the end of the program in any public report.68-70 In “Ponte al 100,” we know how many measures of “functional capacity” were applied, but we do not know how those have benefited the students or the people with obesity, and if they received a counselling session or nutritional advice to address it. For “Agua Saneamiento y Salud” there is no clear description of beneficiaries of improved water sanitation or how many people have received technical support from the program, as the numbers reported by the private and the public partner do not match. While PepsiCo reported that their donations to the IDB provided new or improved access to safe water and sanitary services to more than 765 thousand people (PepsiCo Sustainability Report 2018), the IDB provided the “number of homes with improved access to drinking water in localities with 50 to 900 thousand inhabitants:” 4,000,000,000 baseline and 4,400,000 in 2018. No available information was provided from the public entity.
PPP governance studied
Accountability, transparency, and credibility
Considering the areas of interaction, confrontation, and synergies between public and private actors, we found that public figures with political ambitions, like
governors, communicate openly about their interactions with soda companies or their subsidiaries. Likewise, the soda companies emphasize their cooperation with the
state and the alignment of their social goals with those of the government, as in one of Coca-Cola’s reports: “The Coca-Cola Foundation joined forces with the National Commission for Physical Culture and Sports (CONADE) and the Ministry of Public Education (SEP) for the implementation of “Ponte al 100.” (Informe de sustentabilidad, Industria Mexicana de Coca-Cola, 2014 p. 19)
However, the issue of how private partners have taken part in the programs and information about the goals achieved is unclear and becomes even less clear in the most recent corporate reports.76, 81 They describe these activities as part of their CSR actions, but in recent years while they focus on activities related to the environment, rebuilding communities, and the arts, they have failed to report clearly on activities related to healthy living, diet, or physical activity actions/programs, with only snippets of information on their websites and from their charitable branches. 82 Meanwhile, public figures behave differently, while at the federal level, reports do exist, but leave most of the information, indicators, results, and impact quite unclear (see Box 2), calling into question issues of transparency, accountability, and stewardship.
Some confrontations between public and private actors can be seen in the history of each PPP studied. For the PPP in Ponte al 100, the discussion about accountability created a clear conflict for the program and for the PPP. Compared to its launch, when it was applauded by many politicians (Senate news), by the end it was highly criticised by many scholars, politicians, and public health actors due to the involvement of corporate actors and its lack of effectiveness in reducing childhood obesity (ref). The clear conflicts of interest for people involved in the adoption of Ponte al 100 as federal policy and its poor execution mark a turning point in how these programs are treated by the federal Ministries of Health and Education. The transparency of alliances with the private sector is no longer completely public
and open, but such alliances continue to exist. For example, the partnership between Nestlé and SEP Veracruz to execute the program Nestlé por Niños Saludables in schools is scheduled to continue through 2024. Also, Fundación Movimiento es Salud is still operating Ponte al 100, but as a program called Prospectiva 2030, in 5000 schools. And according to an interviewee, FEMEXFUT and NFL Mexico have promoted sports and physical activity initiatives in schools in different states. Accounts by public officials (CSO/FG representative) suggest a genuine belief that maintaining relations with the soda industry may influence the industry (e.g. to produce healthier products), and they are less inclined to acknowledge that interactions with the industry (or with its front groups) could influence their own institutions’ policies and practices. 52, 53 The flow of financing from the private to the public partner, however, makes it more likely that the F&BI or the private partner will influence the public partner than that the opposite will happen. 52, 53
In the case of the program Agua Saneamiento y Salud, the involvement of the soda industry is not obvious and has not been recognized in any document analysed as a fundamental problem or viewed as having implications for the human right to water. The governance, evaluation, and impact problems of programs carried out through PPPs on the issue of water have not attracted public attention like the other PPP programs studied have, perhaps because the nature of resource management through a bilateral organization like the IDB also dilutes the visibility of private sector participation.
