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

Abstract

BackgroundThe 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. MethodsWe 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. FindingsOne 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. InterpretationDespite 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. FundingFunded by the Department of Health, Policy Research Programme, under the core grant to the Policy Innovation Research Unit.