UKPRPICA: SPECTRUM: Shaping Public hEalth poliCies To Reduce IneqUalities and harM

Lead Research Organisation: University of Edinburgh
Department Name: Centre of Population Health Sciences

Abstract

The main causes of health conditions such as cancer, heart disease, respiratory diseases and diabetes (Non-Communicable Diseases, NCDs) are things we consume such as tobacco, alcohol and foods high in salt, sugar and fat. These products are often manufactured by large companies, 'Unhealthy Commodity Producers' (UCPs), who make a lot of money from their sale and whose interests can conflict with health goals. UCPs try to increase their profits by using advertising to make their products more attractive, selling them in places where they are more likely to be bought, and pricing them in ways that increase consumption. We also know that UCPs target their products at people who may be more susceptible to these tactics. As a result, the health of poorer people and communities can be more affected. Because UCPs are powerful, their actions can have an impact on governments which can mean that policies to protect health (such as taxes on unhealthy products, or advertising bans) are less likely to be put in place, or can be delayed or changed.

SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harm) is an ambitious new programme that aims to reduce NCDs by doing research that will help inform policies and practices to promote health. SPECTRUM's work will support governments, local authorities, public health bodies and other organisations in dealing with the influence of UCPs. SPECTRUM will mainly focus on tobacco and alcohol, but will also consider unhealthy food and drinks.

Our research will be conducted in eight areas of research that will focus on:
1) how thinking about and studying NCD prevention at different levels (as part of a system) can lead to better evidence, policy and practice
2) understanding and finding ways to address the actions and influence of UCPs
3) using better information from surveys and other types of data about people's behaviour which could help inform policies and practices to prevent NCDs
4) analysing the impact of unhealthy products and policies on the economy
5) identifying how changing local communities, and the availability of unhealthy products in these communities, can reduce product use and harms
6) developing and evaluating new policies and practices to prevent NCDs
7) studying how to reduce stigma and mental ill-health related to unhealthy products
8) examining what new or improved regulations or ways of working could reduce (unfair) levels of harm in relation to unhealthy products.

SPECTRUM brings together world-leading researchers from 10 UK Universities with support from academics overseas. Our work will be developed with a range of partner organisations that includes health bodies, charities, and companies who provide data and whose staff have skills that can help our research. We will involve the public through regularly meeting with groups made up of members of the public, specific meetings called 'citizen's juries', and by interviewing people from communities across the country. We will work with our partners, politicians and civil servants, health and social care professionals and others to jointly design and deliver research so that it meets their needs. We expect SPECTRUM to speed up how evidence is used to inform new and existing policy and practices to improve the health of people in the UK, and to develop research that could also support progress in other countries.

Technical Summary

The main causes of NCDs include consumption of unhealthy commodities. These exposures are preventable, but the commodities involved are highly profitable. Their consumption and health and social impacts are also inequitable and driven by complex systems of production, distribution and promotion dominated by transnational companies -Unhealthy Commodity Producers (UCPs). UCPs' economic interests often conflict with health goals and their role in determining health has received insufficient attention.
SPECTRUM aims to generate new evidence to inform the prevention of NCDs caused by unhealthy commodities and to transform policy and practice to encourage the adoption of healthy environments and behaviours.
With a principal focus on tobacco and alcohol, our work will extend to foods high in salt, sugar and fat in key studies. Approaches we develop could in future be applied to other unhealthy commodities. We will conduct research in eight integrated Work Packages: 1.using systems science to understand and prevent behavioural drivers of disease and harm; 2.understanding and countering corporate conduct and influence; 3.using new data sources to inform action; 4.conducting economic analysis to inform policy and practice; 5.shaping the environment to change harmful behaviours; 6.evaluating the effectiveness of policies and natural experiments; 7.reducing mental health inequalities; and 8.building governance for health equity.
Along with an inter-disciplinary research team, SPECTRUM's work will be co-created with research users from civil society organisations, companies and the main public health agencies in Great Britain. The public will be involved through engagement panels, citizen's juries and qualitative research. This partnership will ensure that research findings will benefit from an accelerated pathway to inform new policies and practices and will provide valuable data to assess the extent and effectiveness of approaches to addressing NCDs in the UK and beyond.