Ethics, integrity, participation, fairness, and stewardship
The PPPs studied were not clear on their foundations, policies, or agreements or on their ethical principles, like the commitment not to harm anyone involved, target specific groups, and respect autonomy and equity. Although non-governmental organizations financed by the private sector and soda companies declare their values on their web pages, such principles are not established in the agreements available or evident in their execution as reported by our informants.
Integrity is also at stake in some cases, particularly considering that an institution’s practices are inconsistent with what it says is does (mission) or what it is obliged to do (purpose). While PPPs do not have a mission per se, they do have a purpose, which is to provide a service or improve an existing service. If neither the mission nor the purpose is measurable and achieved, then the integrity of the arrangement can be questioned. 53 A clear example of such discrepancies was found through the FOI requests related to the program Nestlé por Niños Saludables in the State of Mexico. The company had access to thousands of children at participating schools, but the state did not provide any evidence on how it arranged the partnership, nor did it specify its mission or purpose. While the private entity mentions:
“For 13 years, Nestlé por Niños Saludables [formerly Nutrir] has been successfully implemented in different parts of the country, impacting more than 4.5 million children in more than 6,000 public and private schools in Mexico, with a special focus on Mexico City, State of Mexico, Guanajuato and Veracruz. The program has shown that children have increased their consumption of vegetables and fruits, in addition to increasing their physical activity.” (Press release by Nestlé, 14 March 2019)
The public entity replied:
“After a meticulous search in the archives of this Administrative Unit, I hereby inform you that the documents consisting of contracts and / or cooperation agreements between Nestlé and the State of Mexico Department of Education are not available.” (Response from the State of Mexico Department of Education, 2020)
There are issues not only of accountability and transparency, but of integrity as well. Both Nestlé por Niños Saludables and Ponte al 100 are programs that have been granted access to children’s records (including the personal information of thousands of children and students). The private partner was viewed as the party responsible for the data, placing the personal information of thousands of children in the country at risk. Data protection is not even mentioned in any of the agreements reviewed nor was it mentioned in any of the interviews conducted. For example, even after attending a personal meeting at the CONADE to obtain complete information on Ponte al 100, the only information provided was on the agreement entered into between CONADE and Fundación Movimiento es Salud.
The accounts or perceptions of “beneficiaries” are ignored in every single PPP studied. While the PPPs praise the programs as beneficial for the vulnerable population, reports or accounts by interviewees do not confirm substantial concrete benefits for the population, and instead reveal issues of stewardship and participation.
Nevertheless, in relation to the principles of stewardship, fairness, transparency, and accountability, we found that each of these programs has been subject to criticism by the public, either through public representatives in the legislature, either the Senate or the Chamber of Deputies, or through several media outlets. Box 4 provides some examples.
Box 4. Two examples of claims from member of the Legislative Branch related to Centros de Hidratación and Ponte al 100
Centros de Hidratación: In September 2015, Deputy Claudia Corichi Garcia demanded that both the SEP and the SSA make information on the achievements and results of the installation of water fountains in schools public, as part of the National Strategy against Overweight, Obesity and Diabetes (ENPCSOD). She based her demand on the reforms amending Articles 7, 11, and 19 of the General Law on Educational Physical Infrastructure, which stipulate that “The existence of sufficient drinking fountains and a continuous supply of drinking water will be guaranteed in each building for school use in accordance with the guidelines issued by the SSA in coordination with the SEP.”
According to her claim, the aim was to have 40,000 water fountains installed but based on available reports only 6.68 % of them were installed, reaching 1175 water fountains in 2014 and 1,500 in 2015.” (Bulletin No. 0098, 64th Legislature, 26 Sept 2015)
Ponte al 100: In September 2016, Senator Martha Tagle Martinez filed a petition with the CONADE requesting information on the details of the program, including the names of all governmental and non-governmental organizations involved and each one’s contribution to the program. She presented the budget allocated to this program in 2013 and in 2014 (MXN$ 180,773,638 and MXN$ 202,122,147 respectively)*, claiming that “there is no official registration of the program” and the program “left financial damage while Mena was in charge of the CONADE” and that “some of the problems this program had were discussed in Semanario Proceso,” which investigated accounts of delays and the lack of transparency.” She mentions the discrepancies in Coca-Cola’s participation providing materials and equipment for the execution of the program and government expenditures made for that purpose in open tenders, duplicating expenses and raising doubt about corruption in the program’s finances.83
* CONADE reported different amounts related to yearly expenditures: MXN$ 254,392,276 for 2013, $94,085,542 for 2014, and $267,600,699 for 2015.
