Industries whose values are misaligned with the public sector are those for whom an increase in demand for their goods and services leads to a decrease in health. Examples of misaligned industries include the tobacco industry and the firearms industry. These industries are excluded from participation in PPPs, as they have no incentive whatsoever to partner with the public sector. WHO, for example, has explicitly excluded tobacco as an eligible industry for partnership.
Value alignment is a powerful tool for mapping the interests of a given company, but a company's value alignment is not set in stone. Value alignments can move and shift based on market conditions and incentives. One goal of any well-designed PPP, then, is to push the values of the partners as close together as possible, so that both partners are always working in concert with one another. In the case of healthcare PPPs, this usually involves bringing the private sector into better alignment with public sector health goals using effective incentive design. However, it can also involve adjusting public-sector objectives and expectations to include an acceptance of the profit motive. While profits do not necessarily come at the expense of a project's overall efficiency, public-sector partners are often wary of the potential for a conflict of interest. So, though private-sector incentives must be nudged into better alignment with public-sector health goals, value alignment can sometimes involve a shift in the public-sector's values as well.
And of course, PPPs do not exist in a vacuum, either-it is essential to engage the public in order to effect change. After all, no partner can hope to change market dynamics without engaging the public-the consumers themselves-as a partner. We will discuss this further in Chapter Four.