Conceptualising changes to tobacco and alcohol policy as affecting a single interlinked system

Duncan Gillespie, Jenny Hatchard, Hazel Squires, Anna Gilmore, Alan Brennan

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Abstract

Background: To support a move towards a coordinated non-communicable disease approach in public health policy, it is important to conceptualise changes to policy on tobacco and alcohol as affecting a single interlinked system. For health economic models to effectively inform policy, the first step in their development should be to develop a conceptual understanding of the system complexity that is likely to affect the outcomes of policy change. Our aim in this study was to support the development and interpretation of health economic models of the effects of changes to tobacco and alcohol policies by developing a conceptual understanding of the main components and mechanisms in the system that links policy change to outcomes. Methods: Our study was based on a workshop from which we captured data on participant discussions on the joint tobacco–alcohol policy system. To inform these discussions, we prepared with a literature review and a survey of participants. Participants were academics and policy professionals who work in the United Kingdom. Data were analysed thematically to produce a description of the main components and mechanisms within the system. Results: Of the people invited, 24 completed the survey (18 academic, 6 policy); 21 attended the workshop (16 academic, 5 policy). Our analysis identified eleven mechanisms through which individuals might modify the effects of a policy change, which include mechanisms that might lead to linked effects of policy change on tobacco and alcohol consumption. We identified ten mechanisms by which the tobacco and alcohol industries might modify the effects of policy changes, grouped into two categories: Reducing policy effectiveness; Enacting counter-measures. Finally, we identified eighteen research questions that indicate potential avenues for further work to understand the potential outcomes of policy change. Conclusions: Model development should carefully consider the ways in which individuals and the tobacco and alcohol industries might modify the effects of policy change, and the extent to which this results in an unequal societal distribution of outcomes. Modelled evidence should then be interpreted in the light of the conceptual understanding of the system that the modelling necessarily simplifies in order to predict the outcomes of policy change.

Original languageEnglish
Article number17
JournalBMC Public Health
Volume21
Issue number1
DOIs
Publication statusPublished - 4 Jan 2021

Bibliographical note

Funding Information:
This work was conducted by the School of Health and Related Research, University of Sheffield (DG, HS, AB) and the Tobacco Control Research Group, University of Bath (JH, AG) as members of the UK Centre for Tobacco and Alcohol Studies. Funding for UKCTAS from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council and the National Institute of Health Research, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (Grant Reference Number MR/K023195/1). Participants’ travel was funded by UKCTAS and the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) (Grant Reference Number PD-SPH-2015). The Institute of Alcohol Studies hosted the workshop. AB, DG and AG are members of SPECTRUM a UK Prevention Research Partnership Consortium. UKPRP is an initiative funded by the UK Research and Innovation Councils, the Department of Health and Social Care (England) and the UK devolved administrations, and leading health research charities. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The views expressed are those of the authors and not necessarily those of the organisations mentioned above.

Funding Information:
This work was conducted by the School of Health and Related Research, University of Sheffield (DG, HS, AB) and the Tobacco Control Research Group, University of Bath (JH, AG) as members of the UK Centre for Tobacco and Alcohol Studies. Funding for UKCTAS from the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council and the National Institute of Health Research, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. Participants’ travel was funded by UKCTAS and the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) (Grant Reference Number PD-SPH-2015). The Institute of Alcohol Studies hosted the workshop. AB, DG and AG are members of SPECTRUM a UK Prevention Research Partnership Consortium. UKPRP is an initiative funded by the UK Research and Innovation Councils, the Department of Health and Social Care (England) and the UK devolved administrations, and leading health research charities. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The views expressed are those of the authors and not necessarily those of the organisations mentioned above.

Publisher Copyright:
© 2020, The Author(s).

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • Commercial determinants
  • Complexity
  • Interventions
  • Modelling
  • Public health
  • Systems

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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  • SPECTRUM

    Gilmore, A. & Rutter, H.

    MRC

    1/10/1930/09/24

    Project: Research council

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