System-science Informed Public Health and Economic Research for Non-communicable Disease Prevention (the SIPHER Consortium)

Abstract

THE PROBLEM
There is strong evidence that the social and economic conditions in which we grow, live, work and age determine our health to a much larger degree than lifestyle choices. These social determinants of health, such as income, good quality homes, education or work, are not distributed equally in society, which leads to health inequalities. However, we know very little about how specific policies influence the social conditions to prevent ill health and reduce health inequalities. Also, most social determinants of health are the responsibility of policy sectors other than "health", which means policymakers need to promote health in ALL their policies if they are to have a big impact on health. SIPHER will provide new scientific evidence and methods to support such a shift from "health policy" to "healthy public policy".

OUR POLICY FOCUS
We will work with three policy partners at local, regional and national level to tackle their above-average chronic disease burden and persistent health inequalities: Sheffield City Council, Greater Manchester Combined Authority and Scottish Government. We will focus on four jointly agreed policy priorities for good health:
- Creating a fairer economy
- Promoting mental wellbeing
- Providing affordable, good quality housing
- Preventing long-term effects of difficult childhoods.

OUR COMPLEX SYSTEMS SCIENCE APPROACH
Each of the above policy areas is a complex political system with many competing priorities, where policy choices in one sector (e.g. housing) can have large unintended effects in others (e.g. poverty). There is often no "correct" solution because compromises between different outcomes require value judgements. This means that to assess the true benefits and costs of a policy in relation to health, policy effects and their interdependencies need to be assessed across a wide range of possible outcomes. However, no policymaker has knowledge of the whole system and future economic and political developments are uncertain. Ongoing monitoring of expected and unexpected effects of policies and other system changes is crucial so failing policies can be revised or dropped.

We propose to use complex systems modelling, which has been developed to understand and make projections of what might happen in complex systems given different plausible assumptions about future developments. Our models will be underpinned by the best available data and prior research in each policy area. Our new evidence about likely policy effects across a wide range of outcomes will help policy partners decide between alternative policies, depending on how important different outcomes are to them (e.g. improving health or economic growth). We will develop support tools that can visualise the forecasts, identify policies that achieve the desired balance between competing outcomes and update recommendations when new information emerges. Whilst new to public health policy, these methods are well-established in engineering and climate science.

We will
1. Work with policy partners to understand the policy systems and evidence needs
2. Bring together existing data and evidence on each policy system (e.g. links between policies and outcomes, interdependencies between outcomes)
3. Explore citizens' preferences for prioritising when not all outcomes can be achieved
4. Link policies and their health and non-health effects in computer models to analyse benefits and costs over time
5. Build an interactive tool to help policy decision-making, inform advocacy action and support political debate.

SIPHER's MAIN OUTCOME
We will provide policymakers with a new methodology that allows them to estimate the health-related costs and benefits of policies that are implemented outside the health sector. This will be useful to our partners, and others, who want to assess how scarce public sector resources can be spent to maximise the health and wellbeing benefits from all their activities.

Technical Summary

BACKGROUND: Systems science reframes public policies as active components of a complex, dynamic, policy system that includes mechanisms such as feedback between interrelated effects, effect delay and system adaptation. In public health, systems science has challenged and helped to change infectious disease policy, including vaccination strategies for poliomyelitis and measles. However, it has not yet realised its potential impact on non-communicable disease (NCD) policy, in part due to a lack of compatible methods to appraise policy effectiveness and cost-effectiveness.

VISION: SIPHER will be a world-leading centre of excellence for innovative, public health and health economics focused systems science. During UKPRP, it will catalyse a shift from health policies to whole-systems, healthy public policy.

THEORY OF CHANGE: SIPHER's policy partners seek to reduce NCDs and health inequalities (HI) by incorporating health considerations into non-health sectors. Academic and policy partners will co-produce complex systems decision modelling and evaluate its effectiveness in supporting policy design in four focus areas: inclusive economic growth; housing; adverse childhood experiences; and mental health.

RESEARCH: Eight interwoven workstrands will investigate: how policymakers think about and use evidence; iterative evidence synthesis; working securely with sensitive data and building simulated populations; individual- and population-level dynamic models; values and preferences for equitable outcomes; identification of win-wins, best-buys, and adaptable policies across sectors; process evaluation.

USER ENGAGEMENT: Co-production across local, regional and national government and knowledge transfer support by influential partners.

BENEFITS: SIPHER will deliver scalable and transferable methods and tools to design, target, advocate for, implement and monitor policy strategies that maximise NCD prevention and health inequality reductions.

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

THE PUBLIC
SIPHER's ultimate beneficiaries will be communities, initially in our partner jurisdictions and then more widely, through reductions in NCDs and health inequalities, and associated increases in wellbeing, resulting from the more evidence-informed, joined-up approaches to decision-making and policy debate that our research enables.

