Background The Public Health Responsibility Deal (PHRD) in England is a public-private partnership that brings together government, academic experts, and commercial and voluntary organisations to contribute to meeting public health objectives. In this study we examine how other countries have sought to address public health problems targeted by the PHRD using policy instruments ranging from entirely voluntary agreements to mandatory regulation. We seek to assess learning that can be drawn for the PHRD on the core enablers and barriers of regulatory, self-regulatory or voluntary strategies.

Methods Based on a targeted document review of policy interventions in 21 high income countries related to food and alcohol pledges included in the PHRD, we selected two pledges, alcohol labelling and salt reduction, and four countries, Australia, Denmark, Finland and France, for detailed review. For each country and topic we carried out a targeted literature review, followed by interviews with key informants representing government, civil society, academia and industry (n = 4/5 per country and topic). Through these methods we sought to understand the characteristics, aims and context of the policy implementation, the reasons for selecting a particular policy instrument over others, and any evidence on impact. Interview transcripts were analysed in NVivo using a framework approach to draw comparisons between countries and policy areas.

Results The policy mechanisms implemented in each country were influenced by the country context, including the local acceptability of the use of regulatory or voluntary measures, the perception of the issue as a public health problem, and the current political environment. Key informants noted that voluntary agreements allowed policies to be implemented more quickly than through regulation; however the achievements of voluntary schemes were frequently seen as being of a smaller magnitude than would be expected from regulation. Threat of future regulation was seen as an incentive for industry to initiate or engage in voluntary schemes, as was the opportunity for building relationships with government representatives and positive publicity for taking part in the initiative. Key informants suggested that industry were only likely to engage voluntarily in schemes where the cost to industry was low.

Conclusion Existing evidence suggests that voluntary agreements, supported by businesses, may be effective to achieve public policy aims but success will depend upon a number of prerequisites. However, while voluntary agreements might facilitate the introduction of a given policy, their impacts might be smaller in terms of public health gain.