Elizabeth Eastmure

Voluntary agreements between government and business - a scoping review of the literature with specific reference to the Public Health Responsibility Deal.

OBJECTIVES A scoping review was conducted to synthesise the findings of evaluations of voluntary agreements between business and government. It aimed to summarise the types of agreements that exist, how they work in practice, the conditions for their success and how they had been evaluated. METHODS Voluntary agreements were included if they involved a transparent signing-up process and where businesses agreed to carry out specific actions or to achieve specific outcomes. Studies of any design published in English were included. RESULTS 47 studies were identified. Voluntary agreements may help to improve relationships between government and business, and can help both parties agree on target-setting and data-sharing. Governments may also use the experience to help develop subsequent legislation. For voluntary agreements to be successful, targets should be ambitious and clearly defined, with robust independent monitoring. Public knowledge of agreements can help encourage participation and ensure compliance. CONCLUSIONS If properly implemented and monitored, voluntary agreements can be an effective policy approach, though there is little evidence on whether they are more effective than compulsory approaches. Some of the most effective voluntary agreements include substantial disincentives for non-participation and sanctions for non-compliance. Many countries are moving towards these more formal approaches to voluntary agreements.

Are the Public Health Responsibility Deal alcohol pledges likely to improve public health? An evidence synthesis

AIMS The English Public Health Responsibility Deal (RD) is a public-private partnership involving voluntary pledges between industry, government and other actors in various areas including alcohol, and designed to improve public health. This paper reviews systematically the evidence underpinning four RD alcohol pledges. METHODS We conducted a systematic review of reviews of the evidence underpinning interventions proposed in four RD alcohol pledges, namely alcohol labelling, tackling underage alcohol sales, advertising and marketing alcohol, and alcohol unit reduction. In addition, we included relevant studies of interventions where these had not been covered by a recent review. RESULTS We synthesized the evidence from 14 reviews published between 2002 and 2013. Overall, alcohol labelling is likely to be of limited effect on consumption: alcohol unit content labels can help consumers assess the alcohol content of drinks; however, labels promoting drinking guidelines and pregnancy warning labels are unlikely to influence drinking behaviour. Responsible drinking messages are found to be ambiguous, and industry-funded alcohol prevention campaigns can promote drinking instead of dissuading consumption. Removing advertising near schools can contribute to reducing underage drinking; however, community mobilization and law enforcement are most effective. Finally, reducing alcohol consumption is more likely to occur if there are incentives such as making lower-strength alcohol products cheaper. CONCLUSIONS The most effective evidence-based strategies to reduce alcohol-related harm are not reflected consistently in the RD alcohol pledges. The evidence is clear that an alcohol control strategy should support effective interventions to make alcohol less available and more expensive.

Health information on alcoholic beverage containers: has the alcohol industry's pledge in England to improve labelling been met?

AIMS In the United Kingdom, alcohol warning labels are the subject of a voluntary agreement between industry and government. In 2011, as part of the Public Health Responsibility Deal in England, the industry pledged to ensure that 80% of products would have clear, legible health warning labelling, although an analysis commissioned by Portman found that only 57.1% met best practice. We assessed what proportion of alcohol products now contain the required health warning information, and its clarity and placement. DESIGN Survey of alcohol labelling data. SETTING United Kingdom. PARTICIPANTS Analysis of the United Kingdoms 100 top-selling alcohol brands (n = 156 individual products). MEASUREMENTS We assessed the product labels in relation to the presence of five labelling elements: information on alcohol units, government consumption guidelines, pregnancy warnings, reference to the Drinkaware website and a responsibility statement. We also assessed the size, colour and placement of text, and the size and colouring of the pregnancy warning logo. FINDINGS The first three (required) elements were present on 77.6% of products examined. The mean font size of the Chief Medical Officers (CMO) unit guidelines (usually on the back of the product) was 8.17-point. The mean size of pregnancy logos was 5.95 mm. The pregnancy logo was on average smaller on wine containers. CONCLUSIONS The UK Public Health Responsibility Deal alcohol labelling pledge has not been fully met. Labelling information frequently falls short of best practice, with font and logos smaller than would be accepted on other products with health effects.

