More than Obesity Prevention? Defining Outcomes in the Healthy Towns Programme in England
Background In 2008, £30 million was invested by UK Government in the Healthy Towns (HT) Programme in England. Nine urban areas were selected to develop and implement interventions to tackle the obesogenic environment. These involved multi-sector approaches to promoting physical activity and improve diet through the use of environmental interventions. In this paper, we explore how stakeholders conceptualised and defined programme outcomes in relation to national and local priorities, and across multiple policy sectors.
Methods We undertook semi-structured, face-to-face interviews with 65 HT staff (programme leads, intervention managers and staff) in 2010–2011. Interviews lasted 50 to 110 minutes and were digitally recorded, anonymised and transcribed verbatim. Participants were asked about: the main outcomes and benefits of the HT programme, and links and synergies with other policy areas. Thematic analysis was undertaken; three authors developed and discussed the coding framework, coding outputs and agreed the resultant main themes.
Results Programme staff conceptualised outcomes as extending beyond obesity-related behaviours and identified multiple, complementary policy areas that they were attempting to address through the initiative. Four broad categories of outcomes were articulated:  direct obesity-related outcomes (healthy diet, physical activity);  indirect obesity-related outcomes (obesity awareness, infrastructure provision);  wider health-related outcomes (air quality, social capital);  non-health outcomes (environmental sustainability, monetary savings). Stakeholders emphasised the interrelatedness of these four categories of outcomes. For example, tackling obesity, improving transport planning and air quality could all be addressed using active travel interventions; tackling obesity, enhancing social capital and promoting environmental sustainability could be addressed using ‘growing food’ interventions. Furthermore, obesity and non-obesity agendas were seen as complementary in terms of delivery of their respective outcomes.
Discussion The range and number of outcomes identified may have been both a consequence of the multi-sector, holistic approach taken by HT programme and the ‘on the ground’ reality of implementing complex interventions, whose components touch a wide variety of policy sectors. When planning programmes and their evaluation, consideration of the impact on outcomes that extend beyond the focus of a particular programme could also be beneficial. In the HT programme, policy makers and practitioners believed that delivered interventions could address a range of complementary policy areas, which were all equally important. Taking such a ‘joined-up’ perspective could help increase the efficiency and acceptability of social, environmental, and health policies and interventions.