Conflicts of Interest, ethics, and fairness
Conflicts of interest are not part of good governance principles as defined in the existing literature but are a key issue encountered in our examples, particularly institutional conflicts of interest when participating in such arrangements. The status quo in many states and at the operational level is that industry participation is seen as normal in operating schools or public programs:
“I believe that all these programs are good because they provide a substantial benefit for school children. Sometimes, lower socioeconomic groups lack opportunities, and then they receive these
programs which can have a direct benefit for them… independently of [the private partner] promoting a brand, it is providing an extremely valuable benefit.” (Implementation team transnational FG)
This is what some scholars call institutional Conflicts of Interest (CoI). A CoI arises in circumstances where there is the potential for a secondary interest (a vested interest in the outcome – of the programs in these cases) to unduly influence, or where it may be reasonably perceived to unduly influence, either the independence or the objectivity of professional judgment or actions
regarding a primary interest (in this case the program to be delivered). 84 The conflict of interest in all PPPs is imminent, since the private sector parties –the F&BI–are either transnational food or soda corporations and they have a competing interest in their fiduciary duties, which takes precedence over the primary aim of the programs: to improve health and obesity rates. We have found that the public partner’s employees, both in the field and at the coordinating level, are largely unaware that the programs have a private partner or that the public sector has arranged reciprocity commitments with the private sector. 52 For example, for Centros de Hidratación an interviewee mentioned: “The only one who knew who the sponsor is was the director, and he decided if it was made known to the parents or not.”
Some of the interviewees did not consider there to be a problem of institutional conflict of interest by having the F&BI as designers, executers, or evaluators of the programs researched, particularly programs that started a long time ago. However, some of the agreements found include clauses that require the public sector to mention or acknowledge the private party or label program material with its trademarks. 85, 86 For example, this could involve naming Coca-Cola on a silver plaque next to a water fountain or using Nestlé logos on the material provided, among others. Likewise,
Power dynamics
implementers reported in their interviews that brand promotion at sites was present in either a subtle (e.g. brand colours) or an obvious way (e.g. logos), but neither the interviewees nor the beneficiaries considered them relevant or inappropriate (see quote in Box 5).
Some of the public actors interviewed did find it difficult to understand, and to accept, industry collaborations, and they mentioned that they have tried to change the behaviour of local authorities around CoI, but at times higher up in the power chain of actors, relationships with the F&BI prevail and are “untouchable.”
“We are resisting the entry of these companies [to schools and programs], it has cost me at least a series of reprimands and threats because there are commitments at higher levels than mine with these companies. In some ways we have resisted, and that’s why at this time we do not involve those companies.” (Public sector representative)
As explained in previous documents and reports, ties between the F&BI and the authorities have been very close for many years. Although some efforts to eliminate them are considered under the new presidential administration, they continue to exist, particularly with local governments.
In terms of power, in all the PPPs studied the power between partners is unevenly distributed and has changed over time. This power asymmetry starts with the public actor being the “gift receiver” (ref) vis-à-vis corporate involvement. Whereas the significance of a gift for the private actor can be minimal, for the public partner it may “feel like the only thing keeping the recipient afloat” (Marks J, Ch. 4 p. 61).
