A stakeholder analysis of the perceived outcomes of developing and implementing England's obesity strategy 2008-2011.

Corinna Hawkes,Amy L Ahern,Susan A Jebb

doi:10.1186/1471-2458-14-441

Abstract

BackgroundInternational recommendations urge governments to implement population-based strategies to reduce the burden of obesity. This study assesses the development and implementation of the obesity strategy in England 2008–2011, Healthy Weight, Healthy Lives (HWHL). The aim was to identify if stakeholders perceived HWHL to have made any difference to the action to address obesity in England, with the ultimate objective of identifying insights that could inform the development and implementation of future obesity strategies in England and elsewhere.MethodsQualitative study using semi-structured interviews and thematic framework analysis. 40 stakeholders involved in the development and implementation of the obesity strategy were interviewed.ResultsEvidence from this study suggests that HWHL was perceived to have made a positive difference to efforts to address obesity in England. It was credited with creating political buy-in, engaging more stakeholders, stimulating and facilitating action, enhancing knowledge and changing attitudes. But it was reported to have failed to fully catalyse action across all government departments and sectors, or to develop adequate mechanisms for learning about the effectiveness of the different elements and actions in the Strategy. Key elements of the Strategy contributing towards to the perceived positive differences included its multi-faceted, inclusive nature; governance structures; monitoring programme to assess progress against national and local targets; child-focus; and funding. The development of the Strategy was said to be stimulated and aided by the prior synthesis of a critical mass of scientific evidence.ConclusionsThe English experience of HWHL lends support to the recommendations to develop population-based obesity strategies. It indicates that in order to stimulate comprehensive, inter-sectoral action, obesity strategies need to take a population-based, multi-faceted approach, be implemented through a clear governance structure, follow a systematic process of aligning goals, objectives and agendas between government departments and sectors with a stake in obesity, and have a clear system of reporting changes in obesity rates against a target. In order to design effective policies and to build the case for continued investment, obesity strategies also need to incorporate a national framework for learning and evaluation from the outset.

Highlights

International recommendations urge governments to implement population-based strategies to reduce the burden of obesity
This study aims to identify the perceived outcomes of Healthy Weight, Healthy Lives (HWHL) on public health efforts to address obesity in England and the key elements responsible for these outcomes
Interviewees identified four key differences that HWHL made to efforts to address obesity in England: political buy-in and multi-stakeholder engagement to a national obesity strategy, more action taken to address obesity at all levels, other government departments more engaged with obesity as a serious public health problem and positive changes in awareness and attitudes about the role of government in addressing obesity (Table 3)

Summary

Introduction

International recommendations urge governments to implement population-based strategies to reduce the burden of obesity. This study assesses the development and implementation of the obesity strategy in England 2008–2011, Healthy Weight, Healthy Lives (HWHL). To tackle obesity, leading health experts, including those convened by the World Health Organization (WHO) [1], recommend that governments develop and implement “population-based strategies” [2]. The call for population-based strategies reflects the evidence that the causes of obesity are complex and multifaceted and require a range of different solutions at multiple levels and in multiple sectors [2,3,4,5,6]. In England, the first national obesity strategy Healthy Weight, Healthy Lives: A Cross Government Strategy for England (2008–2011) was published in 2008 [9]. There has been no analysis of the impact of the Strategy as a whole, or of what lessons can be learned from the experience

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