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Background: The Public Health Responsibility Deal (RD) is a public--private partnership in England involving voluntary pledges between government, and business and other public organizations to improve public health. One such voluntary pledge refers to the reduction of trans fatty acids (TFAs) in the food supply in England by either pledging not to use artificial TFAs or pledging artificial TFA removal. This paper evaluates the RD's effectiveness at encouraging signatory organizations to remove artificially produced TFAs from their products. Methods: We analysed publically available data submitted by RD signatory organizations. We analysed their plans and progress towards achieving the TFAs pledge, comparing 2015 progress reports against their delivery plans. We also assessed the extent to which TFAs reductions beyond pre-2011 levels could be attributed to the RD. Results: Voluntary reformulation via the RD has had limited added value, because the first part of the trans fat pledge simply requires organizations to confirm that they do not use TFAs and the second part, that has the potential to reduce use, has failed to attract the participation of food producers, particularly those producing fast foods and takeaways, where most remaining use of artificial TFAs is located. Conclusions: The contribution of the RD TFAs pledges in reducing artificial TFAs from England's food supply beyond pre-2011 levels appears to be negligible. This research has wider implications for the growing international evidence base voluntary food policy, and offers insights for other countries currently undertaking work to remove TFAs from their food supply. [ABSTRACT FROM AUTHOR]

Background: This paper proposes that Population Impact Measures (PIMs), the Population Impact Number of Eliminating a Risk Factor over a time period (PIN-ER-t) and the number of events prevented in your population (NEPP), can assist in policy making as they include relevant information which describes the impact or benefits to the population of risk factors and interventions. In this study, we explore the utilization of the indicators from European System of Urban Health Indicators System to produce the two PIMs. Methods: We identified from the indicators list the health determinants, health status and health interventions which can be linked, and searched Medline for evidence of association. We then investigated whether the type of frequency measure available for the indicator match with the measure used in PIMs, and explored data availability for the City of Manchester (UK) as an urban area. Results: Of the 39 indicators relevant to socio-economic factors, health determinants and health status, it was possible to calculate the population impact of a risk factor, i.e. the PIN-ER-t, for only six associations, and the population impact of health interventions, i.e. NEPP, for only one out of the three listed indicators, as the relevant health conditions were not included. Conclusions: The results of this study suggest that if an indicator system is intended to play a part in the policy making process, then the method of presentation to policy-makers should be decided before setting up the system, as it is likely that some indicators which would be essential might not be available. [ABSTRACT FROM AUTHOR]

Background Sustaining public health programmes in the long-term is key to ensuring full manifestation of their intended benefits. Although an increasing interest in sustainability is apparent within the global literature, empirical studies from within the European setting are few. The factors that influence sustainability are generally conceptualized at three levels: programme level, the immediate context and the wider environment. To-date attention has focused primarily on the former two. Using a community-based child injury prevention programme in England as an exemplar, this paper explores the concept of sustainability within the wider policy environment, and considers the impact of this on local programmes. Methods A content review of global and UK national public health policies (1981-2014) relevant to child safety was undertaken. Interviews were held with senior representatives of global and UK agencies involved in developing child safety policy. Results Forty-nine policies were reviewed. The term 'sustain', or its derivatives, featured in 36 (73%) of these. Its' use however, related primarily to conservation of resources rather than continued programme operation. Potential mechanisms for supporting programme sustainability featured within some documents; however, the approach to sustainability was inconsistent between policies and over time. Policy stakeholders identified programme sustainability as relevant to their core business, but its' conceptualization varied according to individual interpretation. Conclusions Programme sustainability is poorly addressed within global and UK-based public health policy. Strengthening a national and international policy focus on sustainability and incorporating sustainability into public health planning frameworks may create a more supportive environment for local programmes. [ABSTRACT FROM AUTHOR]

Most American and English cancer patients prefer to die at home. Factors associated with greater likelihood of dying at home have been contradictory in many studies and no studies have compared the effects of factors in different countries. The objective of this paper is to compare the factors affecting place of cancer death in two major cities, New York and London. Methods: We use data on all individuals aged ≥40 dying of cancer in London (59604) and New York City (51 668) in the years 1995 through 1998. The probability of death at home is examined in each city as a function of gender, age group (40-55, 56-64, 65-74, 75+), year, type of cancer, and area socioeconomic status, using multiple logistic regression. Results: Although the probability of death at home is the same in the two cities (∼1 in 5), being female lowers the odds of death at home by ∼7% in London, and raises it by ∼22% in New York. Older age is associated with increased odds of dying at home in New York but decreased odds of dying at home in London. Being in the lowest tercile of socioeconomic status (relative to the highest) lowers the odds of death at home by 22% in London and 39% in New York. Conclusion: Site of death varies significantly by patient and area characteristics in both cities, an understanding, which should be taken account of in future planning of end-of-life care. [ABSTRACT FROM AUTHOR]

Background: This paper presents an analysis of the English experience of setting and monitoring targets during the 1990s. It draws on two studies of the former national public health strategy, ‘Health of the Nation’ (HOTN). Methods: the two evaluations conducted 16 case studies between them, two in each health region in England. Over 250 individual and group interviews were conducted and over 400 documents were analysed. In eight health authorities, an analysis of expenditure was also carried out to determine what impact, if any, HOTN had on resource allocation. Results: Full results are published elsewhere. Lessons for the new strategy are as follows: i) the role of central government is key in ensuring that there is a consistent message across government in support of the health strategy and in fostering the development and dissemination of an evidence-base for public health, ii) The new strategy needs to address the underlying social and structural determinants of health and health inequalities directly, iii) Both studies found widespread support for targets as a helpful way to prioritise and focus efforts. However, national targets must be credible i.e. based on sound and convincing evidence. The development of local targets needs to be encouraged, and process targets should supplement outcomes locally and nationally, iv) The new strategy needs to be communicated widely – to broaden ownership outside the National Health Service, and include the public, v) To sustain momentum and ensure effective implementation, the strategy must be embedded in the performance management framework for health and local authorities, vi) Partnerships between key local agencies to work together for health need to be encouraged, either via a statutory framework or with other incentives. Discussion: The new English strategy, ‘Saving Lives’, is outlined in relation to the development of targets. The wider issues of a target-based approach to health policy include: i) Importance of distinguishing between the objective to ensure that policy is directed towards the achievement of health outcomes, and monitoring progress to ensure that health policy objectives are being achieved, ii) The role of targets as an inspiration as well as or instead of a management tool, iii) A target-based health policy should: set targets which are realistic, achievable and challenging; involve stakeholders; link targets to implementation; consider technical issues e.g. small numbers, availability of data; be based on evidence; express targets in terms of health improvement, iv) Target-based health policies should avoid: perverse incentives; distortion of data; too many targets; target setting without resources, v) The experience from England provides lessons for other European countries introducing a target-based approach to health policy. [ABSTRACT FROM AUTHOR]