An evaluation of a public–private partnership to reduce artificial trans fatty acids in England, 2011–16

Background The Public Health Responsibility Deal (RD) is a public-private partnership in England involving voluntary pledges between government, and business and other public organizations to improve public health. One such voluntary pledge refers to the reduction of trans fatty acids (TFAs) in the food supply in England by either pledging not to use artificial TFAs or pledging artificial TFA removal. This paper evaluates the RDs effectiveness at encouraging signatory organizations to remove artificially produced TFAs from their products. Methods We analysed publically available data submitted by RD signatory organizations. We analysed their plans and progress towards achieving the TFAs pledge, comparing 2015 progress reports against their delivery plans. We also assessed the extent to which TFAs reductions beyond pre-2011 levels could be attributed to the RD. Results Voluntary reformulation via the RD has had limited added value, because the first part of the trans fat pledge simply requires organizations to confirm that they do not use TFAs and the second part, that has the potential to reduce use, has failed to attract the participation of food producers, particularly those producing fast foods and takeaways, where most remaining use of artificial TFAs is located. Conclusions The contribution of the RD TFAs pledges in reducing artificial TFAs from Englands food supply beyond pre-2011 levels appears to be negligible. This research has wider implications for the growing international evidence base voluntary food policy, and offers insights for other countries currently undertaking work to remove TFAs from their food supply.

Potential impact of removing general practice boundaries in England: A policy analysis☆

In 2015, the UK government plans to widen patient choice of general practitioner (GP) to improve access through the voluntary removal of practice boundaries in the English NHS. This follows a 12-month pilot in four areas where volunteer GP practices accepted patients from outside their boundaries. Using evidence from the pilot evaluation, we discuss the likely impact of this policy change on patient experience, responsiveness and equity of access. Patients reported positive experiences but in a brief pilot in four areas, it was not possible to assess potential demand, the impact on quality of care or health outcomes. In the rollout, policymakers and commissioners will need to balance the access needs of local residents against the demands of those coming into the area. The rollout should include full information for prospective patients; monitoring and understanding patterns of patient movement between practices and impact on practice capacity; and ensuring the timely transfer of clinical information between providers. This policy has the potential to improve choice and convenience for a sub-group of the population at lower marginal costs than new provision. However, there are simpler, less costly, ways of improving convenience, such as extending opening hours or offering alternatives to face-to-face consultation.

Community Alcohol Partnerships with the alcohol industry: what is their purpose and are they effective in reducing alcohol harms?

Background Local initiatives to reduce alcohol harms are common. One UK approach, Community Alcohol Partnerships (CAPs), involves partnerships between the alcohol industry and local government, focussing on alcohol misuse and anti-social behaviour (ASB) among young people. This study aimed to assess the evidence of effectiveness of CAPs. Methods We searched CAP websites and documents, and databases, and contacted CAPs to identify evaluations and summarize their findings. We appraised these against four methodological criteria: (i) reporting of pre-post data; (ii) use of comparison area(s); (iii) length of follow-up; and (iv) baseline comparability of comparison and intervention areas. Results Out of 88 CAPs, we found three CAP evaluations which used controlled designs or comparison areas, and further data on 10 other CAPs. The most robust evaluations found little change in ASB, though few data were presented. While CAPs appear to affect public perceptions of ASB, this is not a measure of the effectiveness of CAPs. Conclusions Despite industry claims, the few existing evaluations do not provide convincing evidence that CAPs are effective in reducing alcohol harms or ASB. Their main role may be as an alcohol industry corporate social responsibility measure which is intended to limit the reputational damage associated with alcohol-related ASB.

