A push for partnership approaches
Unhealthy commodity industries, including the alcohol, food and fossil fuel industries, have consistently advocated for multistakeholder governance approaches that include them as ‘part of the solution’ in public health policymaking (Lacy-Nichols and Williams, 2021; Van Den Akker et al., 2025). Arguments in favour of these partnership approaches often refer to industry’s technical and financial resources and the supposed ability of multi-stakeholder partnerships to unlock efficient, effective and inclusive policy solutions (Van Den Akker et al., 2025). These arguments align with a wider commitment to collaboration on the part of many public institutions, from the local to the global level. Examples of collaborative approaches that have been criticised for their involvement of unhealthy commodity industries include the much-criticised UK New Responsibility Deal, the 2021 global Food Systems Summit, and the EU Platform for diet and physical activity, all of which were criticised for their failure to address corporate power and the limited scope of their solutions (Canfield et al., 2021; EPHA, 2019; Knai et al., 2018). Although the principles behind such partnership approaches – inclusivity, diversity, collaboration – are aligned with public health goals, there is a lack of critical reflection on whether multi-stakeholder partnership approaches in their current iterations can live up to this promise, particularly when they involve unhealthy commodity industries.
The evidence on partnerships
A 2019 review showed that there is no independent evidence to suggest that public-private partnership approaches to health promotion are effective (Parker et al., 2019). Instead, case study evidence repeatedly shows that partnership approaches are likely to result in voluntary approaches that focus on individual responsibility or set highly conservative targets (Knai et al., 2015; Rosewarne et al., 2020). Analysis of the Dutch prevention agreement on overweight details how the government’s commitment to collaboration enabled industry stakeholders to block a sugar levy by threatening to walk away from the policy process (Lelieveldt, 2023). Preserving the collaborative policy process took precedence over adopting more robust public health measures. Analysis of the internal structures of multi-stakeholder partnerships show that these often lack clear accountability structures, suffer from power imbalances, and are limited in who they include as ‘stakeholders’ (Hofmann, 2016; Van Den Akker et al., 2024b). Beyond considering the outcomes of multistakeholder partnerships, it is important to reflect on how their structures shape who is recognised as a legitimate ‘stakeholder’ in policymaking, and whose voices remain marginalised.
Who gets to be a partner?
Examining who is actually able to be involved in partnership approaches speaks directly to one of the main supposed benefits of collaborative governance: inclusivity. Who gets to be involved in the policymaking process explicitly or implicitly limits what problem framings and proposed solutions are deemed acceptable. An analysis of tactics used by extractives industries to increase the socio-political acceptability of extraction refers to ‘inclusionary control’ as the tactic of creating ‘pseudo-participatory’ forums that include manufactured subjects such as ‘the civil society actor’. By creating and controlling who gets to be included as ‘stakeholder’, the corporate organisers of these forums get to set the terms of debate while also weakening dissent through the apparent inclusion of a diversity of ‘stakeholders’ (Verweijen and Dunlap, 2021). As this example demonstrates, participation in itself does not guarantee inclusivity; rather, the design of participatory or collaborative spaces may reproduce existing power imbalances and narratives, while appearing to be consultative. The structural elements of a partnership – where it is hosted, who funds it, and with what requirements – shape who can participate. Seemingly technical decisions about timing and location of meetings can significantly influence who can be present. For example, a global food partnership whose meetings are hosted in Geneva during harvest season is unlikely to be able to have a wide representation of local farmers able to attend. Indeed, a network analysis of global multi-stakeholder food initiatives shows that these mostly include transnational corporations who are headquartered in the global North (Van Den Akker et al., 2024a).
A cycle of corporate access to the policy process
Policy contexts that hold collaborative multi-stakeholder approaches at the core of its approach to governance provide a fertile ground for corporations to influence the policy process. Recent research on the tactics of the ultra-processed food industry in the UK shows how commitment to multistakeholder governance allows commercial actors to advance their agenda through multiple collaborative policy fora (Ralston and Hawkins, 2025). Industry involvement in public health policy can become a self-perpetuating cycle, as commercial actors push for multistakeholder governance by referring to prior involvement in partnerships to further legitimise and embed their role as policy ‘stakeholders’ (Van Den Akker et al., 2025). In support of this, it is a known tactic used by the tobacco, alcohol, gambling and unhealthy food industries to frame the industry as socially responsible actors who can be trusted to self-regulate and should be considered part of the solution (Ulucanlar et al., 2023).
Conflicts of interest and undue industry influence
Amid increasing constraints on public sector resource, calls for more inclusive decision-making and an enduring commitment to multistakeholder governance, there is a need for a more refined understanding of commercial actors’ involvement in public health policymaking. Yet, in the context of unhealthy commodity industries, protecting the policy process against undue industry influence remains key for developing and implementing effective public health policy. This includes rejecting ineffective partnership approaches and developing strong guidelines for industry involvement in public health policymaking.
"While engagement with commercial actors may in itself not always be undesirable, it remains important within this to recognise the primary remit of corporations to be a profitable enterprise."
Amber van den Akker
When a corporation’s profit relies largely on the sale of unhealthy products, this creates a fundamental conflict of interest with the government’s primary responsibility to advance the wellbeing of their population. Recognising this fundamental conflict of interest is a useful starting point for public health researchers, advocates and policymakers to work towards a coherent framework to protect against undue influence on public health policy. Relevant safeguards may include clear conflict of interest guidelines, principles of good governance, transparency requirements and limits on industry involvement through partnership approaches as key measures to enable effective public health policymaking on commercial drivers of ill health.
Amber van den Akker's work is supported by UK Research and Innovation funding for Local Health and Global Profits, part of Population Health Improvement UK (PHI UK).
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