This grant is funded by the UK Prevention Research Partnership (UKPRP) which is administered by the Medical Research Council on behalf of the UKPRP's 12 funding partners: British Heart Foundation; Cancer Research UK; Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Engineering and Physical Sciences Research Council; Economic and Social Research Council; Health and Social Care Research and Development Division, Welsh Government; Health and Social Care Public Health Agency, Northern Ireland; Medical Research Council; Natural Environment Research Council; National Institute for Health Research; The Health Foundation; The Wellcome Trust.

Planned Impact

OUR IMPACT GOALS ARE TO:
1) Co-produce evidence to underpin the development, enactment, evaluation & maintenance of large-scale, generalizable and cost-effective interventions to reduce consumption, harm and inequalities arising from unhealthy commodities.
2) Establish, enhance and sustain mutually beneficial relationships with policy & other partners to increase the visibility, credibility and impact of SPECTRUM evidence, and make the case for future investment in NCD prevention and commercial determinants of health research.
3) Embed sustainable and meaningful strategies for public involvement to ensure our research, outputs and activities are accessible and grounded in lived experience.

WHO WILL BE INTERESTED, AND HOW MIGHT THEY BENEFIT?

LOCAL AND NATIONAL GOVERNMENTS & INTERNATIONAL ORGANISATIONS
Building on our extensive experience of working with policymakers, our research will inform, influence, develop and evaluate novel policies and practices to prevent NCDs and reduce inequalities. This will be of interest to policymakers across different levels and policy spheres. We will continue to collaborate with and engage key stakeholders (LAs, licensing teams, civil servants, cross-party groups, WHO fora etc.) and develop new partnerships (e.g. in urban planning, community justice).

Within 3 years, we will co-produce and disseminate evidence on:
-the effectiveness of current regulation of marketing & potential new areas for intervention (WP1)
-case studies of UCP influence on the policy process, social norms and stigma, and current governance of conflicts of interest (WP2,7 & 8)
-links between unhealthy commodity availability locally and nationally, and economic, social, mental and physical health harms (WP4,5)
-the impact of policy and practice options to reduce UCP influence, harms and inequalities (all WPs esp. 3&6).

Within 5 years, we expect to influence diverse local and national policies and practices, including govnt strategies on tobacco, alcohol and overweight/obesity & international frameworks for NCD prevention.

ORGANISATIONS ENGAGED IN ADVOCACY to reduce NCD harm and address inequalities (e.g. AHA, OHA, Poverty Alliance, Smokefree Action Coalition, NCD Alliance, Mental Health & Smoking Partnership, CRUK)
We will continue to work closely with civil society partners to ensure our research reflects agreed priorities, and builds the case for policy change via new and more accessible evidence. Robust intelligence regarding industry activity will help shape advocacy strategies, the development and implementation of cross-sectoral approaches will increase efficiencies through reducing duplication of effort, and both will help to limit UCP influence on policy. We will work with research councils, charities and other funders to further promote NCD prevention and strengthen research governance.

NATIONAL & DEVOLVED HEALTH ORGANISATIONS
We will co-produce evidence and outputs with PHE, Health Scotland, PH Wales and others to develop and communicate evidence to local and national governments, the NHS and community organisations so as to reduce environmental cues and marketing strategies that promote unhealthy commodity use. Knowledge brokers seconded from PHE, HS and PH Wales will ensure that SPECTRUM's research is policy relevant and that, in turn, the evidence rapidly feeds into their work, is channelled through their strong policy links, and enhances our trusted relationships with local, devolved and national policymakers.

GENERAL PUBLIC
We will use a variety of new and existing methods (Citizen's Juries, PPI panels) to engage the public in co-producing proposals, shaping interventions, and interpreting and communicating findings. Our findings will benefit the public via enactment of innovative, effective policies and practices to reduce pro-consumption influences, inequalities, and stigma, whilst reaching those directly experiencing harms with evidence-based tested messages.

Publications

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