23/85 Commercial determinants of health

The Public Health Research (PHR) Programme would like to draw researchers’ attention to the commissioning brief below, which was first advertised in Summer 2023. This is a brief that we have previously advertised as a commissioned funding opportunity. We are still interested in receiving applications in this research area, as it remains a priority in our portfolio. However, please note that the commissioning brief, along with the underpinning literature searches, has not been updated since originally written.

Research question(s) 

• What are the health and health inequalities impacts of the commercial determinants of health?

Through its strategies and actions to produce, protect and promote its products and services, the commercial sector influences the social, physical and digital environments in which people live and work. The commercial determinants of health (CDoH) are the commercial sector activities that affect people’s health positively or negatively.

In recent years, increasing attention has been paid to the impact that CDoH has on non-communicable diseases (NCDs) such as:

• cardiovascular disease
• cancers
• chronic respiratory disease
• type 2 diabetes

NCDs are the leading cause of death and disability in the UK and are often the result of our social and physical environments, including CDoH. These diseases are mostly preventable and avoidable. NCDs are a major contributor to the social gradient in health outcomes and a driver of health inequalities. In addition, there is increasing recognition of the role of the commercial sector in determining mental health outcomes and inequalities. Evaluations of interventions relating to any physical or mental health condition are of interest to the Public Health Research (PHR) Programme.

Commercial interests are sometimes at odds with the promotion and protection of public health, for example, consumption of harmful commodities may increase profits for companies but worsen pre-existing economic, social and ethnic inequalities. Consequently, public health research on CDoH has focused on industry practices relating to commodities such as tobacco, alcohol or highly processed foods and beverages. Other examples where research has been undertaken include fossil fuels, financial services, pharmaceuticals, and the advertising, social media, gaming and gambling industries. Evaluations of interventions relating to any of these, or similar areas of commerce, are of interest to the PHR Programme.

Examples of CDoH research previously funded by the PHR Programme include an evaluation of the health impacts of the UK Treasury Soft Drinks Industry Levy (SDIL), an evaluation of the public health impact of no and low alcohol drinks and an evaluation of an intervention to prevent gambling harm in young people.

There is also recognition that some approaches used by the commercial sector could have a beneficial impact on public health. For example:

• co-operative and social enterprise business models that aim to foster health-promoting forms of commerce
• corporate social responsibility programmes (where such initiatives are not tokenistic)
• organisations that prioritise health-improving products, and ethical, carbon-neutral and fair-trade practices

Understanding how commercial sector action can have positive health impacts is of interest to the PHR Programme. A particular area of interest here is climate change and the physical environment, where positive steps to address (for example) building design and tackle poor air quality have the potential to improve health and address health inequalities.

Public health research on CDoH has been undertaken on macro-social and political practices such as the influence of the commercial sector on public health policy making, as well as on downstream practices such as the influence of marketing promotions to shape individual preference. Public health research has also sought to understand the commercial sector’s influence on specific population groups across the life course.

The PHR Programme is interested in applications to evaluate the:

• health and health inequality impact of:
  1. policy and regulatory changes
  2. commercial sector strategies to increase or sustain influence at a macro-level
  3. local planning or licensing changes
  4. new and non-traditional business models
  5. changes to public understanding about CDoH
• health and health inequality impact of marketing, campaigns, advertising, digital, packaging, labelling and pricing practices to influence consumer choice and behaviour;
• mechanisms by which individual commercial determinants impact (positively or negatively) on health and health inequalities.

This call is intentionally broad to capture a wide range of potential research in this emerging area of study. However, the PHR Programme expects researchers to be targeted in their research, such as by industry, population group, geographic location. The interventions under investigation could have a national or local focus. For example, national fiscal policies such as food taxes and subsidies have the potential to impact on outcomes and health inequalities associated with NCDs. With regard to local policy levers, the PHR Programme is particularly interested in research to understand what local authorities can do to take action on CDoH.

The PHR Programme is predominantly interested in the evaluation of interventions operating at a population level rather than at an individual level, which should address health inequalities and the wider determinants of health. The PHR Programme recognises that interventions are likely to impact different (sub)populations in different ways and encourages researchers to explore such inequalities of impact in their study design. 

Of particular importance to the PHR Programme is an understanding of inequalities in access to, and engagement with, services between ethnic groups in the UK. Evaluations of interventions seeking to reduce health inequalities experienced by people from specific ethnic groups are also of interest to the PHR Programme.

The PHR Programme recognises that, for some proposals, intervention development work might be beneficial. The PHR Programme is willing to consider applications that include a maximum six-month period of intervention development work. If this is the case, please contact the PHR Programme before applying to discuss further. 

A range of study designs and outcome measures can be used. Researchers will need to identify and justify the most suitable methodological approach. Researchers will also need to specify key outcomes and how these will be measured in the short, medium, and long term. Primary outcomes must be health related however the PHR Programme will accept broader outcomes provided the causal pathways to health outcomes are justified.  The PHR Programme welcomes applications where researchers and local communities work together to determine the outcomes to be measured.  Researchers must demonstrate that sufficient data already exist or can feasibly be collected during the study to assess the effect of the intervention on health inequalities.  As part of their application and with relevance to their own study, researchers need to clearly identify where there are gaps in the existing evidence base and how their proposed study will be complementary.  

Understanding the value of public health interventions - whether the outcomes justify their use of resources - is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification. 

The PHR Programme would like to receive applications where there is involvement from relevant population groups and organisations in the design of the evaluation and in the research team. We will consider inclusion of experts as costed members of the study team if appropriately justified. The PHR Programme welcomes applications from researchers from a wide range of disciplines, not just public health. Researchers should demonstrate the relevance of their proposed research to key stakeholders including local and national policy makers, community and neighbourhood groups. The Public Health Research Programme recognises that funding for interventions comes from a range of sources including interventions that are funded through the commercial sector. Applicants will need to demonstrate the independence and transparency of their proposed research.

For further information on submitting an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information.