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.

Authors: Keira Charteris, Ilona Johnson+ 8 more
, Mariana Dyakova, Zuwaira Hashim, Morgan Savoury, Anna Howells, Josh Levett, Leonor Gonzalez de Mendoza Cremades, Sumina Azam, Emily Finney

Investing in a Healthier Wales: prioritising prevention

Good health is a fundamental right, but in Wales, health outcomes vary unfairly across communities. This report emphasises the importance of investing in prevention to help everyone live longer, healthier lives. Effective prevention programmes offer great value for money and essential for prioritising public funding. They can address health inequalities, reverse the nation’s health decline, and promote well-being.

The report integrates previous findings with recent research on value-for-money public health programmes, highlighting successful interventions across three life stages: early years, healthy adults, and healthy ageing. It highlights that prevention must be part of a broader strategy to reduce health inequalities, focusing on early years and poverty reduction, with targeted spending in Wales’ most deprived communities.

Authors: Rebecca Masters, Ann Jones+ 6 more
, Anna Stielke, Rajendra Kadel, Sumina Azam, Jo Davies, Leah Jenkins, Aseel Dardur

Putting the Spotlight on Health, Well-being and Equity Using Health Impact Assessment: Case Studies from Public Bodies in Wales

This publication focuses on the use of Health Impact Assessment (HIA) by public bodies in Wales as a process that can support policymakers and those involved in decision taking to maximise well-being benefits, minimise harm to health, and avoid widening health inequalities. It also supports public bodies in meeting duties under the Public Health (Wales) Act (2017).

Authors: Mark Drane, Liz Green+ 3 more
, Kathryn Ashton, Michael Fletcher, Sumina Azam

Cold homes in Wales: Is the satisfactory heating regime appropriate for health and well-being?

The report presents evidence that living in a colder home (at a temperature below 18°C) is linked with negative impacts on health and well-being, particularly for people who are older or who have health conditions or disabilities. The report also includes a set of recommendations on the satisfactory heating regime in Wales.

Authors: Rebecca Hill, Daniella Griffiths+ 5 more
, Hayley Janssen, Kat Ford, Nicholas Carella, Ben Gascoyne, Sumina Azam

Determining the Public Health Impact of Climate Change: A National Study Using a Health Impact Assessment Approach in Wales

Climate change is recognised as the biggest threat to global health of the 21st century and impacts on health and wellbeing through a range of factors. Due to this, the need to take action in order to protect population health and wellbeing is becoming ever more urgent.

In 2019, Public Health Wales carried out a comprehensive mixed-method Health Impact Assessment (HIA) of climate change. Unlike other risk assessments, it appraised the potential impact of climate change on health and inequalities in Wales through participatory workshops, stakeholder consultations, systematic literature reviews and case studies.

The HIA findings indicate potential impacts across the wider determinants of health and wellbeing. For example, air quality, excess heat/cold, flooding, economic productivity, infrastructure, and community resilience. A range of impacts were identified across population groups, settings, and geographical areas.

These findings can inform decision-makers to prepare for climate change plans and policies using an evidence-informed approach. The work has demonstrated the value of a HIA approach by mobilising a range of evidence through a transparent process, resulting in transferrable learning for others.

Authors: Liz Green, Kathryn Ashton+ 6 more
, Nerys Edmonds, Michael Fletcher, Sumina Azam, Karen Hughes, Phil Wheater, Mark A Bellis

Keeping warm at home during winter in Wales: Differences in heating behaviours, coping strategies, and wellbeing from 2022 to 2023

People’s homes can have a significant impact on their health and well-being. This includes the ability to keep warm at home during winter. This report describes the findings of a national household survey of residents in Wales aged 18 years and over between January to March 2022 (wave one) and repeated between January to March 2023 (wave two). The findings use a sample of 507 participants who completed both survey waves.

Authors: Kat Ford, Nicholas Carella+ 5 more
, Rebecca Hill, Hayley Janssen, Lauren Heywood, Daniella Griffiths, Sumina Azam

Cold indoor temperatures and their association with health and well-being: a systematic literature review

Evidence suggests that indoor temperatures <18°C are associated with negative health effects. This study aimed to identify, appraise and update evidence on the association between cold temperatures (i.e. <18°C) within homes (i.e. dwellings) and health and well-being outcomes. Significant gaps in the current evidence base are identified, including research on the impacts of cold indoor temperatures on mental health and well-being, studies involving young children, and the long-term health effects of cold indoor temperatures.

Authors: Hayley Janssen, Kat Ford+ 5 more
, Ben Gascoyne, Rebecca Hill, Manon Roberts, Mark Bellis, Sumina Azam

Health Impact Assessment for Climate Adaptation: Examples from Practice

This briefing focusses on adaptation to address climate change and the application of Health Impact Assessment (HIA) as a process that can support policy makers to maximise wellbeing benefits, minimise harm to health, and avoid widening health inequalities when designing adaptation policies. It contains five case studies – two international and three from Wales, and provides action oriented examples of putting HIA into practice.