“The companies that have the financial capacity to support […] are companies that produce unhealthy food ... telling people not to consume certain products, and the companies that help you to pay salaries are the ones that produce them. I wish we had 5% of the money that they have but we don’t.” (Public sector representative)
The power of decision and control over the political agenda in the initial period of the PPPs, particularly those related to schools, is strongly controlled by the F&BI. In some agreements, the industry is portrayed as providing’ a “donation,” while the recognition of the soda industry or food industry in government’s public events was a stipulated requirement. This is an imminent example of the exercise of undue corporate influence. However, we
see that in other fields, such as when accountability has been publicly demanded (See box 4), power rests with the claimant, and the government entity involved in the PPP is the one responding, with or without information or vaguely.
In other cases, such as water management, we see that both soda companies and other entities, like municipalities, wield more power than any other actor involved. CONAGUA, in this case, becomes an instrument for the corporations, as it has minimal power over water concessions. Water concessions are already granted, and it is the concession holder, for example a transnational soda company, who has absolute authority over the use of and access to water. 87 There are no clear and precise accountability mechanisms for these efforts, and they remain in the hands of the private sector and beneficiaries at the municipal level.
Efforts to combat corporate power in food policymaking have been constant in recent years, and more so since the current left-leaning administration took office. Corporate power has been blocked through very specific actions and mechanisms, in which civil society and some academics are involved, like the Open Government Partnership (OGP) (an initiative starting even before the new administration took office) or the intergovernmental strategy GISAMAC, recently established under the current administration. 88 The power to define problems and to shape the agenda has shifted, giving greater voice to civil society groups that defend public policy. Civil society and members of vulnerable groups have had greater influence in decision-making and a greater voice in governance. This change has been explained and exposed in internal GISAMAC documents, by several interviewees, and in the OGP reports, but it has not been officially documented on any government portal. Nevertheless, such new governing aids have also had problems, as some of the rights and terms demanded have been circumvented by government or private actors.
Risks and benefits of PPPs
Several risks and benefits were mentioned by interviewees and identified through the document analysis. We describe them in this section.
Private
partner framing the problem and the solution
We found that framing problems and the solutions for public health nutrition programs in certain ways, has become a strategy to perpetuate PPPs. For example, at least two of the PPPs studied support framing obesity as a matter of personal responsibility or the idea that water consumption and physical activity are a result of individual decision-making. This framing has been well studied and has been used systematically by politicians and by private sector actors, especially by the soda industry, in particular to emphasise that inactivity is the main cause of obesity. The emphasis of this approach is called “nudging bias” in obesity policy and tries to influence the decision and behaviours of individuals. This nudge has led leaders and policymakers to neglect public interventions directed at changing corporate behaviour and instead focus on individual behaviours. 89 For example, the Fundación Movimiento es Salud website affirms that:
“Ponte al 100 is an educational initiative on wellbeing that empowers the population to take responsibility for their physical health and have the tools to adopt healthy lifestyle habits and create appropriate school, work, and community environments.” (Website: movimientoessalud.org.mx, consulted Oct 2019)
Additionally, the framing of support by the private partner prevails for PPPs to continue, and positive perceptions of such arrangements also prevails among local governments and the population. As the local government of Guanajuato framed the collaboration with Nestlé:
“By combining our efforts between business, society, and government, we are all strengthening the state’s ability to achieve better things, which reach more places and on the best terms, giving us a model for ongoing support in the area of nutrition.” (Guanajuato Government Bulletin, December 10, 2017)
The public-private partnerships studied generated benefits for the private partner and alleviated the net financing of public programs. The belief that the government is financially unfit or lacks adequate personnel or capacity was a recurring theme among several interviewees and reports. For example, an interviewee mentioned:
“Some alliances with the industry might work, but not in schools [...] Now we are working on a diabetes program [outside schools] in partnership with a private university and in alliance with Fundación Bepensa. They sponsor the glucometers […] I’m not thrilled because it’s a health program. It is an alliance that helps them ease their guilty conscience; it helps us because we don’t have resources; these are scenarios where we value working with them.” (SSA informant)
This belief might be used as an argument for perpetuating the status quo of private sector involvement in these partnerships. And it might also influence the public partner or “gift receiver,” as they might then have a compromised attitude and a duty of reciprocity.
