Health in all policies: can whole systems, cross-sectoral economic evaluation help? A brief introduction to the Systems science In Public Health & Health Economic Research Consortium (SIPHER) Prof Petra Meier & Dr Robin Purshouse University of Sheffield 1 Our vision A shift from public health policy to healthy public policy to reduce chronic disease & tackle health inequalities across local, regional & national governments 2 Challenges in moving towards health in all policy Our health is greatly determined by action in sectors other than health but our evidence is often not geared to be relevant to these sectors. Policy (cost-)effectiveness evaluations tend to have narrow sets of inputs and outputs

but for many policies there is a multitude of indirect, unexpected, long-range effects There are complex causal pathways at play but we assume linear, direct mechanisms linking intervention and effect. 3 What SIPHER wants to achieve A new systems-science approach to policy effectiveness and cost-effectiveness New insights into complex cause-and-effect relationships, initially in 4 policy areas: - Inclusive Economic Growth - Housing - Promotion of Mental Wellbeing - Adverse Childhood Experiences Real-time policy appraisal and evaluation across sectoral boundaries (e.g. crosssector business cases) New ways of working academics and policy partners 4 Our policy partners: 3 scales of government, one common struggle: above

average NCD burden and persistent health inequalities Loca l Region al Nation al Sheffield City Council (population: 570,000): aims to become a public health organisation with a focus on life expectancy gaps. HiAP because public health cannot buy back health lost in other sectors. Greater Manchester Combined Authority: new city-region (population: 2.7 million) with devolved powers. Large economy, with an ambitious lifecourse and place-based strategy. Scotland (population: 5.3 million): strategic priorities around societal fairness and wellbeing creation, with multi-sectoral strategies on social, economic and health inequalities. Public Health Reform Programme underway. 4 5 Co-production between researchers, policy and practice partners is at the heart of SIPHER

Policy partners are coinvestigators on grant 4 embedded researchers employed by partner organisations 1.2 million coinvestments Focus on policy partners priorities Jointly responsible for health gains & tackling inequalities In-depth analysis of

policy contexts and processes Costs & benefits of alternative policy prioritisation across relevant outcomes Tools that visualise effect profiles over time WS1 Understandin g the policy systems WS7 Data & Evidence Economic models and decision support

Public and stakeholder values for different outcomes, e.g. more income vs more health WS6 vs more equitable wealth distribution Evidence reviews Integrated secure data infrastructure for system monitoring Simulated (synthetic) populations for 3 areas WS2 WS3 Preference s and social valuation Complex systems modelling

WS8 EVALUATION WS4 WS5 System dynamic modelling: causal links over time between big concepts e.g. health, labour market, income, social security Policy microsimulation: distributional effects populations, geographies 7 SIPHERs Impact & Timescales 5-year investment New methods and tools in routine use by consortium partners

Evidence informs policy, early effects on social determinants of health New partnerships (academia & policy) Beyond the 5years METHODS used by researchers in UK & internationally TOOLS used for budget decisions beyond partners EVIDENCE drives policy action beyond partners Systems MONITORING reduces costs and human suffering from failed

policies Long-term vision for UKPRP Impact Cost-effective prevention solutions delivered at scale Decreased disease burden & health inequalities Increased productivity & more inclusive growth 8 Or, as one of our partners says: We are confident that a more inclusive economy would have big positive impacts on society in many different ways, but so far no-one has done the forward modelling that gives us, collectively, faith in changing ways of working and major investment decisions. Greg Fell, Sheffield DPH

9 Who is involved? Directors Meier: public health policy (Sheffield) Purshouse: complexity, multi-criteria optimisation (Sheffield) Academic partners Bambra: social inequalities & health (Newcastle) Bentall: public mental health (Sheffield) Birkin: data analytics (Leeds) Brazier: wellbeing, quality of life measures (Sheffield) Brennan: mathematical/decision modelling (Sheffield) Bryan: labour economics (Sheffield) Goyder: health behaviours, housing (Sheffield) Heppenstall: geocomputation (Leeds) Holmes: public health, childhood & youth (Sheffield) Kadirkamanathan: complex systems (Sheffield) Lomax: data science, dynamic microsimulation (Leeds) Lupton: education, inclusive growth (Manchester) Paisley: information specialist (Sheffield) Smith: political science (Strathclyde) Stewart: politics, public engagement (Edinburgh) Strong: model uncertainty, value of information (Sheffield) Such: NIHR Knowledge Mobilisation Fellow: HiAP (Sheffield) Tsuchiya: health economics, inequality aversion (Sheffield) Watkins: housing, planning, land economics (Sheffield)

Policy Partners Bain/Ishaq: Public Health Reform Programme, Scottish Government Cox/Hann: Heads of Research, Greater Manchester Combined Authority Fell/Brewins: DPH/Public health intelligence, Sheffield City Council Management Team Gavens: Consortium Manager (Sheffield) Stirr: Consortium Administrator (Sheffield) Knowledge Transfer Partners Bellis, Director: WHO Collaborating Centre for Investment in Health & Wellbeing, Public Health Wales Betts: Chief Executive, Learn Sheffield (ACEs) Blunkett: Chair, Sheffield City Partnership Craig: Economics of Prevention lead, NHS Health Scotland Ferguson: Chief Economist, PHE Hannan: Northern Health Sciences Alliance Leng: Deputy Chief Executive, NICE McGee: Head of Research Management, Turing Institute Ogden: Senior Advisor, Local Government Association Somerville: Data Innovation Director, Edinburgh City Deal Please come & talk or email [email protected] 1 1 Thanks to team & funders This work is supported by the UK Prevention Research Partnership (MR/S037578/1), which is funded by the 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), Medical Research Council, National Institute for Health Research, Natural Environment Research Council, Public Health Agency (Northern Ireland), The Health Foundation and the Wellcome Trust. 1 2

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