Health Hub: Systems Approaches to Commercial Determinants of Health and Equity

In the UK, and more so in deprived areas, many people are dying earlier than they should from largely preventable chronic diseases such as cancer and heart disease. To prevent this and create communities where everyone can thrive, we need the right building blocks in place including jobs, good pay, and environments free of pollution and where it is easy to make healthy choices - eat the right food, exercise, and so on. In many communities these building blocks are missing. This project aims to address this.
Local governments across England are responsible for many of these building blocks and can, therefore, significantly improve health and wellbeing. There are many ways to do this, for example, changing the focus of their local economy to consider population wellbeing alongside measures such as productivity, ensuring that organisations they contract have fair employment practices, using planning rules to reduce the density of fast-food outlets and implementing car-free cities.

However, local governments face many barriers to implementing these measures including a lack of capacity and locally relevant evidence on the most important building blocks in their areas and how they can best be altered to improve health. One of the building blocks that remains poorly understood at local level is the commercial sector, despite growing evidence of its major impacts on health and equity. On one hand local businesses create jobs and contribute to the economy. On the other, 40% of chronic disease deaths are directly linked to transnational corporations manufacturing just four products - tobacco, ultra-processed foods, alcohol and fossil fuels (fossil fuel deaths primarily due to air pollution). These corporations actively oppose interventions that local governments could implement. They particularly oppose the most effective interventions - those that work at population or community level (e.g. restricting advertising of or outlets for their products). To ensure that local governments can harness the positive impacts of the commercial sector while mitigating the negative ones, it is essential to better understand these 'commercial determinants of health' (CDOH).

Health Hub: Systems Approaches to Commercial Determinants of Health and Equity is an ambitious new research cluster that brings together local governments, researchers, and civil society groups to work with local populations to improve the health, wellbeing and equity of communities across England. They will do this by better understanding the building blocks - including the commercial factors- that impact on communities' health and use that knowledge to identify, implement and evaluate the population-level interventions most likely to improve health, wellbeing and equity at scale. It will do this through seven interconnected packages of work that, working at local government level, will:
1.Explore the building blocks influencing health in each area as part of a complex system in which building blocks and interventions can all impact on each other, using this to identify the most important points in the system to intervene to improve health;
2.Assess the evidence for population level interventions that can be applied locally to improve health at scale and reduce health inequities;
3.Identify the facilitators and barriers to implementing these interventions and develop resources and support systems to help overcome these barriers;
4.Model the anticipated health and economic impacts of the interventions, comparing different ways of estimating these impacts and compiling new large-scale data resources for local governments;
5.Support implementation of chosen interventions using the resources and support systems developed;
6.Evaluate the impacts of interventions, resources and support systems, whether and how they inter-link and vary with context;
7.Ensure the data, evidence, resources and support systems developed can be used to maximum effect well beyond the project.

Local authorities, responsible for public health in England, face multiple barriers to implementing effective public health interventions. These include resource and capacity constraints, a persistent framing emphasis on individual responsibility, corporate pressure against regulatory action and a lack of systems-based and locally salient evidence. Moreover, despite growing evidence of the commercial sector impact on health, understanding of how commercial determinants impact on health and intersect with other upstream economic, social and political health determinants at local level remains limited.
Health Hub: Integrated Systems Approaches to Commercial Determinants of Health and Equity will conduct research in seven integrated Work Packages: 1. using a systems approach to identify and prioritise potential areas for action on the upstream (particularly commercial) determinants of health at local authority level; 2. identifying population-level interventions that may address the CDOH at a local level; 3. identifying and addressing barriers and enablers to these systems-based interventions; 4. assess the potential impacts of interventions through large scale data; 5. implementing identified interventions at the local authority level across England; 6. undertaking a complex systems evaluations of selected interventions and tools, and; 7. emphasising scale up and knowledge exchange.
It aims to generate systems-based, locally relevant evidence to inform the development and implementation of interventions to improve health and equity at scale through action on upstream (particularly commercial) determinants of health at a local government level across England. Along with an interdisciplinary team of academics and civil society experts, Health Hub's research will be co-created with local authorities to ensure that research findings are salient and will support transformations in policy and practice to reduce health inequities and build sustainable community wellbeing.