Some actors perceive F&BI “support” as an important economic aid to the government, while others see it as a risk to the public health agenda or perceive PPPs as a mechanism that is diluting public health actions and serving commercial goals instead. Positive and negative perceptions of PPPs are summarized in Box 5. Either way, the perception that the government is in need or unfit to execute and achieve health objectives on its own prevails and continues to perpetuate the narrative around corporate relief.
Box 5. Perceptions about PPPs among interviewees.
Positive:
• Private sector intervention is not always seen as a negative, for example in the case of water governance:
“In Monterrey, Fundación FEMSA’s work on water looks great, because they’re from Monterrey and it’s almost a source of pride, and they have a good water system... Instead, Coca-Cola in San Cristóbal had to negotiate a lot, they were perceived as the bad guys.” (IDB informant)
• The PPPs are perceived as a positive arrangement because the state lacks the (financial) capacity to provide needed services and the civil society organizations providing the services fill the vacuum.
• For some civil society actors, what’s relevant is that the “sponsors” (the private sector) know exactly what they are doing in the field, but it is not deemed appropriate to disclose the relationship with the private partner to the population in general or to beneficiaries.
• Another perception is that “Government is not taking advantage of the services or support NGOs are giving them” (CSO/FG representative) and see private sector funding as useful to provide services that the government wouldn’t provide otherwise.
Negative:
• For some interviewees, the participation of the F&BI or NGOs financed by the F&BI was perceived as a conflict, because programs are health related.
“Coca-Cola was promoting it [Ponte al 100]… It was a very complicated strategy, with very high costs, even though they said it took a holistic approach, it was loaded towards the physical activity part; to sanitize their image, they took advantage of it, and everything was painted red.” (SSA informant)
“They achieve the specific goal of appealing to potential consumers in certain populations… since they [corporations] really consider or believe that there are benefits for the school. The disadvantage is in the strategic ways the industry ensures that consumers are exposed to and driven to consume products positioned as healthy. They take advantage of their economic power and the vulnerability in which we find ourselves.” (Expert)
“On multisectoral governance or collaboration platforms, it looks great to involve civil society; the problem is what kind of civil society participates because when you look closely, they are NGOs sponsored by the F&BI. However, since they are presented as civil society, they always have this image of an independent organization, and the reality is that they are not.” (Expert)
• Other negative opinions of PPPs are related to their origin and operation and circumstances where the private partner benefits from the partnership. For example: “They [private partner] create their altruistic foundations to generate a structure for tax deductions” (Expert).
“The moment it [the program] is given to the private sector, they are no longer merely public resources [and] a problem of accountability arises. [The private partner] is not being held accountable, for instance, if the children improved or not” (Expert).
PPPs promote brands, have unclear results, and have limited liability
The promotion of the private entity and its brands occurs in all cases, either directly or indirectly, without much negative perception, because it is seen as a common practice. An interviewee explained this situation in schools: “The sugary drinks industry, and mainly Coca-Cola, installs water fountains or soccer fields, obviously with a sign, and when you talk with teachers and the school principals, they have no issues with it.” (Member of international organization).
Branding and promotion activities while conducting a program intended to promote health interferes with its aim. It is a conflict of interest, as the secondary interest to unduly influence participants as potential consumers of those brands interferes with the program’s primary aim: to improve dietary habits and childhood obesity rates.
