Has a public–private partnership resulted in action on healthier diets in England? An analysis of the Public Health Responsibility Deal food pledges
Introduction
Diet plays an essential role in influencing the risk of major non-communicable diseases (NCDs) and poor diet incurs high costs to individuals and health services. Moreover there are considerable and widening inequalities, both in the consumption of healthy diets and in nutrition-related diseases. Recommendations for addressing nutrition-related NCDs increasingly focus on intervening across a range of sectors, particularly prioritising supply side policies to curb caloric availability and improve affordability (WHO, 2013).
The most recent data suggest that the English population consumes excessive saturated fat, added sugars and salt (Bates et al., 2014). The current response of the Government in England hinges upon the “Reducing Obesity and Improving Diet” policy (Department of Health, 2013a), which includes helping people make healthier choices through the public-facing Change4Life programme, the flagship Public Health England healthy lifestyle social marketing campaign, and encouraging food companies and other actors to contribute to improving public health through the Public Health Responsibility Deal (RD).
The RD was launched in March 2011 by the Department of Health as a national level public–private partnership with the overall aim of improving public health. It involves voluntary agreements between the Government and the corporate sector, academia and voluntary organisations who can commit to a range of pledges in the areas of food, alcohol, physical activity and health at work (Department of Health, 2014). At the time of writing (April 2015), 781 organisations had committed to the RD pledges (across all networks) (Department of Health, 2014).
The involvement of industry in food and nutrition policymaking by past UK Governments has been criticised (Caraher et al., 2009) and is one of the more controversial aspects of the RD (Panjwani and Caraher, 2014). There can be benefits and opportunities from public–private partnerships (Kraak et al., 2012), as demonstrated by the headway made over the last decade by the food industry in voluntarily reducing salt content from processed foods sold in the UK (FSA, 2013, Griffith et al., 2014). However there are risks and challenges from a public health perspective, as increasingly illustrated by independent evaluations of public–private partnerships (Ng and Popkin, 2014, Ng et al., 2014). The involvement of the food industry in public health has raised a number of concerns about the motivations and effectiveness of such partnerships in meeting health objectives (Moodie et al., 2013).
This paper analyses the RD food pledges in terms of (i) the evidence on the effectiveness of specific interventions within pledges and (ii) the likelihood that the pledges have brought about actions among organisations that would not otherwise have taken place. This paper is part of a wider evaluation (Bryden et al., 2013, Petticrew et al., 2013, Knai et al., 2015a, DOI: 10.1111/add.12892.Knai et al., 2015b) which is drawing on publically available data, interviews and case studies.
Section snippets
Rationale for analysing six food pledges
We focused on six (Table 1) out of the eight RD food pledges, as at the end of 2013 (Department of Health, 2014): out-of-home calorie labelling, salt reduction, calorie reduction, front-of-pack nutrition labelling, fruit and vegetable consumption, and saturated fats. We excluded salt in the catering trade because it is on the whole covered under the salt reduction pledge. A separate analysis of the trans fats pledge is currently underway.
Evidence synthesis
We first considered the RD food pledges in the broader
Who signed up to the RD food pledges?
Most (95%) organisations signing up to the food pledges under analysis were from the private food sector, including retailers, manufacturers, caterers and food outlets (such as restaurant chains). For the calorie reduction, front-of-pack labelling and saturated fat pledges, 100% of organisations were from the food sector. The other sectors represented across the food pledges under analysis included the education, voluntary and health sectors, and accounted for 5% of signatories to the food
Discussion
The majority of the RD food pledges propose interventions that favour information provision, awareness raising and communication with consumers which may have limited effect (Table 1), but the pledges which propose structural changes such as reformulation of menus or of products themselves could contribute to improving diet in England, if fully implemented. However this conclusion comes with two important caveats: first, our assessment of the potential effectiveness of RD pledges will likely
Conclusions
The evidence suggests that some of the interventions proposed by the RD can contribute to improving the diet of the English population, if fully implemented. Implementation of interventions was difficult to establish given the paucity and heterogeneity of progress reports, warranting efforts to greatly improve progress reporting both in terms of internal consistency and inclusion of metrics. Moreover most interventions reported by organisations seemed either clearly or possibly already underway
Author contributions
CK conceived, designed and planned the study, and led the production of the manuscript. MP, EE, NM, and MAD participated in study design. CK, LJ, AM, MP and CS contributed to data collection and CS and MP contributed to data analysis. All authors contributed to manuscript revisions.
Acknowledgements
We would like to acknowledge the critical review of this paper by Professor Elizabeth Water, Professor Ashley Adamson and Dr. Corinna Hawkes.
The evaluation of the Public Health Responsibility Deal is part of the programme of the Policy Innovation Research Unit (http://www.piru.ac.uk/). This is an independent research unit based at the London School of Hygiene and Tropical Medicine, funded by the Department of Health Policy Research Programme. Sole responsibility for this research lies with the
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