What makes effective advocacy? An exploration of public health nutrition advocacy in England

Background: This research explores aspects of the widely discussed gap between the state of public health nutrition in England and the appropriateness of government and commercial responses. Specifically, it explores the role of NGO advocacy in altering and improving this situation. Recognising that NGOs conduct their advocacy to protect the public good and shape public health nutrition policy, this research analyses the role and effectiveness of NGO advocacy in shifting and shaping the dynamics of food and nutrition policy, and how it can be measured. Drawing on interdisciplinary political theories and existing models of advocacy, the research applies an academic lens to some of the practical challenges and issues faced by NGO advocates. Aim: The aim of this research was to understand the role and effectiveness of NGO advocacy in public health nutrition, a previously under-researched area. The research focuses on England, a country with an active NGO presence, and explored the different types of advocacy and the different ways in which advocacy success is, and could be, measured. The research has relevance for the academic literature, for our understanding of advocacy effectiveness in public health nutrition and, not least, for improving the way NGOs engage with policy and change. Research questions: Three research questions were posed: 1. What conditions support or hinder NGO advocacy in public health nutrition? 2. What advocacy tactics are adopted by NGOs working in public health nutrition? 3. How can the effectiveness of public health nutrition advocacy be measured? Methods: Qualitative research methods were used, primarily drawing on the experiences in England from three implemented public health nutrition policies (FOP labelling, marketing restrictions and salt reduction) and four NGOs working on public health nutrition. A combination of methods, including semi-structured interviews (N=29) and document analysis of grey literature from campaigning groups and government agencies, were used to answer each research question to aid triangulation and validation of the findings. Main findings: Advocacy was found to be a complex mix of positions and strategies, with no single model utilised by NGOs. There is a range of ‘advocacies’ which mean different things, at different times, in different contexts and to different people. Advocacy was found to be intrinsically linked to external conditions, and these conditions often dictate the most appropriate approach and likelihood of success. The research demonstrated different ways in which advocacy can react to, shape and navigate these conditions as part of efforts to achieve change. As a result of the conditions, advocacy was found to be rarely straightforward or predictable, adding a layer of complexity for measuring advocacy. A number of short- and long-term indicators for measuring advocacy were identified and, drawing on the overall findings, it is suggested that in order to get the most value from an advocacy monitoring framework, advocacy should always be contextualised within the wider conditions, and a range of different indicators should be used to reflect these different conditions. The thesis ends by reflecting on the practical implications of the research and proposing a practical framework for monitoring advocacy. Implications: The results of this research provide insights into public health nutrition advocacy and the complexity and dynamics within which it operates. The vital role of the conditions highlights the need to contextualise any assessment of advocacy and thus utilise measures across a range of domains. Progress was found to result from both abrupt and incremental change and as such advocacy which is fluid and dynamic will be necessary in order to react, shape and navigate different conditions. While needing further refinement and research, the monitoring framework presented in this thesis is valuable as a means to identify appropriate advocacy tactics and measures, while being underpinned by the conditions at play. The measuring challenge for advocacy remains, but the proposed framework developed can aid future monitoring and refinement of advocacy and thus help improve the ability of NGOs to support improvements to public health nutrition

South Africa; 21 Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases (C-POND)

Summary The International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS) proposes to collect performance indicators on food policies, actions and environments related to obesity and non-communicable diseases. This paper reviews existing communications strategies used for performance indicators and proposes the approach to be taken for INFORMAS. Twenty-seven scoring and rating tools were identified in various fields of public health including alcohol, tobacco, physical activity, infant feeding and food environments. These were compared based on the types of indicators used and how they were quantified, scoring methods, presentation and the communication and reporting strategies used. There are several implications of these analyses for INFORMAS: the ratings/benchmarking approach is very commonly used, presumably because it is an effective way to communicate progress and stimulate action, although this has not been formally evaluated; the tools used must be trustworthy, pragmatic and policy-relevant; multiple channels of communication will be needed; communications need to be tailored and targeted to decision-makers; data and methods should be freely accessible. The proposed communications strategy for INFORMAS has been built around these lessons to ensure that INFORMAS's outputs have the greatest chance of being used to improve food environments

Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial

Background Arthroscopic sub-acromial decompression (decompressing the sub-acromial space by removing bone spurs and soft tissue arthroscopically) is a common surgery for subacromial shoulder pain, but its effectiveness is uncertain. We did a study to assess its effectiveness and to investigate the mechanism for surgical decompression. Methods We did a multicentre, randomised, pragmatic, parallel group, placebo-controlled, three-group trial at 32 hospitals in the UK with 51 surgeons. Participants were patients who had subacromial pain for at least 3 months with intact rotator cuff tendons, were eligible for arthroscopic surgery, and had previously completed a non-operative management programme that included exercise therapy and at least one steroid injection. Exclusion criteria included a full-thickness torn rotator cuff. We randomly assigned participants (1:1:1) to arthroscopic subacromial decompression, investigational arthroscopy only, or no treatment (attendance of one reassessment appointment with a specialist shoulder clinician 3 months after study entry, but no intervention). Arthroscopy only was a placebo as the essential surgical element (bone and soft tissue removal) was omitted. We did the randomisation with a computer-generated minimisation system. In the surgical intervention groups, patients were not told which type of surgery they were receiving (to ensure masking). Patients were followed up at 6 months and 1 year after randomisation; surgeons coordinated their waiting lists to schedule surgeries as close as possible to randomisation. The primary outcome was the Oxford Shoulder Score (0 [worst] to 48 [best]) at 6 months, analysed by intention to treat. The sample size calculation was based upon a target difference of 4·5 points (SD 9·0). This trial has been registered at ClinicalTrials.gov, number NCT01623011. Findings Between Sept 14, 2012, and June 16, 2015, we randomly assigned 313 patients to treatment groups (106 to decompression surgery, 103 to arthroscopy only, and 104 to no treatment). 24 [23%], 43 [42%], and 12 [12%] of the decompression, arthroscopy only, and no treatment groups, respectively, did not receive their assigned treatment by 6 months. At 6 months, data for the Oxford Shoulder Score were available for 90 patients assigned to decompression, 94 to arthroscopy, and 90 to no treatment. Mean Oxford Shoulder Score did not differ between the two surgical groups at 6 months (decompression mean 32·7 points [SD 11·6] vs arthroscopy mean 34·2 points [9·2]; mean difference −1·3 points (95% CI −3·9 to 1·3, p=0·3141). Both surgical groups showed a small benefit over no treatment (mean 29·4 points [SD 11·9], mean difference vs decompression 2·8 points [95% CI 0·5–5·2], p=0·0186; mean difference vs arthroscopy 4·2 [1·8–6·6], p=0·0014) but these differences were not clinically important. There were six study-related complications that were all frozen shoulders (in two patients in each group). Interpretation Surgical groups had better outcomes for shoulder pain and function compared with no treatment but this difference was not clinically important. Additionally, surgical decompression appeared to offer no extra benefit over arthroscopy only. The difference between the surgical groups and no treatment might be the result of, for instance, a placebo effect or postoperative physiotherapy. The findings question the value of this operation for these indications, and this should be communicated to patients during the shared treatment decision-making process. Funding Arthritis Research UK, the National Institute for Health Research Biomedical Research Centre, and the Royal College of Surgeons (England)

Psychological and ethical issues in third party assisted conception and surrogate motherhood

The continuing increase in babies born via third party assisted conception (AC) and surrogate motherhood across the world shows the success of and medical and social demand for third party interventions in family building. However, with the increasing use of such interventions world-wide, commercialisation and commodification have proliferated. This in turn has led to inequality in access to AC services, in choice of third party input, and in questionable human rights and psychosocial welfare issues. Transitioning to parenthood using third party AC and surrogate motherhood, in addition to requiring equality in access, also demand accuracy of birth and genetic information. In the absence of accurate record keeping, continuing practices of anonymity, and marginalization of the contribution of donors and surrogates, psychological, social, health and ethical questions are raised for donors, recipients and potentially for (genetic, gestational) part, half and full offspring, siblings and others in the extended family such as grandparents

Role of salt intake in prevention of cardiovascular disease: controversies and challenges.

Strong evidence indicates that reduction of salt intake lowers blood pressure and reduces the risk of cardiovascular disease (CVD). The WHO has set a global target of reducing the population salt intake from the current level of approximately 10 g daily to 85 categories of food; many other developed countries are following the UK's lead. In developing countries where most of the salt is added by consumers, public health campaigns have a major role. Every country should adopt a coherent, workable strategy. Even a modest reduction in salt intake across the whole population can lead to a major improvement in public health and cost savings

Children and Their Parents: A Comparative Study of the Legal Position of Children with Regard to Their Intentional and Biological Parents in English and Dutch Law

This is a book about children and their parents. There are many different kinds of children and at least about as many different kinds of parents. In addition to the many different disciplines that study children and their parents, such as sociology, psychology, child studies and gender studies, to name but a few, this study concerns a legal question with regard to the parent-child relationship, namely how the law assigns parents to children. This subject is approached in a comparative legal perspective and covers England and The Netherlands. The book contains a detailed comparison and analysis of the manner in which the law in the two jurisdictions assigns the status of legal parent and/or attributes parental responsibility to the child’s biological and intentional parents. The concept ‘procreational responsibility’, which is introduced in the concluding chapter of the book, may be used as a tool to assess and reform existing regulations on legal parent-child relationships. The structure of the book, which is based on a categorisation of different family types in a ‘family tree’, enables the reader to have easy access to family-specific information.FdR – Publicaties zonder aanstelling Universiteit Leide