As it happens, I know quite a bit about health promotion. It was an area I worked in prior to becoming an MP. What differentiates health promotion from the strict biomedical model, or from health education, for example, is its focus on communities and risk environments, rather than individual risk factors. That’s because health status is not randomly distributed amongst individuals, but rather clustered. Poor health predominates in communities that are disempowered in some way (eg poverty) or exposed to other “risk environments” (including both physical and social environments as well as economic factors).
The two greatest causes of preventable illness and death in New Zealand are tobacco and unhealthy diets. Alcohol does not cause the same amount of health-related harm as these other two, but because of the harm it causes in other parts of society (eg violence) it is also considered one of the “big three”.
What health promotion says is that it is not very helpful just to give individuals information about healthy and unhealthy alternatives. Evidence is strong that this will have little effect. The measures that are successful are more about using law, regulation and other tools to increase the price of these unhealthy products, reduce availability and reduce marketing and normalisation, as well as engage whole communities in creating new community norms and setting health goals.
I was a strong supporter of the establishment of the Health Promotion Agency, and have argued for its role to be expanded. However, the significant criticism I have had is over the composition of the HPA’s Board – it doesn’t have the expertise you would expect for an agency like this, it is stacked with people who seem to be political appointments (a couple of National Party electorate chairs and a former MP, for a start) and at least one person has very substantial conflicts of interests.
Managing conflicts of interest is a common problem in New Zealand. We are a small country and people often end up playing multiple roles in a given sector. This has led to well-developed processes and ethical standards in the corporate and community sectors. In the state sector these have been taken further, with specific duties defined in law. The duties applying to members of the Board of the Health Promotion Agency are set out in the Crown Entities Act 2004, and in related guidance from the State Services Commission and other authorities. They are highly specific both to ensure that such conflicts don’t compromise the actual work of the entity concerned, but also to enable transparency, so that we can all retain trust and confidence in the integrity of the organisation.
In the case of the Health Promotion Agency there are three levels of protection:
- All members must declare their “interests’ (what else they’re involved in) at the time of appointment, and then update this as required at every meeting.
- At the beginning of each meeting, members of the Board who have a conflict of interest with any paper being presented to the Board or item to be discussed by the Board at that meeting, say so and it is recorded in the minutes.
- Any member who has a conflict of interest with an agenda item may not participate in the discussion or decision-making (or do anything else actually) in relation to that item. Very occasionally the person who has a conflict of interest may well be the person around the Board table with the most knowledge and experience about it. The law recognises this and provides for the Chair to permit a member with a conflict of interest to participate if this is in the public interest. However, such a waiver must be in writing prior to the meeting, and must be recorded in the Annual Report of the entity.
Which all brings us to Katherine Rich. When she was an MP I admired Mrs Rich enormously. Even though she was on “the other side” of politics from me, she was a social liberal and was gutsy with it, standing up for human and civil rights in a National caucus that often didn’t seem well-disposed towards them, most famously against the “hollow men” regime of Don Brash.
So I was disappointed to see her take on the role of chief executive of the Food and Grocery Council. The Council is a voluntary organisation of companies involved in the manufacture and distribution of, well, food and grocery products, and exists to advance their interests, including profitability. Many of these products are unexceptional, of course, and I have no knowledge of how Mrs Rich spends most of her days there.
However, the activities that go with her role that I am aware of involve her public advocacy (including engagement with Parliament and Government), on behalf of those members of the FGC who are tobacco companies, alcohol companies and companies manufacturing or distributing food and drink products known to be unhealthy. With her FGC hat on, Mrs Rich has opposed all of the legislative and regulatory measures designed to reduce smoking (display bans, tax increases, plain packaging), has advocated for minimising the effect of alcohol law reform, has opposed taxes on sugary drinks and other regulatory approaches to improving food content, and has also opposed “traffic light” front of pack content labelling on food and drink products. For a start.
