When we look at some of today’s biggest public health threats (such as cardiovascular diseases and cancer), a substantial proportion of the burden is linked to products sold by unhealthy commodity industries. Alcohol, tobacco, and unhealthy foods contribute to millions of preventable illnesses and deaths each year. For example, according to the WHO, around 2.6 million deaths were caused by alcohol consumption globally in 2019.
Governments have powerful tools to advance public health, such as the introduction of population level regulatory measures targeting these products (e.g. minimum unit pricing or restrictions on marketing). Yet getting these policies onto the political agenda, into law and effectively implemented can be notoriously difficult. Unhealthy commodity industries frequently use their vast resources to lobby decision-makers, delay legislation, and cast doubt on public health evidence.
So, what kind of evidence can help overcome this opposition? And how can public health researchers and advocates ensure that their findings inform real-world policies? To explore these questions, our recent study published in BMJ Public Health surveyed and interviewed UK advocates, civil servants and researchers working across alcohol, tobacco, and food policy. Here is what we found.
The ‘Evidence Jigsaw’
One of the key findings from our research is that participants felt successful examples of policy change to tackle unhealthy commodities have usually been supported by an ‘evidence jigsaw’: a combination of different types of evidence that help address the multiple different questions and needs that arise at different stages of the policymaking process:
- Setting the agenda: epidemiological data showing the scale of harm caused by a product can help get an issue on political radars.
- Designing the policy: modelling studies and evidence from other countries’ experiences can help policymakers think through the potential impacts of more specific policy proposals for reducing harms.
- Adopting a policy: lived experience and public opinion polls can illustrate likely public support, which is often needed to convince politicians to progress proposals.
- Evaluating the policy: robust monitoring and evaluation after a policy is introduced are essential to assess its effectiveness, identify any potential gaps, and to defend it against legal challenges.
In addition, evidence about unhealthy commodity industries and their practices was unusual in being positioned as useful across all of these policy stages. Examples were given in which this type of evidence had been used to help identify and expose the strategies that industries use to avoid, delay or weaken regulation at each of these stages and this type of evidence was viewed as crucial in countering these efforts. Participants highlighted an important gap here: while this type of research is well-established in tobacco control, where policy progress has been substantial, it is far less developed in relation to the alcohol and unhealthy food industries.
Generating evidence is, of course, only one contribution and data do not speak for themselves. To play a role in policy change, evidence needs to be communicated to the right people at the right time. Here, our study highlighted the importance of sustained engagement with policymakers and strong partnerships between advocates and researchers. Political opportunities can emerge unexpectedly and disappear rapidly so having relationships that can help ensure relevant evidence reaches policymakers when policy windows open is essential.
The next steps
The success of global tobacco control shows that ambitious public health policies can be implemented when research, advocacy, and policy align. To achieve similar breakthroughs in alcohol or unhealthy food regulation, we must learn from these successes. We need to help build the kinds of ‘evidence jigsaws’ that support policy change, invest more in understanding and scrutinising industry practices, and foster strong networks between researchers, advocates, and decision-makers.
Written by Alice Fabbri and Britta K Matthes, University of Bath, and Katherine E Smith, University of Strathclyde.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.