Authors: Mark Drane, Nerys Edmonds+ 3 more
, Kristian James, Liz Green, Sumina Azam

The health, well-being and equity impact of the Comprehensive and Progressive Trans-Pacific Partnership (CPTPP) Agreement on Wales

This report provides a short summary of the findings of a Health Impact Assessment (HIA) of the Comprehensive and Progressive Trans-Pacific Partnership (CPTPP) Agreement on Wales. This report is a high-level, evidence-based strategic overview. It summarises the main health, well-being and equity impacts that could potentially occur in the short and longer-term following the UK’s accession to the CPTPP.

Authors: Liz Green, Leah Silva+ 6 more
, Michael Fletcher, Louisa Petchey, Laura Morgan, Margaret Douglas, Sumina Azam, Courtney McNamara

Cold homes and their association with health and well-being: a systematic literature review

As part of a wider project to determine whether current indoor temperature standards for households in Wales are optimal for people’s comfort, health, and well-being, this review aims to identify and appraise the current evidence on the association between cold homes and health and well-being.

Authors: Hayley Janssen, Ben Gascoyne+ 4 more
, Kat Ford, Rebecca Hill, Manon Roberts, Sumina Azam

Cost of living crisis in Wales: A public health lens

The cost of living crisis is having, and will continue to have, wide-ranging and long-term impacts on the day-to-day lives of people in Wales.
This report summarises the ways in which the cost of living crisis can impact on health and well-being. It takes a public health lens to identify actions for policy makers and decision-makers to protect and promote the health and well-being of people in Wales in their response to the cost of living crisis, outlining what a public health approach to the crisis could look like in the short and longer-term.

Authors: Manon Roberts, Louisa Petchey+ 4 more
, Aimee Challenger, Sumina Azam, Rebecca Masters, Jo Peden

Protecting the mental wellbeing of our future generations: learning from COVID-19 for the long term

This comprehensive Mental Wellbeing Impact Assessment (MWIA) has been carried out by the Wales Health Impact Assessment Support Unit to identify the impacts of the COVID-19 pandemic, and associated policy responses, on the mental wellbeing of young people aged 10-24 in Wales.

The MWIA was carried out with the engagement of young people, teachers and lecturers and the support of a Strategic Advisory Group with representatives from a range of organisations in Wales.

The report aims to provide evidence and learning to inform cross-sector policy and practice directed at pandemic recovery, future emergencies and improving population mental wellbeing for the long term.

Authors: Nerys Edmonds, Laura Morgan+ 7 more
, Huw Arfon Thomas, Michael Fletcher, Lee Parry-Williams, Laura Evans, Liz Green, Sumina Azam, Mark Bellis

The Health and Well-being Impact of Regional Funding in Wales

This report focuses specifically on the health and well-being impact of the loss of European Union (EU) Structural Funds and the risks and opportunities presented by a replacement scheme. It aims to inform national, regional and local decision makers in Wales, particularly those involved in the allocation and management of future regional funding schemes. The report contains key insights on the current importance of the EU Structural Funds for the health and well-being of local areas with a focus on different population groups.

Authors: Mischa Van Eimeren, Laura Morgan+ 2 more
, Sumina Azam, Mark Bellis

Rising to the Triple Challenge of Brexit, COVID-19 and Climate Change for health, well-being and equity in Wales, Spotlight on: Rural Communities

A new report published by Public Health Wales highlights how the combined influences of Brexit, Coronavirus and climate change will potentially see rural communities in Wales experience a time of great change, with both opportunities and negative impacts to navigate.

Authors: Liz Green, Kathryn Ashton+ 7 more
, Michael Fletcher, Laura Evans, Tracy Evans, Lee Parry-Williams, Sumina Azam, Adam Jones, Mark Bellis

Maximising health and well-being opportunities for spatial planning in the COVID-19 pandemic recovery

The pandemic has explicitly exposed, and in some examples, exacerbated the health, well-being and inequalities impacts across the population which are derived from determinants such as the environment, land use, transport, economy and housing. This report aims to highlight the major positive and negative health impacts of spatial planning policies during the COVID-19 pandemic on the population of Wales, learn from these, any positive interventions and co-benefits in order to shape a healthier future environment for all.