POLICY MAKERS, POLICY ADVISORS AND POLICY ANALYSTS
SIPHER's consortium members include policy organisations who wish to develop cost-effective and implementable policy proposals that maximise gains across various policy priorities, including reducing NCDs and health inequalities. SIPHER supports our policy colleagues by addressing four central problems that have restricted UK policy progress despite a strong and growing evidence-base about the upstream causes of ill health:
1) Policy makers struggle to articulate and defend the case for taking upstream, equity orientated action to prevent downstream health crises. Combining policy studies, public health, economic and modelling expertise, SIPHER will address this by two key means: a) working in close partnership with policy organisations (e.g. embedding SIPHER analysts) to provide policy makers with a trusted and accessible means of demonstrating the the costs and benefits of specific upstream preventative policy options compared to more downstream, responsive activities; and b) providing new evidence of public preferences regarding necessary trade-offs between different policy options and across relevant health and non-health outcomes, enabling advisors to provide policy makers with a more informed sense of likely public responses.
2) Policy makers repeatedly bemoan the lack of evidence on 'best buys' for policy investment, particularly in conditions of uncertainty. SIPHER will transform the policy utility of available evidence: it brings together what scientists, policy makers and communities know about a policy area, and uses models to test causal pathways and provide the kind of quantified projections that policymakers seek. This enables them to assess multiple different scenarios where major uncertainties about future developments (e.g. Brexit) exist, and adapt policies as uncertainties resolve.
3) While the complexity and interdependencies of systems linking upstream determinants to health outcomes are widely recognised, decision-makers often regard this complexity as difficult to navigate and therefore paralysing. Our systems science approach captures the dynamics of systems in our policy areas to facilitate joined-up decision-making and budget allocations through making visible the simultaneous impacts of policy options on multiple cross-sectoral policy outcomes.
4) Policy actors consistently cite the lack of timeliness of research as a key barrier to its use. The flexible, adaptive nature of our modelling will enable SIPHER to provide policy projections that can be rapidly adjusted to incorporate shifts in policy context and priorities.

POLITICIANS, PUBLIC HEALTH NGOs AND INTEREST GROUPS
Politicians, NGOs and others (e.g. media, professional bodies) will be able to access, independently assess and employ SIPHER's outputs, tools, and evidence base via the familiar channels of our KT partners (including PHE, LGA, NHSHS), enabling advocacy efforts for policy options that are demonstrably good for public health. Given the crucial role of politics and interests in decision-making, SIPHER's efforts to ensure that these wider policy networks can understand, access and employ our outputs will be crucial to achieving long-term impacts in hotly contested policy areas.

SCIENTISTS AND ANALYSTS
Having shown the policy utility of systems science, SIPHER will scale up its impact ambitions radiating from our investigator's networks to embed our freely accessible methods and tools into policy analysis across and beyond the UK, helping others carry out research to realise widespread reductions in NCDs and health inequalities.

Publications

10 25 50
 
Description Contribution to Paper on the Social Determinants of Health for the All Party Parliamentary Group for Longevity
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description SIPHER Response to DHSC Consultation on "Advancing our health: prevention in the 2020s"
Geographic Reach National 
Policy Influence Type Participation in a national consultation
URL https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s
 
Description ACSE PhD Studentship
Amount £69,018 (GBP)
Organisation University of Sheffield 
Sector Academic/University
Country United Kingdom
Start 10/2019 
End 03/2023
 
Description ACSE PhD Studentship
Amount £69,018 (GBP)
Organisation University of Sheffield 
Sector Academic/University
Country United Kingdom
Start 10/2020 
End 03/2024
 
Description Inclusive Growth Expert Research Capacity
Amount £6,920 (GBP)
Organisation Joseph Rowntree Foundation (JRF) 
Sector Charity/Non Profit
Country United Kingdom
Start 09/2019 
End 12/2019
 
Description Leeds PhD Studentship
Amount £63,861 (GBP)
Organisation University of Leeds 
Sector Academic/University
Country United Kingdom
Start 10/2020 
End 09/2023
 
Description QR Strategic Priorities Fund (KE Delivery)
Amount £145,835 (GBP)
Organisation United Kingdom Research and Innovation 
Department Research England
Sector Public
Country United Kingdom
Start 01/2020 
End 03/2020
 
Description Quantifying Utility and Privacy Preservation in Synthetic Populations (QUiPP)
Amount £408,611 (GBP)
Funding ID TPS2019\100019 
Organisation Alan Turing Institute 
Sector Academic/University
Country United Kingdom
Start 10/2019 
End 03/2021
 
Description Research and Knowledge Transfer Practitioner Post
Amount £39,492 (GBP)
Organisation UK Clinical Research Network (UKCRN) 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2020 
End 03/2021
 
