Some years ago, one of us (S P) left his job as a specialist physician in the Danish National Health Service to take up a position in the pharmaceutical industry, with the Danish diabetes care company, Novo Nordisk. He spent the next 15 years fielding the questions of worried people who wanted to know if he missed working as a (real, honest) doctor.

Today, he heads the Oxford Health Alliance, a non-profit global collaboration for health — started with an industry grant from the same company. The Alliance is trying to find solutions to the huge problems arising from lifestyle disorders such as diabetes, cardiovascular diseases and chronic lung diseases.1 The Alliance includes not only academia, government and non-government organisations, but the private sector, including some global corporations. In some people’s minds, this makes it inherently untrustworthy. We find ourselves fielding another question: “Can you work with industry to improve the public’s health without sacrificing your professional and organisational ethics and integrity?”

Surprisingly, the most vocal critics of any involvement of for-profit organisations in efforts to advance public health come from opposing camps. On one side are purist academics and certain non-government organisations, and on the other, some business people and fundamentalist economists.2 One obvious problem is conflict of interest arising from extensive alliances between scientists and academic institutions and the private sector.3 Another valid criticism is that the pursuit of self-interest comes at the expense of objectivity, demonstrated by studies that have found a significant relationship between industry-funded research and results that favour industry.4

The politically based critics of alliances with industry automatically assume that industry is motivated by the desire for improved public relations, the co-option of opinion leaders in the scientific community, or leverage to forestall legislative and regulatory efforts that may prove unfriendly to business. When companies are driven by the need to make profits for their owners and investors, corporate objectives are seen by many as inherently incompatible with initiatives to improve the health of the general public.5 In the business world, it is not uncommon to hear phrases such as “the business of business is business”, or that the only true responsibility is to the shareholders and any deviation from this is bad business. But, in the light of global warming and the magnitude of the social and health burden associated with contemporary lifestyles, these truisms do not hold up.

We are not advocating naivety. After all, tobacco use has been fought for 50 years and still it increases in many countries, despite the World Health Organization’s Framework Convention on Tobacco Control and the irrefutable evidence that underpins it. The tobacco war has left almost everyone in the public health professions with the feeling that you cannot trust industry. At the same time, the powerful pharmaceutical industry has gradually lost much of its credibility by concentrating more on making money than finding new and better drugs.

The pharmaceutical industry has also been repeatedly, and in many cases deservedly, criticised for suppressing unfavourable research results.5 However, while we unreservedly subscribe to the notion that “two wrongs don’t make a right”, we cannot quite come to terms with the different standards often applied to the self- interest of government and the self-interest of corporations. For example, there is considerable anecdotal evidence that government departments have declined to publish commissioned reports, or parts thereof, for fear of attracting criticism if they or the incumbent government fail to act on the content. What this tells us is that whenever two or more parties interact, regardless of whether the interaction is public–private or public–public, there will always be potential for interference and tensions between the self-interests of the parties concerned. Such conflicts are part of life, so the lesson is not to refrain from working together, but to put safeguards in place to control the dominance of the party whose interests may have detrimental consequences and, in the case of industry, to engage early and transparently to find solutions that produce mutual benefit.

In the long term, business can only grow and thrive in societies that function well, and faltering economies, damaged human capital and global warming will also heat boardrooms. All businesses function within the legal frames defined by the societies in which they operate and will not survive in the long run if they do not. In an ideal world, business could be regulated in ways that are closely aligned with the goals of the democratic societies in which they function. But regulation is often too little, too late, and we do not always know precisely what will fix the problems we create. Furthermore, governments are far better at using regulation to punish bad corporate practice than at creating incentives for companies to compete on their contribution to improving health and the environment. However, the recent leadership of the climate change debate, adopted by many corporations previously opposed to change, is one example of how change is possible when the balance between punishment and incentives is shifted. The collaboration between the World Wide Fund for Nature and the large construction company Lafarge is an example of integrating sustainability into the company vision.6 The Forest Stewardship Council is an example of a successful worldwide collaboration for sustainable forestry among loggers, foresters, and environmentalists.7

Today, we see some early adopters — these are corporations that are adjusting their product portfolios and corporate social responsibility policies to contribute to solving big societal issues. For example, Novo Nordisk has for many years reported on its environmental impact. The company works to reduce harm through corporate programs and a foundation to support better access to health in the least developed nations.8

Some companies are redefining what it means to be a good business and playing important roles in finding solutions to the problems of health and environment, for a variety of reasons — social responsibility, or to grow and protect their future as well as their current business interests.9 Capitalism has many forms, and the Scandinavian model seems to show that a collaborative public–commercial approach can work if people want it to, and even in a way that creates happiness for the population, as evidenced by the consistently high rating of the Scandinavian countries on world happiness rankings.10 And, as well understood by Gro Harlem Brundtland when she called on relevant industries to collaborate on the global diet and physical activity strategy shortly before retiring as Director-General of WHO, markets can be shaped to promote better lifestyles if we can find the right levers.11 We will never know how successful Brundtland may have been in this had she remained at WHO, but we do know that the dialogue between WHO and industry has continued.

A synergistic approach will take time, and we have little history of sustained interaction to guide us. We must therefore seek ground where profitability and public health coincide and challenge practices that place profits and public health in conflict. Market forces, applied appropriately, could be a powerful means of advancing health. Having no interaction with industry means missing the opportunities for using the unique skills and resources of all parties. Yet interaction, particularly when money changes hands, must not undermine public confidence or the common good, or distort what all progress must be based on — sound evidence from rigorously objective research and evaluation.

So the answer to our question about working with industry and business is that we cannot afford not to. They make our world go around: their products, services and advertising shape our lives and construct our futures, and their capacity to employ people far outstrips that of governments. Health and the physical environment cannot be changed without them.

We must put aside ideological trench wars and make a genuine and concerted effort to find ways of working together for health that satisfy and uphold transparency, accountability and community ethics. This will require experimentation and the will and innovation of public authorities to find appropriate and accountable ways of working with all stakeholders, including the food, agriculture, building and other industries. There will be mistakes, possibly even blunders, but if we are to achieve lasting, positive change, this must be tried and tested.

The Oxford Health Alliance illustrates a new way of working with industry, that is, bringing public and private interests to the same debate at the same table. It intentionally works with industry and, in its short life, has been instrumental in taking the chronic disease prevention agenda out of the health silo and into the broader environment in which the agents of chronic disease are generated. The Alliance is conscious of the potential pitfalls associated with industry partnerships. It guards against these by: (1) making public its methods1 and the names of its collaborators and funders (see http://www.oxha.org); (2) having and following transparent guidelines for working with industry; and (3) prohibiting the use of its name in association with specific products.

The Alliance will not work with the tobacco industry and has been a strong supporter of the Framework Convention on Tobacco Control. It is willing to work with any legally constituted, credible entity that wishes to align its business goals with promoting health and human capital, whether public or private, and which is willing to work within the Alliance’s philosophy and framework for transparency.