91�ȱ�

With the backing of around 150 companies, this week the government unveiled its 'responsibility deal' on public health in England.

It's a series of voluntary pledges by industry designed to tackle big health issues like alcohol abuse and obesity.

But while companies such as the major supermarket chains, big drinks producers and high street food outlets have all signed up, many health groups have walked away from the scheme.

They include Alcohol Concern, the British Medical Association and the Royal College of Physicians, and they argued the pledges were not specific or measurable enough, and that industry had been dictating policy.

Their rejection of the deal raises the wider question - can voluntary agreements with industry really address the huge health problems associated with alcohol abuse and obesity?

There were five main areas covered by the responsibility deal itself - food, physical activity, alcohol, health at work and behaviour change.

But it is food and alcohol that have been the focus for criticism.

Conflict of interest

Professor Anna Gilmore, a public health expert from Bath University, says there is a fundamental conflict of interest that has been ignored.

"These large corporations, whether they sell tobacco, food or alcohol, are legally obliged to maximise shareholder returns. They therefore have to oppose any policies that could reduce sales and profitability - in other words, the most effective policies."

"Food companies, for example, have two basic options when it comes to enhancing shareholder revenue: to persuade consumers to eat more or to increase profit margins.

"Experts indicate that much higher profits come from processed compared to fresh foods - so promoting the latter, advising people to eat less or eat more healthily contradicts the core business models of many food companies."

And Professor Gilmore says there is another key problem: A lack of evidence to support the kind of partnership approach employed by the responsibility deal.

"There's no evidence that voluntary approaches work. Look at what happened with the tobacco industry.

"The internal records of the tobacco companies became available when they were sued. They show the companies pushed voluntary approaches specifically in order to avoid binding legislation. Yet independent evaluations show that these voluntary approaches were ineffective."

But once legislation on smoking was introduced - from warnings on cigarette packets to bans on smoking in enclosed public places - along with tough tobacco tax policies, the number of smokers fell sharply.

Borrowed tactics

Professor Gilmore says that to sell products and to influence policy makers, the food and drinks industries share many of the tactics used by the tobacco companies before them.

"They include focusing on personal responsibility, claiming government intervention infringes individual liberty, vilifying critics, labelling studies contrary to their interests 'junk science', using corporate social responsibility to enhance reputation and promote brands, opposing effective binding regulation and promoting self-regulation via voluntary codes."

Many public health experts argue that all the big advances in public health have relied on legislation, from seat belt laws to smoking bans.

But the health secretary Andrew Lansley believes legislation takes time and regulation is expensive - and working with industry is the quickest way to get results.

"Public health is everyone's responsibility and there is a role for all of us, working in partnership, to tackle these challenges. We know that regulation is costly, can take years and is often only determined at an EU-wide level anyway.

"That's why we have to introduce new ways of achieving better results. The deals demonstrate the effectiveness of our radical partnership approach to deliver more and sooner."

Specific promises

The drinks company SABMiller is one such partner who has signed up to measures that include a general pledge to "foster a culture of responsible drinking".

It has also agreed more specific promises such as clear labelling of products, support for the charity Drinkaware and strengthening responsible marketing practices.

Sue Clark, the company's director of corporate affairs, strongly supports the government's model of closely involving industry.

"It makes complete sense for the government to get all relevant parties around the table to find ways of addressing alcohol abuse. A complex, multi-faceted problem like alcohol abuse requires a comprehensive, multi-faceted response - and that is what the Public Health Responsibility Deal provides.

"It sets out practical, measurable and deliverable steps which can be a real catalyst for change if everyone plays their part."

Ministers feel the criticism of the 'responsibility deal' by health groups is unfair; the health groups say their credibility would have been undermined had they signed up to the pledges.

Even critics of the government's approach say there should be a place for working alongside the food and drinks industry and the government says it will regulate if the voluntary approach fails to produce results.

But perhaps getting the balance between cooperation and regulation has proved to be more difficult and controversial than ministers had anticipated.