A stakeholder analysis of the perceived outcomes of developing and implementing England’s obesity strategy 2008–2011

BMC Public Health

Susan A Jebb¹  Amy L Ahern²  Corinna Hawkes³ 

[1] Current address: Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK;MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge, UK;Current affiliation WCRF International, 22 Bedford Square, London, UK

关键词: Monitoring;    Evaluation;    England;    Stakeholder perceptions;    Qualitative;    Population-based;    Policy;    Strategy;    Obesity;   

Others  :  1131437
DOI  :  10.1186/1471-2458-14-441

 received in 2013-06-13, accepted in 2014-05-01,  发布年份 2014

【 摘 要 】

Background

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). 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.

Methods

Qualitative study using semi-structured interviews and thematic framework analysis. 40 stakeholders involved in the development and implementation of the obesity strategy were interviewed.

Results

Evidence 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.

Conclusions

The 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.

【 授权许可】

   
2014 Hawkes et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]WHO: Population-based prevention strategies for childhood obesity. Geneva: WHO; 2010.
• [2]Kumanyika SK, Obarzanek E, Stettler N, Bell R, Field AE, Fortmann SP, Franklin BA, Gillman MW, Lewis CE, Poston WC 2nd, Stevens J, Hong Y, American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention: Population-based prevention of obesity. the need for comprehensive promotion of healthful eating, physical activity, and energy balance. Circulation 2008, 118:428-464.
• [3]Swinburn B, Gill T, Kumanyika S: Obesity prevention: a proposed framework for translating evidence into action. Obes Rev 2005, 6(1):23-33.
• [4]Lang T, Rayner G: Obesity: a growing issue for European policy? J Eur Soc Pol 2005, 15:301.
• [5]Branca F, Nikogosian H, Lobstein T: The Challenge of Obesity in the WHO European Region and the Strategies for Response. Copenhagen: World Health Organization Regional Office for Europe; 2007.
• [6]Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, Parry V: Foresight - Tackling Obesities - Future Choices Project. London: Government Office for Science; 2007.
• [7]World Health Organisation: Assessing national capacity for the prevention and control of non- communicable diseases: report of the 2010 global survey. Geneva: World Health Organization; 2012. Available at: http://www.who.int/cancer/publications/national_capacity_ prevention_ncds.pdf webcite
• [8]Share M, Strain M: Making schools and young people responsible: a critical analysis of Ireland’s obesity strategy. Health Soc Care Community 2008, 16(3):234-243. doi:10.1111/j.1365-2524.2008.00763.x. Epub 2008 Mar 3
• [9]Cross-Government Obesity Unit, Department of Health and Department of Children, Schools and Families: Healthy Weight, Healthy Lives: a cross-government strategy for England. London: HM Government; 2008.
• [10]Jebb SA, Aveyard PN, Hawkes C: The evolution of policy and actions to tackle obesity in England. Obes Revdoi:10.1111/obr.12093
• [11]National Audit Office: An update on the government’s approach to tackling obesity. Memorandum for the Committee of Public Accounts, 17 July 2012. London: NAO; 2012.
• [12]National Audit Office (NAO): Tackling Child Obesity - First Steps. London: The Stationary Office; 2007.
• [13]House of Commons Committee of Public Accounts: Tackling Child Obesity—First Steps Eighth Report of Session 2006–07. London: Stationary Office; 2006.
• [14]HM Treasury: Meeting the aspirations of the British people. 2007 Pre-Budget Report and Comprehensive Spending Review. London: HM Treasury; 2007.
• [15]Department of Health: The operating framework for the NHS in England 2008/09. London: Department of Health; 2007.
• [16]Public Health England: Obesity Knowledge and Intelligence. Online resource at: http://www.noo.org.uk webcite
