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

Highlights

• Business partners participated in the Responsibility Deal for reputational reasons.

• Partners frequently chose pledges reflecting work they were already doing.

• The Responsibility Deal is likely to have limited ‘added value’.

• Government needs to set out a clear vision for the RD.

• These findings have implications for the development of other voluntary agreements.

Abstract

Objectives

The Coalition Government's Public Health Responsibility Deal (RD) was launched in England in 2011 as a public–private partnership designed to improve public health in the areas of food, alcohol, health at work and physical activity. As part of a larger evaluation, we explored informants’ experiences and views about the RD's development, implementation and achievements.

Methods

We conducted 44 semi-structured interviews with 50 interviewees, purposively sampled from: RD partners (businesses, public sector and non-governmental organisations); individuals with formal roles in implementing the RD; and non-partners and former partners. Data were analysed thematically: NVivo (10) software was employed to manage the data.

Results

Key motivations underpinning participation were corporate social responsibility and reputational enhancement. Being a partner often involved making pledges related to work already underway or planned before joining the RD, suggesting limited ‘added value’ from the RD, although some pledge achievements (e.g., food reformulation) were described. Benefits included access to government, while drawbacks included resource implications and the risk of an ‘uneven playing field’ between partners and non-partners.

Conclusions

To ensure that voluntary agreements like the RD produce gains to public health that would not otherwise have occurred, government needs to: increase participation and compliance through incentives and sanctions, including those affecting organisational reputation; create greater visibility of voluntary agreements; and increase scrutiny and monitoring of partners’ pledge activities.

Introduction

Public–private partnerships (PPPs), which involve co-operative agreements between corporate and public sectors [1], are increasingly employed in addressing health challenges [2], [3]. The Public Health Responsibility Deal (RD) was launched by the then Coalition Government of Conservatives and Liberal Democrats in England in 2011 as a voluntary, pledge-based, public–private partnership between government, business, the public sector and non-governmental organisations (NGOs), to improve public health in the areas of food, alcohol, health at work and physical activity. Andrew Lansley, then Secretary of State for Health, asserted that, ‘By working in partnership, public health, commercial and voluntary organisations can agree practical actions to secure more progress, more quickly, with less cost than legislation’ [4]. The RD is overseen by a Plenary Group, and consists of four networks: Food (F), Alcohol (A), Health at Work (HAW) and Physical Activity (PA). A fifth network focusing on Behaviour Change was reconfigured in 2013, and its work incorporated into the remaining four networks. Each network has Steering and Working groups consisting of representatives of participating sectors, and has developed collective pledges (e.g., ‘We will do more to create a positive environment that supports and enables people to increase their consumption of fruit and vegetables’)[5] (see https://responsibilitydeal.dh.gov.uk/ [5] for full list). Partners are required to sign to at least one collective pledge from any of the networks, and to produce delivery plans describing how they will implement their pledges as well as annual progress reports. DH places these on the RD website [5].

The public health effectiveness of PPPs, voluntary agreements and industry self-regulation has been questioned, particularly when they involve the food and alcohol industries [6], [7], [8], [9], [10]. Lessons learned from the tobacco arena suggest that voluntary agreements may initially appear helpful, but can ultimately serve to stall government action on public health [11]. However, the benefits of PPPs have also been elucidated [1]. Bryden et al. [12] concluded, based on a review of the evidence, that voluntary agreements can potentially be an ‘effective policy approach for governments to take to persuade businesses to take actions’, but only where components such as ambitious, clearly defined targets, sanctions for non-compliance, disincentives for non-participation and strong monitoring systems are in place.

This paper reports the findings of a qualitative analysis of interviews with RD partner organisations, those with a formal role in implementing the RD, and interested non-partners or former partners about their experiences and views of the development, implementation and achievements of the RD overall. This analysis forms part of a wider evaluation of the RD's processes and likely impact on the health of the English population.