Resources

International Health Insights: Dementia Prevention

This International Health Insights report explores global evidence on dementia prevention and the importance of supporting brain health across the life course.

The report reviews international best practice and highlights successful approaches from countries including Finland, Japan, South Korea, Uruguay, and the United Kingdom.

Key messages:

Dementia is not an inevitable part of ageing. Addressing modifiable risk factors across the life course could prevent up to 45% of cases. Effective prevention requires integrated action at three levels:

1. Single component behavioural change interventions remain essential foundations, targeting individual risk factors such as physical inactivity, smoking, social isolation, alcohol misuse, and untreated hearing or vision loss. component behavioural change interventions

2. Multi component interventions that target multiple, clustered risk factors represent the most promising strategy.

3. Structural population-level measures such as fiscal policies, legislation, marketing restrictions, environmental adaptations are critical to complement lifestyle-based approaches.

Urgent care components and their effectiveness: A rapid review of evidence and international insights

This report explores how different components of urgent care services can help reduce pressure on emergency departments and support patient independence. Drawing on the latest research through a systematic rapid review and international insights, it highlights best practices from across the UK and globally to inform urgent care service design in Wales. The review covers a range of urgent care service components, including:
• Task shifting strategies to optimise workforce capacity and efficiency
• Improved access to diagnostic services, such as radiology
• Smart tools like digital triage and decision-support systems for staff
• Expansion of urgent care/treatment centres for timely, appropriate care
• Virtual urgent care, including phone and video consultations for urgent advice
The findings suggest that well-designed urgent care services can deliver safer, faster, and more effective care. While further research is needed, the evidence highlights a promising opportunity to ease pressure on hospitals and ensure patients receive the right care, in the right place, at the right time.

About the review:
This work is a collaboration between the Evidence Service (Research, Data and Digital Directorate) and the International Health Insights team (Policy and International Health Directorate, WHO Collaborating Centre on Investment for Health and Wellbeing) within Public Health Wales.

Social Value E-Guide for Public Health

The Social Value E-Guide for Public Health is a step-by-step resource that explains how to use socially focused approaches for decision-making and financial prioritisation.

It aims to support stakeholders including practitioners, researchers and decision-makers in understanding and capturing the social value of the interventions and services they design and deliver.

The E-Guide presents approaches and resources for adopting a social value approach including methods such as Social Return on Investment and Social Cost Benefit Analysis, tailored specifically to the public health context.

Social Return on Investment (SROI) of mental health related interventions—A scoping review

Social Return on Investment (SROI) is a methodological approach which incorporates all three aspects for evaluating interventions. Mental health problems are one of the leading causes of ill health and disability worldwide. This study aims to map existing evidence on the social value of mental health interventions that uses the SROI methodology. This scoping review is a first of its kind to focus on SROI of mental health interventions, finding a good number of SROI studies that show a positive return on investment of the identified interventions. An evidence brief has been produced outlining the key findings of the scoping review. The evidence brief highlights the social value of mental health interventions in high- and middle-income countries and outlines individual examples.

The social value of investing in public health across the life course: a systematic scoping review

This review maps an overview of the application of Social Return on Investment (SROI) and Social Cost-Benefit Analysis (SCBA) in existing literature to identify the social value of public health interventions at individual stages of the life course. The importance of capturing social value is highlighted and the results indicate the positive value of investing in public health interventions. This evidence can be used as a starting point by public health professionals and institutions that are looking beyond traditional economic measures, and towards capturing social value when investing in interventions across the life course. An evidence brief has been produced outlining the key findings of the scoping review and provides individual examples of the social value of interventions at individual stages of the life course identified in the scoping review.

Toward an economy of wellbeing: The economic impact of the Welsh healthcare sector

In this paper, the economic importance of the healthcare sector to the Welsh economy is explored. We use a large number of data sources for the UK and Welsh economy to derive an economic model for 2017. This economic modelling aims to quantify the contribution of the healthcare sector (the National Health Service, NHS) to the wider economy in Wales, looking at the economic output, population income, value added imports, and employment. Results suggest that the healthcare sector has an above average contribution in four explored economic aspects of the Welsh economy (output, income, employment, value-added), according to its impact on the surrounding economic ecosystem. A summary of the report has been developed to support and inform national and international stakeholders across various sectors, including economics, finance, health, and policy. It is particularly useful for those working in relation to the Foundational Economy, Social Value and Wellbeing Impacts and Value-Based Health.