How the food, beverage and alcohol industries presented the Public Health Responsibility Deal in UK print and online media reports

Abstract The Public Health Responsibility Deal (RD) in England is a public–private partnership between government, industry and other stakeholders aiming to improve public health in four key areas: food, alcohol, health at work and physical activity. Wider literature shows that industry engages in framing of public health policy problems, solutions and its role in solutions that is favourable to its interests. As part of an evaluation of the RD, we conducted a media analysis to explore how industry spokespersons (from commercial enterprises, trade associations and social aspects/public relations organisations) represented the RD in newspaper and online reports. We systematically searched databases indexing articles of British national newspapers and the online news services of national broadcasters for articles published between 2010 and 2015. After application of inclusion criteria, we identified 247 relevant articles. We extracted direct quotations by industry spokespersons and analysed them thematically. Media reporting about the RD provided industry spokespersons with a high-profile platform to present frames relating to food, beverages and alcohol that were favourable to advancing or protecting industry positions and agendas. Framing of issues addressed responsibility for public health problems, policy options and the role of industry, also legitimising industry spokespersons to advocate a position on how public health policy should evolve. Media analysis can elucidate industry discourses around public health and examine their engagement in framing to extend their influence in public health policy.

Knai and colleagues’ response to comments of the Portman Group in news story about their research on the “responsibility deal” on alcohol

Some statements from the Portman Group about our evaluation of the “responsibility deal” on alcohol are seriously misleading.1 The statement about our “track record of campaigning against voluntary agreements” is inaccurate. One of our first studies set out to understand the characteristics of effective voluntary agreements,2 which should be based on clearly defined, evidence based, and quantifiable targets; should push partners to go beyond “business as usual”; and should include penalties for not delivering the pledges. Our …

Evaluation of the Choice of GP Practice Pilot, 2012-13

The choice of general practice pilot began in April 2012 for 12 months and allowed patients to choose to seek care from any volunteer general practice in four volunteer Primary Care Trust (PCT) areas of the country (Westminster, Salford, Manchester and Nottingham City) without being restricted by practice boundaries. Patients could either register with a pilot practice as an out of area (OoA) patient, or be seen as a ‘day patient’, while remaining registered with their original practice. The aim of the evaluation was to describe the uptake of the pilot scheme, and give an early indication of its potential costs and benefits for participating practices and patients over a 12-month period, recognising that it would not be possible to quantify costs and benefits definitively over such a short time.

The Public Health Responsibility Deal: how should such a complex public health policy be assessed?

Abstract Background The Public Health Responsibility Deal (RD) in England is a public–private partnership organised around a series of voluntary agreements that aims to bring together government, academic experts, and commercial and voluntary organisations to meet public health objectives. The scope of the RD includes food, alcohol, physical activity, health at work, and behaviour change. Through the RD, businesses commit to voluntary pledges to undertake actions for a public health benefit. The RD has been criticised by public health advocates and others, and there are increasing demands to know whether it works. Methods We did a detailed scoping review to identify, review, and synthesise the findings of assessment studies or other relevant reports presenting evidence for other voluntary agreements between business and government in relation to public policy goals. This review was done to provide an overall idea of the types of agreements that exist in non-health sectors, how they work in practice, conditions for success, and different approaches to assessment, and to inform the development of a logic model. Additionally, we undertook semistructured interviews with five network chairs to help to understand what the RD is, how it operates, how it could be improved, and what in their view should be the focus of the RD assessment. Findings One of the key conclusions is that the RD operates at two levels: as a whole and with individual pledges. Both levels have different processes and outcomes, and need different approaches to assessment. Assessment of the deal needs to be oriented towards investigation of whether the processes are in place to allow progress towards achieving health improvements, whereas appraisal of the pledges needs to be oriented towards whether they are achieving the health gains. We used the scoping review and the initial interviews to produce a detailed logic model to guide the future development of the evaluation of the RD. Interpretation Despite the validity of questions about whether it works, we suggest that more useful questions at this stage of the development of the RD are about what it is, its objectives, how it is expected to work, how it can be assessed, and how will we know whether it works. The implications for the full assessment of the RD will be presented with the logic model, which will be refined with time as more data become available. Funding Funded by the Department of Health, Policy Research Programme, under the core grant to the Policy Innovation Research Unit.