Conflicts of interest: an invisible force shaping health systems and policies

Despite years of discussion and frustration about why public health evidence does not influence policy decisions as much as it should, there has been little attention to a fundamental force in decision making: conflicts of interest. Conflicts of interest arise when the potential for individual or group gain compromises the professional judgment of policy makers or health-care providers. Conflicts of interest underpin rent-seeking and informal practice across the world, but their nuanced nature makes them challenging to identify, research, and address. Conflicts of interest are often very subtle; no action needs to be taken for them to exist. In many countries, the heterogeneous nature of mixed health systems and complex care pathways are compounded by weak governance mechanisms,1 which increase the potential for conflicts of interest to occur and make them difficult to address with existing regulatory and policy frameworks, including self-disclosure mandates or malpractice procedures. To begin to illuminate these issues and to develop a research agenda, we have characterised three different types of conflicts of interest that are particularly pervasive in mixed or pluralistic health systems (table). We emphasise how these conflicts impede the development of health policies to better structure and govern state and non-state health-care providers.

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Rahman-Shepherd, A., P. Balasubramaniam, M. Gautham, E. Hutchinson, F. E. Kitutu, R. Marten, M. S. Khan (2021) Conflicts of interest: an invisible force shaping health systems and policies. Lancet Global Health 9(8). https://doi.org/10.1016/S2214-109X(21)00202-3