These are all classic health promotion measures intended to reduce the risk of the environments around vulnerable communities. These are exactly the kinds of measures we should expect to see supported by New Zealand’s health promotion agency, and because of their contribution to New Zealanders’ health status, should be the top three areas of work. What’s more one of the consistent themes across the FGC’s advocacy on all three product categories, has been the line pioneered by the tobacco industry that everything’s a matter of individual choice. This theory of individual choice is not supported by evidence, and is completely at odds with the health promotion “risk environments/social determinants” approach we should expect to see from the HPA.
I argue (and I’m not alone – essentially the entire health promotion sector, and the wider public health community agree with me) that Mrs Rich’s role in the FGC, and the activities it has required her to undertake, constitute a serious conflict of interests with the work of the HPA, and her responsibilities as a member of its Board. Essentially her job at the FGC is to maximise consumption (or at least profitability) for her members, including those involved in tobacco, alcohol and unhealthy foods, whereas the HPA’s job is to minimise consumption of products from those same companies. I cannot imagine a more direct and unambiguous conflict of interests.
What the record shows is that Mrs Rich appears to have been assiduous in the first of her duties around conflicts of interest – she has maintained the record of her “interests” in the HPA Board’s Register of Interests. Unfortunately, there it stops. She has never declared a conflict of interest with any item on a HPA Board agenda, despite every single Board meeting considering some aspect of strategy or approach around tobacco, alcohol or food. She has never withdrawn from discussion or decision-making over a single item on the Board’s agenda. No “public interest” waiver from the requirements of the law has ever been recorded in the minutes of the Board or in the HPA’s Annual Report, which Board Chair Lee Mathias would be obliged to record if she’d granted Mrs Rich such a waiver
In other words Katherine Rich has maintained that she has no conflict of interest, and this appears to be accepted by Ms Mathias and by Jonathan Coleman, the Minister of Health. In a way I feel a bit sorry for Jonathan Coleman. He wasn’t the person who appointed the HPA Board, and Mrs Rich may well be a personal friend of his. But he has chosen to be flippant, rather than give genuine answers to parliamentary questions, and to refuse to investigate the matters I have raised.
In particular he has noted that the Board chair, Lee Mathias, must tell him if there has been a conflict of interest, and as she hasn’t then there’s nothing to see here. What this is about, of course, is making Lee Mathias the “fall guy”. That hasn’t stopped him asking the Ministry of Health, apparently, to check over the HPA minutes to see if he has anything to worry about. He tells us they found nothing. In answer to my written questions, however, he was forced to admit that the Ministry has no authority to investigate breaches of the Crown Entities Act by Board members. That’s right. It’s the State Services Commission who would normally undertake such an investigation. Except they can’t initiate one. The Minister must ask for it; Coleman refuses to do so.
So we’re left with Mrs Rich’s assertion, despite all the evidence, that she has no conflict of interest whatsoever, while neither of those who could take action to investigate, Lee Mathias or Minister Coleman, is prepared to. That’s why I have taken my concerns to the Office of the Auditor-General.
Before closing I want to just cover off some defences mounted by Mrs Rich’s supporters.
One person has pointed out that the FGC represents lots of companies that don’t manufacture or distribute these big 3 health threats, and may even make a positive contribution. Sure, that’s true. But for the case for conflict of interest to be made out it isn’t necessary that everything in a person’s other roles is in conflict with the role in question. Just one conflict is enough, and Mrs Rich’s are multiple.
Some have pointed out that this government has been clear that it wants to make progress on improving health by working with industry, rather than independently of it. I first respond by pointing out that “working with industry” does not require industry to be on the Board of our Health Promotion agency, and secondly note that, even if Government were to use this unusual Board membership strategy to achieve constructive engagement, that would not in any way change what constitutes a conflict of interest under law, nor the legal duties that would arise from one.
Finally some have noted that Mrs Rich is very highly regarded by fellow Board members and staff, some saying she makes the best contribution to Board meetings of any member. I can well believe it. She is a very skilled and smart operator. But the law doesn’t say “you’ve made a great contribution so we’re going to disregard your legal duties”.
The legal duties exist both to ensure integrity of the entity itself, and also to maintain public trust and confidence in the State itself. Those both seem quite important to me.