Although a partnership might sound laudable, there is little evidence that the partnerships achieved what policymakers were hoping. Efforts to address obesity or associated chronic diseases with the PPPs studied failed to show an impact on water drinking habits, physical activity levels, or water access or have a measurable impact on obesity. For example, Ponte al 100 was implemented nationwide, as an intervention to help reduce sedentary lifestyles and indices of overweight and obesity, but results showed a “decrease in fat from 1% to 2%, so it was not possible to give the Physical Culture programs credit for helping to promote a culture of health and contributing to the solution of the public problem of lack of physical activity.” 71
Several risks were identified by this study or by participants and some potential solutions or changes to publicprivate relations surrounding food and nutrition programs were identified. For instance, new approaches to policymaking described by some of our interviewees are questioning long-held beliefs and narrative around financing and framing. New approaches to conducting and producing policies to change environments and to tackle commercial determinants of poverty and nutrition (defined as “strategies and approaches used by the private sector to promote products and choices that are detrimental to health”12 are emerging. For example, GISAMAC, a program launched by the new administration, is working transversally on harmonized aims to achieve better food for all in a sustainable way (Gisamac internal document), as discussed below.
Changes in food policymaking within PPPs
PPPs with the F&BI aiming to execute programs related to food and nutrition remain the norm in Mexico, regardless of the ascent of President Manuel Lopez Obrador and his leftist political ideology. More examples than the four PPPs selected for this study exist. Nevertheless, a slow change in perceptions around them is occurring. The next section explains some of the changes this study explored.
Changes in food and nutrition governance in Mexico
As mentioned above, civil society support in favour of public policies that protect the right to health has been strengthened in recent years. This has not been an isolated case, but rather the reaction and the result of multiple efforts and citizen complaints about governance problems, including water management in CONAGUA, corporate influence in former president Pena Nieto’s obesity policy, and commitments made to combat corruption and poverty.90 An exceptional case that created a precedent for the current GISAMAC proposal and served as a case study in abuse of power and the unilateral nature of certain decisions was the experience of the Open Government Partnership (OGP).91
The OGP exercise has occurred three times in Mexico, the last was for the period from 2016 to 2018. The objective of the alliance is to have a horizontal mechanism for permanent dialogue between government and civil
society to improve the transparency of government actions and guarantee the participation of civil society in the definition and relevance of government actions, thereby improving accountability, participation, and transparency. In it, priorities and commitments for public policy are discussed and drawn up. These include the problems of health and obesity, public services and water, combating corruption, governance of natural resources, poverty and inequality, human rights, and gender equality. According to informants, the experience of the last exercise generated controversy and resulted in civil society’s withdrawal due to multiple violations of the agreements. After reaching a consensus, the wording of the commitments was changed unilaterally, reducing their scope. Regarding the Obesity commitments: “The Health and Obesity commitment presented significant changes from the original proposal, which proposed addressing substantial
deficiencies in combating the conflict of interest and drafting changes to the official Mexican regulations for the control of overweight […] and the powerful influence of the food and beverage industry on obesity policy.”90
This experience, as well as the implementation of front-of-package warning labels in 2019, have provided motivation for a new public policy proposal based on transversal and inter-institutional policies in which objectives, goals and actions that protect and improve the current food system and lead to a sustainable system are outlined (up to date, on a voluntary basis, according to our informant):
“[Members] of this group [GISAMAC] have so far achieved many joint actions such as front-of-pack labelling, which becomes official as of October 1 [2020]… It was achieved because this group got together and when it was necessary to participate and vote in the different areas, all voted together in favour of the norm and it was enacted.” (Civil Society Representative).
Although at the time of our investigation there was no document whereby the GISAMAC was formally constituted, the group had been working for several months, and before the pandemic, they referred to the group as an effort of wills and policy entrepreneurs: “here is good will to make everything you have available
with a common goal. What is that goal? Change the Mexican agricultural system.” (Civil Society Representative).
Another important finding has been the call issued by the country’s Human Rights Commission to protect the rights of children . This call was made specifically to state-level public officials to prioritize programs and policies that protect children.92 This has served as an argument to shield policies from undue influence by the F&BI. However, despite this being the official and federal rhetoric, in practice the industry’s involvement continues to be seen in several states throughout Mexico and under certain governorships (Nestlé por Niños Saludables case, Monterrey Conagua / Femsa case, Ponte al 100 case).
