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Where is the Public Health Responsibility Deal?

posted Dec 27, 2016, 1:23 PM by Ben Jane   [ updated Jan 4, 2017, 1:50 AM ]

The Public Health Responsibility Deal (RD) was set up in 2011 as a public–private partnership that involved voluntary pledges between industry, government and other stakeholders and was designed to improve public health by changing the environment in which people made decisions about certain health related behaviours. 


It was a policy developed by the Cameron-Clegg coalition government (although it's origins can be traced back to Tony Blair's speech on public health in 2006*), and there has been a distinct lack of action or official comment in this area since March, 2015 when the previous administration was winding down. 


In 3 months time, it will be 2 whole years without any official comment on how successful the RD was and the current situation will therefore exist within the following scenarios:

  • The RD was a great success, yet has been left to wander untended for nearly two years,
  • The RD was a failure, yet this has not been acknowledged, and the public have not been told what lessons were learnt and how these have been implemented subsequently,
  • Aspects of the RD worked, yet the public have not been told what lessons were learnt and how these have been implemented subsequently,
There have, however, been independent reviews of the RD's impact covering physical activity (Sept, 2015: Knai et al, 2015a), food (July, 2015: Knai et al, 2015c), alcohol (March, 2015: Knai et al, 2015b), and workplace health (June, 2016: Knai et al, 2016), yet still no comment from politicians past or present.

Maybe it's because these evaluations came to the conclusion that the RD had been largely ineffectual suggesting that in most domains pledges focused on minimally effective interventions, progress reports were limited and vague and that very few of the actions cited as part of the pledges were anything different from those that would have occurred had the RD not been implemented. As long ago as mid 2013, Panjwani and Caraher looked into the RD and concluded that,

"The Responsibility Deal approach is fundamentally flawed in its expectation that industry will take voluntary actions that prioritise public health interests above its own. Being government-led counts for little in the absence of sanctions to drive compliance. Instead the initiative affords private interests the opportunity to influence in their favour the public health policies and strategies that affect their products."

What now?

At some point, a politician should be made to respond to the independent evaluations and subsequent comments from the media and public health advocates. In theory, we're now under a new administration which presents an opportunity to blame its failure on someone else; the problem is that the new administration is pretty similar to the last one. It's a shame the RD hasn't been officially ended and reviewed though, I’m sure one of the signatories would be more than willing to pay for a party (as long as it can be branded and there’s media opportunities).

Politicians hate a policy void and it would be particularly difficult to bring attention to the end of the RD without having a plan to replace it. The recent development of the childhood obesity strategy addresses some aspects of the food and physical activity environment however, this is bearing all the similar hallmarks of a project that has the potential for real change yet is being influenced by the lobbying powers of large food corporations.

Will we even miss it?

It’s clear from the evaluations that the RD has fallen short of being a particularly effective public health initiative and as de Andrade and Hastings (2016) identified, it increasingly resembled the perfect example of stakeholder marketing where far from achieving its public health aims, it had too many positive outcomes for the businesses in question such as co-opting critics, recruiting allies, creating a health halo around a brand and redirecting consumers to alternate lines of product that are often more profitable. Far from changing the environment to improve public health, at worst it could have helped many businesses sell more product than they would have otherwise and at best it acted as a smoke screen preventing more robust actions from being taken.

So maybe we shouldn't lament it's passing. We should however be able to hear the government's response to the independent evaluations and to hear how future initiatives will be informed by the experience of the RD. It would make sense to have this conversation before future initiatives such as the childhood obesity strategy were signed off, however I suspect this may not be the case.

[* My thanks go to @davidjbuck, of The King's Fund for pointing out the omission of the Blair influence in my original text - 4/1/17]

References

de Andrade, M. & Hastings, G. (2016) Stakeholder marketing and the subversion of public health. In Spotswood, F., (Ed.) Beyond Behaviour Change: Key Issues, Interdisciplinary Approaches and Future Directions. Bristol: Policy Press, 181–198.

Knai, C., Petticrew, M., Scott, C., Durand, M.A., Eastmure, E., James, L., Mehrotra, A. & Mays, N. (2015a) Getting England to be more physically active: are the Public Health Responsibility Deal’s physical activity pledges the answer? The International Journal of Behavioral Nutrition and Physical Activity. Vol. 12, No. 1: 107: pp. . [Online] Available from: http://www.ijbnpa.org/content/12/1/107.

