What Is and What Is Not a Conflict of Interest in the Sphere of Public Health

A conflict of interest is a set of circumstances or relationships that create the risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. Secondary interests may be internal, meaning limited to the personal sphere, or external, linked to the interests of third parties or institutions. Internal interests are related to individual identity and personality, and tend to be perfectly aligned with the primary professional interest. Therefore, we usually only speak of a conflict of interest when external secondary interests, usually of a financial nature, are opposed to the primary professional interest (preserving the health of the population in the case of public health). In addition, biases due to internal interests are bidirectional and difficult to quantify, while those deriving from financial conflicts of interest are predictable, unidirectional and large-scale. Although they are different phenomena, they are often mixed up with one another to create confusion and divert attention from financial conflicts of interest. In public health, conflicts of interest can arise in the field of research when studies are conducted on the health effects of pharmaceuticals, chemicals, tobacco, alcohol or food and in decision-making regarding policies related to these same products. In this chapter we present several examples of conflicts of interest in public health and a series of recommendations for their management, beyond their public declaration, which is necessary but insufficient. All public health organizations should adopt standards to avoid, detect, eliminate or minimize the impact of conflicts of interest and ensure that these are put into practice.