It is still too early to conclude that changes have been made in governance that have impacted PPPs at this level, but the perception is that changes are being made to the normative values of these associations in relation to health and nutrition, particularly with children.
Public awareness on COI and of industry interference in food policy
Several informants have linked the issue of PPPs to current changes in food policy and the growing consolidation of civil society free from corporate influence, and the academic community, to exercise the right to information and accountability. Greater awareness of the commercial determinants of health has been generated in the country and the issue has been received with great interest in the SSA under the new administration. However, it is not clear that it has been received the same way in other public agencies. Recent proposals to limit the sale of junk food in several states and the national strategy for front-of-package labelling of food have been protected and defined by key players, with international support.
In general, in relation to policies linked to tackling childhood obesity, civil society is prepared to expose and advocate for policies that exclude the participation of the F&BI.
“…forty percent of my time, [was spent] discussing conflicts of interest. The issue [should] always be placed at the centre of policy discussions.” (Member of international organization)
Recommendations
Our findings yield several recommendations to be considered by government, academia, and civil society organizations and private partners. In general, they are for anyone who is committed to consistency and ethics in the public policy agenda and concerned about the need for the government to address pressing social and health issues in relation to improved nutrition and access to safe water and food in Mexico.
Actions for Government
• Improve resources, access, and tools to enhance accountability in public programs aiming to improve health.
• Public entities should explore alternative schemes of financing for public health programs aiming to control obesity, increase physical activity, and improve access to water and sanitation and other health-related programs, rather than engaging in PPPs with corporations with conflicted interests.
• Government actors in general, and parliamentary commissions (e.g., health, education, and human rights) in particular, should discuss and propose guidelines and legislation to regulate PPPs. These should include restrictions on engaging in PPPs with transnational F&BI when conducting public programs aiming to control obesity, improve nutrition, increase physical activity levels, and improve access to water and sanitation.
• An expert panel or commission should be formed to evaluate conflicts of interest around potential PPPs and rule for or against the creation of such partnerships, after assessing their risks.
• As regards existing PPPs with the food and beverage industry, a core redesign should be considered to avoid ineffective interventions purportedly aimed at alleviating public health nutrition problems. For example:
Develop tools to protect public policy and public programs from partnerships with private sector entities that have inherent conflicts of interest.
Ensure the participation of community and civil society groups that support the human right to adequate and nutritious food, including the right to water, as a key element of any intervention seeking to improve nutrition and health and address obesity and chronic diet-related diseases.
Enable external (non-conflicted) evaluators to assess the design, implementation, and evaluation of the programs conducted under PPP arrangements.
In general, improve national norms and regulations on fiscal transparency and on non-promotional practices when engaging in PPPs.
Actions for Civil Society
• Support citizens and beneficiaries to hold private and public partners to account when they engage in public health programs.
• Question the framing of public problems and solutions when private partners involved, such as national or transnational F&BI, have conflicts of interest.
• Advocate for community and civil society participation in policymaking and in all stages of developing programs to support the human right to adequate food, nutrition, and water.
• Demand transparency in programs conducted under PPPs and expose potential financing and implementation loopholes that perpetuate the government’s use of such partnerships.
• Analyse discursive commitments (on paper) versus actions taken in existing PPPs to hold them to account.
• Ensure that the human rights to adequate food and nutrition are protected from any commercial interest when engaging with private partners.
Actions for Academia
• Conduct and disseminate exploratory studies to generate evidence on PPPs related to food, nutrition, and health at the national and sub-national levels.
• Question the framing of problems and solutions when the domestic or transnational F&BI industry is involved in programs or projects related to food, nutrition, and health.
• Independently evaluate the design, implementation, and evaluation of programs conducted under PPPs.
• Academic institutions should follow codes of ethics and guidelines to protect science from any engagement with private partners that may interfere with the performance or impact of research principles.
Actions for Private Partners
• Improve information management, public access to information and accountability tools for programs conducted under PPPs.
• Guarantee that resources that ensure transparency are available to the public and match public records.