The Social Return on Investment of Physical Activity and Nutrition Interventions – a Scoping Review

Scarcity of resources for public health and mounting pressures on health systems such as the Covid-19 pandemic, make it vital to evaluate public health interventions and move away from traditional evaluation methods. This is important to understand not just the financial value of public health interventions, but also the wider social, environmental and economic value. This review aims to present the existing evidence base on the Social Return on Investment of physical activity and nutrition interventions, demonstrating the wider social and environmental benefits of these interventions.

It becomes increasingly important that the holistic impact of nutrition and physical activity interventions and programmes is understood to enable the development and implementation of interventions which have the greatest value to people. An evidence brief has been produced outlining the key findings of the scoping review and provides individual examples of the social value of interventions identified which aimed to increase levels of physical activity and improve nutrition.

International Horizon Scanning and Learning Report: Fiscal Levers to Address Obesity Report 51

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.
In focus: Fiscal Levers to Address Obesity.

Self-administered sexual health testing in an open prison setting: a pilot health impact assessment and social return on investment analysis

The sexual health of the male prison population is often among the poorest in a country. This paper aims to identify the wider health impacts and social value of a sexual health self-sampling programme offered to male prisoners in an open prison setting in Wales.

This study applied a unique pilot approach of using Health Impact Assessment and Social Return on Investment Frameworks in tandem. Key stakeholder groups affected by the intervention were identified, and engaged with through workshops, interviews and questionnaires to identify and quantify the health impacts and wider outcomes. Outcomes were then valued using proxy financial values to present the overall estimated social value of the self-sampling service.

Based on a small sample, results indicate that for every £1 spent on the self-sampling service in the prison, a potential value of £4.14 was created. This resulted in a ratio of £4.14:£1. Approximately one-third of the value created (£1,517.95) was categorised as monetarily returnable, whereas the remaining value (£3,260.40) was purely illustrative social value, for example improved mental well-being.

This unique pilot study demonstrates the health impacts and wider social value of providing a self-sampling sexual health service to prisoners within an open prison setting. By innovatively testing the feasibility of using a Health Impact Assessment process alongside Social Return on Investment analyses, this paper has outlined how the frameworks can be used in synergy to illustrate not just direct return on investment but also the social value of providing such a service.

International Horizon Scanning and Learning Report: The Commercial Determinants of Health: Children and Young People Report 49

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.
In focus: The Commercial Determinants of Health: Children and Young People

International Horizon Scanning and Learning Report: Impact of Poverty on Babies Children and Young People Report 48

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.
In focus: Impact of Poverty on Babies, Children and Young People

Influencing the Health Gap: Multi-Country Perspectives

The Welsh Health Equity Status Report initiative (WHESRi) has updated a spotlight feature blog on the innovative decomposition analysis methodology. This now includes the addition on a summary report on a multi-country webinar, with insights from Wales, Italy and Slovenia. The webinar was a solutions-focused session which explored how the application of the decomposition analysis methodology has generated insights into the drivers of health inequalities.

A key finding of the webinar was the need to strengthen the case for investing in well-being and health equity in Wales and beyond through policies and solution-based actions that were identified throughout the webinar.

International Horizon Scanning and Learning Report: Embedding Prevention in Primary and Community Care Report 47

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.
In focus: Embedding Prevention in Primary and Community Care

Advancing the Social Return on Investment Framework to Capture the Social Value of Public Health Interventions

Investment in public health has far-reaching impacts, not only on physical health but also on communities, economies, and the environment. There is increasing demand to account for the wider impact of public health and the social value that can be created, which can be captured through the use of the social return on investment (SROI) framework. This study aims to explore the application of SROI and identify areas of advancement for its use in public health.

Public Health Wales: Our International Health Strategy 2023-2035

Public Health Wales has updated its 2017 International Health Strategy to better reflect the significant changes in the global landscape and to enable Public Health Wales’ new Long-Term Strategy.

