Has a public–private partnership resulted in action on healthier diets in England? An analysis of the Public Health Responsibility Deal food pledges

Abstract

The Public Health Responsibility Deal (RD) in England is a public-private partnership involving voluntary pledges between government, industry and other organisations in the areas of food, alcohol, physical activity, and health at work, and is designed to improve public health. The RD is currently being evaluated in terms of its process and likely impact on the health of the English population. This paper analyses the RD food pledges in terms of (i) the evidence of the effectiveness of the specific interventions in the pledges and (ii) the likelihood that the pledges have brought about actions among organisations that would not otherwise have taken place. We systematically reviewed evidence of the effectiveness of the interventions proposed in six food pledges of the RD, namely nutrition labelling (including out-of-home calorie labelling and front-of-pack nutrition labelling), salt reduction, calorie reduction, fruit and vegetable consumption, and reduction of saturated fats. We then analysed publically available data on organisations' plans and progress towards achieving the pledges, and assessed the extent to which activities among organisations could be brought about by the RD. Based on seventeen evidence reviews, some of the RD food interventions could be effective, if fully implemented. However the most effective strategies to improve diet, such as food pricing strategies, restrictions on marketing, and reducing sugar intake, are not reflected in the RD food pledges. Moreover it was difficult to establish the quality and extent of implementation of RD pledge interventions due to the paucity and heterogeneity of organisations' progress reports. Finally, most interventions reported by organisations seemed either clearly (37%) or possibly (37%) already underway, regardless of the RD. Irrespective of the nature of a public health policy to improve nutritional health, pledges or proposed actions need to be evidence-based, well-defined, and measurable, pushing actors to go beyond 'business as usual' and setting out clear penalties for not demonstrating progress.

Downsizing: policy options to reduce portion sizes to help tackle obesity

“…This would involve reductions of over 50% for some energy dense products, far greater than the typical 5% reductions currently offered and negotiated with the food industry. 20 …”

Obesity prevention strategies: Could food or soda taxes improve health?

“…22 However, evidence shows that it has achieved little, failed to improve eating habits and excludes most of the measures that would make a real impact. 23,24 The industry vetoed discussion of the most effective interventions -price and advertising -and reformulation was discussed but did not result in effective changes to food products. Voluntary agreements with industry are weak or ineffective, as proven by the recent Department of Health commissioned independent evaluation of the Responsibility Deal.…”

The childhood obesity strategy

“…The previous attempt to improve public health "further, faster and at lower cost," the Public Health Responsibility Deal, 7 8 was launched by the coalition government in England in 2011 as a voluntary, pledge based, partnership between government, business, the public sector, and non-governmental organisations. It was dominated by businesses, 7 which seem to have participated mainly to meet their corporate social responsibility commitments, enhance their reputations, and reduce the possibility of regulation. 8 Most businesses committed to activities they were already undertaking, 8 and the resulting pledges were largely not underpinned by evidence of effectiveness.…”

“…8 Most businesses committed to activities they were already undertaking, 8 and the resulting pledges were largely not underpinned by evidence of effectiveness. 7 Retailers and manufacturers now seem to want stronger measures, partly to achieve a "level playing field" for their business. 8 The chief executive of supermarket chain Sainsbury's stated that the strategy "needs to be tougher" and requires "compulsory and measured targets for the reduction of sugar (and other nutrients such as saturated fats) across the whole of the food and drink industry.…”

“…Evaluation of the responsibility deal found that progress reports were not consistently submitted and were mostly incomplete and vague because clear measurable targets had usually not been set. 7 Supporting the school food standards for healthier school meals is essential, but given the importance of nutrition in 1-5 year olds for growth and development, early years settings should also be given mandatory food standards instead of voluntary guidelines. The evidence shows that reduced marketing and price promotion of unhealthy foods is fundamental, as promotions and advertising directly shape purchasing and consumption choices.…”