• Have clearly defined goals to benefit the public.
• Declare all related interests.
• Ensure ongoing transparent communication among partners and with beneficiaries.
Limitations
Whilst this research was designed and implemented using best practice available to us to address the study aims, we acknowledge the following limitations:
Looking at individual partnerships in isolation might neglect the cumulative and synergistic effect of PPPs, regardless of some of them being ethically problematic. To identify and discuss the systemic impact of PPPs, it is necessary to look farther, and examine the network of influence these transnational F&BI have on domestic and global policymaking.
This research was conducted prior to and in the midst of the Covid-19 pandemic, when global public health issues and challenges were not only occurring and constantly limiting the availability of informants and responses from the government but shaping local and international action in response to the pandemic. This might have affected some views and answers among our interviewees.
A challenge encountered during the research process is that each partner or actor provides different information in relation to the same program or objective. It was challenging to track the collaborations, as there is no consistency in naming, reporting, monitoring, or talking about these PPPs. For the purposes of this report, we use the title as we first encountered it in the literature, although it might have changed over time or by the time this report is published.
Conclusions
A detailed examination of existing partnerships in the field of public health nutrition sheds light on subtle ethical dimensions and limitations of PPPs that might otherwise be missed. This research adds evidence on the negative outcomes of PPPs and the concerns surrounding them (framing effects, influencing the agenda, reporting results, etc.), specifically regarding education, health, and water access and quality. Although a partnership might sound commendable, there is little evidence that the partnerships achieved what policymakers were hoping to achieve and what local populations most needed. The efforts to address obesity or associated diseases, or access to water, through tailored programs run by the PPP arrangements studied here have failed to show an impact on the population’s health, mainly because there are no clear indi cators or impact evaluations available.
Although there has been concern about PPPs for many years among scholars, public officials, and activists,50, 93 no clear guidelines have been given on how to handle conflicts of interest and governance problems in such arrangements other than those published in collaboration with representatives of the food industry or the general guidance for any type of engagement with the food and beverage industries and with the tobacco industry.84, 94,96 Low- and middle-income countries are in a more vulnerable situation than high-income countries due to their known lack of resources in public bodies and poor resource management, as in the case of the PPPs studied. Furthermore, progress in changing public perceptions of the problems PPPs create in nutritional public health is slow. Such arrangements are permanent in many settings, but with more complex forms of governance in low-resource countries, they fail to respect autonomy and to engage the active participation of the beneficiaries or the populations served and can lead to potential human rights violations.
PPPs are endemic and in some instances they may still be a good way of financing public health initiatives; nevertheless, a core redesign of participants and governance needs to be considered so that they do not end up doing more harm than good. PPPs might enable the involvement of industries other than the F&BI, whose products or practices are not contributing to public health problems, to avoid the unethical principles of the PPPs studied. Nevertheless, this will not be sufficient to change the problems that these PPPs have in framing problems and solutions and shaping the policy agenda. As our results show, lack of trust in public institutions increases when engaging in PPPs with F&BI for health-related programs. Therefore, for public institutions to preserve their independence, integrity, and credibility they need to insulate themselves from industry influence. As shown in this study, the private sector uses the public sector as a vehicle to reach the population it wants and set its own agenda.
The use of core principles and practices is a necessary way to move forward, including those on ethical decisionmaking and good governance. Efforts to achieve these types of positive interactions are emerging in Mexico due to unprecedented exhorts by the Human Rights Commission to protect children, or the GISAMAC initiative taken by the current administration aiming to reduce industry i nterference in food policy making.
Nevertheless, we need to see if these arrangements move forward given the normative power soda companies have exercised in Mexico for years. Even with the new government’s powerful mandate to avoid relationships with the F&BI (at least at the federal level under the SSA), financing and webs of influence are powerful factors that can undermine the firm intent of the current mandate, making the establishment and adoption of PPP guidelines by government bodies and vigilance by the academic community and public health advocates essential.