International Horizon Scanning and Learning Report: Five Essential Conditions for Health Equity Report 46

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.
In focus: Five Essential Conditions for Health Equity

International Horizon Scanning and Learning Report: Mental Health and Well-being of Refugees and Asylum-Seekers Report 45

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.

In focus: Mental Health and Well-being of Refugees and Asylum-Seekers

Welsh Health Equity Solutions Platform (WHESP)

The Welsh Health Equity Solutions Platform will act as a repository of information, case studies, and previous interventions used to help combat inequity and share good practice in Wales.
The platform features searchable data tools and a report-generating function which allows users to input their search terms and produce outputs related to those terms. The platform also offers a spotlight feature that can be used to highlight particular solutions or themes.
The team will develop the platform over time to add additional content and features.

International Horizon Scanning and Learning Summary Calendar 2022/23

This International Horizon Scanning and Learning Summary Calendar is the third in the series, following the Summary Calendars from 2020/21 and 2021/22. This Summary Calendar has collated, synthesised, and presented a clear and concise synopsis of the five International Horizon Scanning Reports over the past year, since April 2022 through to March 2023. In addition, the two summary reports (published in 2022) are included. The International Horizon Scanning and Learning work stream has proved to showcase informative and impactful research whilst collating data from other countries and has provided guidance, recommendations, and useful insights regarding the evolving nature and uncertainties of emerging public health topics, which has sought to improve and inform such actions and approaches in Wales.

The summary aims to inform a succinct overview of comprehensive, coherent, inclusive and evidence-informed policy action, which has supported and continues to support the national strategies towards a healthier, more equal, resilient, prosperous and globally responsible Wales. This calendar includes key messages and key recommendations from the high level synthesis pages of each International Horizon Scanning report.

Themes include:
• Intermediate care
• The cost of living crisis
• COVID-proofing the educational environment: 4-18 years
• Early childhood education and care
• Communication campaigns for vaccine acceptance
• The impact of COVID-19 on mental health and increasing vulnerability
• The impact of COVID-19 on increasing the health gap and vulnerability

IHCC Progress Report 2018-22

This report outlines the International Health Coordination Centre’s (IHCC) progress in driving and enabling implementation of the Charter for International Health Partnerships in Wales (the Charter) across the NHS over the last four years. It also provides examples of international health partnership working from across the Health Boards and NHS Trusts. The report highlights the IHCC’s plans and aspirations for the future, in supporting a healthier, more equal, globally responsible, resilient and prosperous NHS in Wales.

The report highlights the IHCC’s role, achievements, ways of working, collaborative structures and activities; and outlines the evolution of the IHCC in relation to global, UK, national and local developments. These include challenges and opportunities such as the UK withdrawal from the European Union (‘Brexit’), the COVID-19 pandemic and the ‘cost of living’ crisis. It demonstrates the tools used to enable shared learning, facilitate cross-NHS and cross-sector synergies, and maximise benefits to the health and well-being of the people in Wales and beyond.

International Horizon Scanning and Learning Report: Communication campaigns for vaccine acceptance

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.

In focus: Communication campaigns for vaccine acceptance

The Cost-of-Living Crisis: Implications for Public Health and the Identification of Solutions report

The report summarises learning from the World Health Organisation (WHO) All-Regions for Health Network (RHN) webinar facilitated by the WHO Collaborating Centre at Public Health Wales on the 21st of September 2022.

International Horizon Scanning and Learning Report: Early childhood education and care

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.

In focus: Early childhood education and care

Understanding health inequalities in Wales using the Blinder-Oaxaca decomposition method

Throughout Wales and the world, health inequality remains a problem that is interconnected with a wider and complex social, economic and environmental dynamic. Subsequently, action to tackle inequality in health needs to take place at a structural level, acknowledging the constraints affecting an individual’s (or community’s) capability and opportunity to enable change. While the ‘social determinants of health’ is an established concept, fully understanding the composition of the health gap is dependent on capturing the relative contributions of a myriad of social, economic and environmental factors within a quantitative analysis. The decomposition analysis sought to explain the differences in the prevalence of these outcomes in groups stratified by their ability to save at least £10 a month, whether they were in material deprivation, and the presence of a limiting long-standing illness, disability of infirmity. The analysis not only quantified the significant health gaps that existed in the years leading up to the COVID-19 pandemic, but it has also shown what determinants of health were most influential. Understanding the factors most closely associated with disparities in health is key in identifying policy levers to reduce health inequalities and improve the health and well-being across populations.