Description ScHARR PhD Studentship
Amount £70,000 (GBP)
Organisation University of Sheffield 
Sector Academic/University
Country United Kingdom
Start 10/2020 
End 03/2024
 
Description Strathclyde PhD Studentship
Amount £60,000 (GBP)
Organisation University of Strathclyde 
Sector Academic/University
Country United Kingdom
Start 10/2020 
End 09/2023
 
Description Attendance at the monthly Turing Urban Analytics group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Monthly meeting and exchange of ideas about research funding and development of ideas for the Turing Urban Analytics programme.
Year(s) Of Engagement Activity 2019,2020
 
Description Centre for Progressive Policy Inclusive Growth Conference 2019 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Panel discussion with SIPHER's contribution focused on the topic 'Increasing healthy life expectancy: a proxy for inclusive growth in action?'. Short presentation followed by a discussion, question and answer session with members of the audience.
Year(s) Of Engagement Activity 2019
URL https://www.progressive-policy.net/events/igconf2019
 
Description Conservative Party Conference Fringe Event hosted by the Centre for Progressive Policy 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact A fringe event on Inclusive Growth at the Conservative Party Conference in Manchester in October 2019. Lots of using contacts made and interesting discussion about use of language.
Year(s) Of Engagement Activity 2019
 
Description Looking Back Looking Forwards: Learning Together for Wider Non-Communicable Disease Prevention 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Introduced policy and non-governmental organisation colleagues working at a local level in Scotland to SIPHER.
Year(s) Of Engagement Activity 2020
URL https://www.rehis.com/event/scottish-government-looking-back-looking-forwards-learning-together-wide...
 
Description Meeting to discuss Public Mental Health work with colleagues in the Scottish Government 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Meeting to discuss proposed work across Public Mental Health and Inclusive Growth with colleagues in the Scottish Government. Good connections made for future SIPHER activity.
Year(s) Of Engagement Activity 2019
 
Description Meeting to explore collaboration between SIPHER and the Behavioural Science and Public Health Network 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Discussion of how the Behavioural Science and Public Health Network and SIPHER can work closely together and learn from one another. The BSPHN has valuable links to practitioners across the UK that SIPHER can link to. We also shared opportunities to collaborate. As a result of the meeting both the BSPHN and Hertfordshire County Council joined SIPHER as Practice Partners.
Year(s) Of Engagement Activity 2019
 
Description Meeting with South Yorkshire Police 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Meeting to discuss how SIPHER and South Yorkshire Police can work together. Explored topics of mutual interest and ways to share data and expertise across teams. Agreed actions to further develop the relationship and share knowledge, including an invitation to share our work with inspectors across South Yorkshire.
Year(s) Of Engagement Activity 2020
 
Description Meeting with the Scottish Government to explore the Triple I Tool 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Meeting with colleagues from the Scottish Government to explore their Triple I Tool and outline SIPHER modelling plans. Useful links made and valuable follow up conversations planned.
Year(s) Of Engagement Activity 2020
 
Description SIPHER Blog 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact We launched a SIPHER blog in January 2020. The blog will provide regular updates from SIPHER team members on different aspects of our research, and it is tailored to a policy maker audience. We advertise the blog through Twitter and LinkedIn to reach different audiences.
Year(s) Of Engagement Activity 2020
URL https://sipher.ac.uk/sipher-blog/
 
Description SIPHER Consortium Launch 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Event organised by SIPHER to formally launch the Consortium in November 2019. 70 people attended from over 20 government and third sector organisations across England and Scotland. The event raised awareness of our research and sparked interest from a number of policy colleagues who have since request further information or follow-up meetings to discuss potential collaborations.
Year(s) Of Engagement Activity 2019
 
Description SIPHER Presentation to the Sheffield City Partnership Board 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact SIPHER presentation and discussion at the Sheffield City Partnership Board. SIPHER was very well received and following the meetings we had requests for meetings from the Police, Police & Crime Commissioner and Sheffield City Region.
Year(s) Of Engagement Activity 2019
 
Description Sheffield Health and Wellbeing Board (November 2019) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact Presentation and discussion of SIPHER components-of-wellbeing. Board members contributed to an active discussion and gave advice on the future development of SIPHER.
Year(s) Of Engagement Activity 2019
 
Description Turing workshop on reproducibility 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Co-organiser of the "Reliability and reproducibility in computational science: Implementing verification, validation and uncertainty quantification in silico" workshop.

As a result of this event, I discussed methods with Prof Peter Challenor (Exeter) and wrote and submitted a Turing grant on Uncertainty.
Year(s) Of Engagement Activity 2020
URL https://www.turing.ac.uk/events/reliability-and-reproducibility-computational-science