Knai, C., Petticrew, M., Durand, M. A., Eastmure, E., & Mays, N. (2015b). Are the Public Health Responsibility Deal alcohol pledges likely to improve public health? An evidence synthesis. Addiction, 110(8), 1232-1246.

Knai, C., Petticrew, M., Durand, M. A., Eastmure, E., James, L., Mehrotra, A., ... & Mays, N. (2015c). Has a public–private partnership resulted in action on healthier diets in England? An analysis of the Public Health Responsibility Deal food pledges. Food Policy, 54, 1-10.

Knai, C., Scott, C., D'Souza, P., James, L., Mehrotra, A., Petticrew, M., ... & Mays, N. (2016). The Public Health Responsibility Deal: making the workplace healthier?. Journal of Public Health, fdw047.

Panjwani, C., & Caraher, M. (2014). The Public Health Responsibility Deal: brokering a deal for public health, but on whose terms?. Health Policy, 114(2), 163-173.


Further Reading

Bryden, A., Petticrew, M., Mays, N., Eastmure, E., & Knai, C. (2013). Voluntary agreements between government and business—a scoping review of the literature with specific reference to the Public Health Responsibility Deal. Health Policy, 110(2), 186-197.

Dept of Health (2011) The Public Health Responsibility Deal: Monitoring and evaluation pack


Durand, M. A., Petticrew, M., Goulding, L., Eastmure, E., Knai, C., & Mays, N. (2015). An evaluation of the Public Health Responsibility Deal: Informants’ experiences and views of the development, implementation and achievements of a pledge-based, public–private partnership to improve population health in England. Health Policy, 119(11), 1506-1514. http://www.healthpolicyjrnl.com/article/S0168-8510(15)00217-1/pdf 

Gilmore, A. B., Savell, E., & Collin, J. (2011). Public health, corporations and the new responsibility deal: promoting partnerships with vectors of disease?. Journal of Public Health, 33(1), 2-4.

Glasgow, S., & Schrecker, T. (2015). The double burden of neoliberalism? Noncommunicable disease policies and the global political economy of risk. Health & place, 34, 279-286

Hastings, G. (2012). Why corporate power is a public health priority.BMJ, 345(7871), 26-29.

He, F. J., Brinsden, H. C., & MacGregor, G. A. (2014). Salt reduction in the United Kingdom: a successful experiment in public health. Journal of human hypertension, 28(6), 345-352.

Hernandez-Aguado, I., & Zaragoza, G. A. (2016). Support of public–private partnerships in health promotion and conflicts of interest. BMJ open, 6(4), e009342.

Instutue for Alcohol Studies (2016)  Dead on Arrival? Evaluating the Public Health Responsibility Deal for Alcohol

Lobstein, T., & Brinsden, H. (2014). Symposium report: the prevention of obesity and NCDs: challenges and opportunities for governments. Obesity Reviews, 15(8), 630-639.

Mindell, J.S., Reynolds, L., Cohen, D.L. & McKee, M. (2012) All in this together: the corporate capture of public health. BMJ. Vol. 345, No. December: e8082–e8082: pp. . [Online] Available from: http://www.bmj.com/cgi/doi/10.1136/bmj.e8082.

Petticrew, M., Eastmure, E., Mays, N., Knai, C., Durand, M. A., & Nolte, E. (2013). The Public Health Responsibility Deal: how should such a complex public health policy be evaluated?. Journal of Public Health, 35(4), 495-501.

Popkin, B. M., & Kenan, W. R. (2016). Preventing type 2 diabetes: Changing the food industry. Best Practice & Research Clinical Endocrinology & Metabolism.

Rayner, G. (2015) Policy Briefing: Political Rhetoric, Corporate Responsibility and Contested Bodies [Online] Available from: http://discoversociety.org/2015/04/01/policy-briefing-political-rhetoric-corporate-responsibility-and-contested-bodies/ [accessed 4/1/17]

Swinburn, B., Kraak, V., Rutter, H., Vandevijvere, S., Lobstein, T., Sacks, G., ... & Magnusson, R. (2015). Strengthening of accountability systems to create healthy food environments and reduce global obesity. The Lancet, 385(9986), 2534-2545.


The Guardian (20th Aug, 2016) Will the government's new childhood obesity strategy have any effect?