International Horizon Scanning and Learning Report: COVID-proofing the educational environment: 4-18 years

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.

In focus: COVID-proofing the educational environment: 4-18 years

Facilitators, Barriers and Views on the Role of Public Health Institutes in Promoting and Using Health Impact Assessment—An International Virtual Scoping Survey and Expert Interviews

Public health institutes have an important role in promoting and protecting the health and well-being of populations. A key focus of such institutes are the wider determinants of health, embracing the need to advocate for ‘Health in All Policies’ (HiAP). A valuable tool to support this is the health impact assessment. This scoping study aims to support public health institutes to advocate more successfully for the use of health impact assessments and HiAP in order to promote and protect health, well-being and equity. It highlights the enablers and barriers to the use of HIA in the contexts of the participants and suggests some actions which PHIs can take and Units they can learn from. The results from this study can serve as a platform to help build knowledge, networks and expertise, to help support a ‘Health in All Policies’ approach and address inequalities which exist in all societies.

Cost of health inequality to the NHS in Wales

There are wide inequalities in health and healthcare use between people living in more deprived neighborhoods and those living in less deprived neighborhoods in Wales. Tackling health inequality through a combination of health promotion and early intervention policies targeted toward deprived communities could yield substantial improvement in health and wellbeing, as well as savings for the Welsh NHS.

International Horizon Scanning and Learning Report: The Cost of Living Crisis

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.
In focus: Cost of living crisis

Exploring the social value of Public Health Institutes: An international scoping survey and expert interviews

Making the case for investing in preventative public health by illustrating not only the health impact but the social, economic and environmental value of Public Health Institutes is imperative. This is captured by the concept of Social Value, which when measured, demonstrates the combined intersectoral value of public health. This research can inform future work to understand how to measure the holistic social value of Public Health Institutes, in order to strengthen institutional capacity and impact, as well as to achieve a more equitable society, and a more sustainable health system and economy, making the case for investing in public health, as we recover from COVID-19.

Influencing the Health Gap in Wales: Decomposition analysis discussion paper

The aim of this discussion paper is to help inform further policy action and potential solutions in order to reduce the health gap in Wales and beyond.
It provides a snapshot of the health inequalities experienced by different population groups in the years leading up to the Coronavirus (COVID-19) pandemic, applying an innovative statistical methodology, a ‘Decomposition analysis’.

The paper attempts to quantify the health gap in Wales, as well as to provide a better understanding of its main drivers across the five essential conditions for healthy prosperous lives for all, using a novel World Health Organization framework. It uses three measures of self-reported health: 1) the prevalence of fair/poor health; 2) the prevalence of low mental well-being; and 3) the prevalence of low life satisfaction, comparing these between:
• Those who are able to make a saving of at least £10/month and those who are not;
• Those who report being in material deprivation and those who do not; and
• Those who report a limiting longstanding illness, disability or infirmity and those who do not.

The analysis has generated an insight into the drivers of health inequities, identifying those which contribute the most, namely ‘Social and Human Capital’ and ‘Income Security and Social Protection’; while ‘Health Services’ has accounted the least. However, systematic differences are able to explain less than half (<50%) of the health gaps for the majority of the health outcomes, based on the statistical models.

The paper highlights the need for a basket of policy and investment decisions, prioritising the key drivers of health inequity, in consensus across sectors. Further exploration and engagement with experts, stakeholders, relevant groups and communities is essential to improve understanding of the health equity gap and its drivers.

It hopes to inform the following national and international stakeholders:
• Public health professionals
• Public policy makers and budget holders on national and local levels
• Statisticians, health scientists and data analysts
• All those who have a role in influencing the health equity gap in Wales and further afield