• [17]Health and Social Care Information Centre: National Child Measurement Programme. Online resource at: http://www.hscic.gov.uk/ncmp webcite
• [18]Department of Health: Healthy Lives, Healthy People: A call to action on obesity in England. London: DH; 2011.
• [19]Ritchie J, Spencer L: Qualitative data analysis for applied policy research. In Analyzing Qualitative Data. Edited by Bryman A, Burgess RG. London and New York: Routledge; 1994:173-194.
• [20]Department of Health: Healthy Weight, Healthy Lives: One Year On. London: DH; 2009.
• [21]Department for Communities and Local Government (DCLG): National Indicators for Local Authorities and Local Authority Partnerships: Handbook of Definitions Annex 2: Children and Young People. London: DCLG; 2007.
• [22]National Obesity Observatory: Standard Evaluation Frameworks. Oxford: NOO; 2012. Online resource at: http://www.noo.org.uk/core/frameworks webcite
• [23]Obesity Learning Centre http://www.obesitylearningcentre-nhf.org.uk webcite
• [24]Brownell KD, Kersh R, Ludwig DS, Post RC, Puhl RM, Schwartz MB, Willett WC: Personal responsibility and obesity: a constructive approach to a controversial issue. Health Aff (Millwood) 2010, 29(3):379-387.
• [25]Stahl T, Wismar M, Ollila E, Lahtinen E, Leppo K (Eds): Health in All Policies: Prospects and Potentials In Ministry of Social Affairs and Health, Helsinki, Finland, European Observatory on Health Systems and Policies, Brussels (2006)http://www.euro.who.int/__data/assets/pdf_file/0003/109146/E89260.pdf?ua=1 webcite
• [26]Garrett J, Natalicchio M (Eds): Working Multisectorally in Nutrition. Principles, Practices, and Case Studies Washington DC: IFPRI; 2011. http://www.ifpri.org/sites/default/files/publications/oc68.pdf webcite
• [27]Public Health Agency of Canada (PHAC): Crossing sectors – experiences in intersectoral action, public policy and health. In Prepared by the Public Health Agency of Canada in collaboration with the Health Systems Knowledge Network of the World Health Organisation’s Commission on Social Determinants of Health and the Regional Network for Equity in Health in East and Southern Africa (EQUINET). Ottawa: PHAC; 2007.
• [28]Government of South Australia: The South Australian Approach to Health in All Policies: Background and Practical Guide. Department of Health, Government of South Australia, 2011http://www.sahealth.sa.gov.au/wps/wcm/connect/cb6fa18043aece9fb510fded1a914d95/HiAPBackgroundPracticalGuide-v2.pdf?MOD=AJPERES&CACHEID=cb6fa18043aece9fb510fded1a914d95 webcite
• [29]Levinson FJ, Balarajan Y, Marini A: Addressing Nutrition Multisectorally. What have we learned from recent international experience?. New York: United Nations; 2013.
• [30]Garrett J, Kadiyala S, Kohli N: Working Multisectorally to Improve Nutrition: Current Status in India and Global Lessons. In POSHAN Policy Note #1. New Delhi, India: International Food Policy Research Institute; 2014.
• [31]Exworthy M, Hunter DJ: The challenge of joined-up government in tackling health inequalities. Int J Publ Admin 2011, 34(4):201-212.
• [32]Campbell H, Gibson A: Health targets in the NHS: lessons learned from experience with breast feeding targets in Scotland. Br Med J 1997, 314(7086):1030.
• [33]Gunning-Schepers LJ, Van Herten LM: Targets in health policy. Eur J Publ Health 2000, 10(suppl 4):2-6.
• [34]WHO: NCD Global Monitoring Framework. Online resource 2013. http://www.who.int/nmh/global_monitoring_framework/en/ webcite
• [35]Ogilvie D, Cummins S, Petticrew M, White M, Jones A, Wheeler K: Assessing the evaluability of complex public health interventions: five questions for researchers, funders, and policymakers. Milbank Q 2011, 89(2):206-225.
• [36]Blackman T, Elliott E, Greene A, Harrington B, Hunter D, Marks L, McKee L, Williams G, Smith K: Tackling health inequalities in post‒devolution Britain: do targets matter? Publ Admin 2009, 87(4):762-778.