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

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.

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.

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.