Authors: Liz Green, Sue Toner+ 7 more
, Laura Evans, Lee Parry-Williams, Tom Johnson, Gemma Christian, Cheryl Williams, Sumina Azam, Mark Bellis

No place like home? Exploring the health and well-being impact of COVID-19 on housing and housing insecurity

This comprehensive and participatory Health Impact Assessment (HIA) explores the health and well-being impact of COVID-19 on housing and housing insecurity, and looks at the importance of having a consistent home that is of good quality, affordable, and feels safe. It also considers security of tenure in relation to stability, and being able to maintain a roof over one’s head and ultimately prevent homelessness. It is the third in a series, which focus on the impact of the COVID-19 pandemic on the population of Wales including the ‘Staying at Home and Social Distancing Policy’ and the impact of home and agile working. This report can be read in conjunction with these and the sections on housing and home working within them.

Authors: Louise Woodfine, Liz Green+ 9 more
, Laura Evans, Lee Parry-Williams, Christian Heathcote-Elliott, Charlotte Grey, Yoric Irving-Clarke, Matthew Kennedy, Catherine May, Sumina Azam, Mark Bellis

Rising to the Triple Challenge of Brexit, COVID-19 and Climate Change for health, well-being and equity in Wales Spotlight on: Food Security

This paper highlights how the combined influences of Brexit, Coronavirus and climate change will potentially impact everyone through the food that is produced, accessed, available and consumed.

Authors: Liz Green, Kathryn Ashton+ 7 more
, Adam Jones, Michael Fletcher, Laura Morgan, Tom Johnson, Tracy Evans, Sumina Azam, Mark Bellis

Rising to the Triple Challenge of Brexit, COVID-19 and Climate Change for health, well-being and equity in Wales

This report provides a strategic overview of the impact, and interconnectedness, of the enormous events of Brexit, COVID-19
pandemic and climate change. It identifies the key determinants and population groups affected by the Triple Challenge and provides a key example against a determinant.

Authors: Liz Green, Kathryn Ashton+ 7 more
, Michael Fletcher, Adam Jones, Laura Evans, Tracy Evans, Lee Parry-Williams, Sumina Azam, Mark Bellis

Brexit and Poverty in Wales: A Public Health Lens

The aim of this report is to strengthen knowledge and understanding of the implications of the United Kingdom’s (UK) exit from the European Union (EU) – ‘Brexit’ – on poverty, and health and well-being in Wales.

Authors: Sumina Azam, Katie Hardcastle+ 6 more
, Laura Morgan, Rebecca Hill, Michael Fletcher, Tom Johnson, Liz Green, Mark Bellis

Using health impact assessment (HIA) to understand the wider health and wellbeing implications of policy decisions: the COVID-19 ‘staying at home and social distancing policy’ in Wales

This paper focusses on a HIA of the ‘Staying at Home and Social Distancing Policy’ or ‘lockdown’ in response to the COVID-19 pandemic in Wales conducted by the Welsh national public health institute. It describes the process and findings, captures the learning and discusses how the process has been used to better understand the wider health and well-being impacts of policy decisions beyond direct health harm. It also examines the role of public health institutes in promoting and using HIA.

Authors: Liz Green, Kathryn Ashton+ 4 more
, Sumina Azam, Mariana Dyakova, Timo Clemens, Mark Bellis

A COVID-19 pandemic world and beyond: The public health impact of Home and Agile Working in Wales

Due to the pandemic and policies such as the ‘Staying at Home and Social Distancing policy’, home and agile working has become necessary for many organisations and employees. This HIA aims to identify the impact of this shift in working practice and to articulate the differential impacts of such a change for organisations, the working population of Wales, their families and local communities.

Authors: Liz Green, Richard Lewis+ 5 more
, Laura Evans, Laura Morgan, Lee Parry-Williams, Sumina Azam, Mark Bellis

Process, Practice and Progress: A Case Study of the Health Impact Assessment (HIA) of Brexit in Wales

In 2018, the Health impact assessment (HIA) support unit in Wales carried out a comprehensive and unique HIA on the impact of Brexit in Wales. The aims were to understand the differential impacts that Brexit would have on the health and well-being of the population and to provide evidence to inform decision makers across a range of public bodies. This paper reflects on the process of carrying out the HIA and the methods used. It discusses the stages of the HIA, and shares the findings and reflections of implementation which will be beneficial to other HIA practitioners and policy makers.

Authors: Liz Green, Kathryn Ashton+ 2 more
, Nerys Edmonds, Sumina Azam

A Health Impact Assessment of the ‘Staying at Home and Social Distancing Policy’ in Wales in response to the COVID-19 pandemic.

The HIA outlines the potential health and wellbeing impacts of the Staying at Home and Social Distancing Policy (commonly referred to as ‘Lockdown’) on the population of Wales in the short, medium and long term. It draws upon learning from international evidence, latest data and intelligence and the views of expert stakeholders.

Authors: Liz Green, Laura Morgan+ 5 more
, Sumina Azam, Laura Evans, Lee Parry-Williams, Louisa Petchey, Mark Bellis

Young People and Brexit

In the years that have followed the European Union (EU) referendum in 2016, Brexit has seldom been out of the news. Despite considerable activity, there was still uncertainty around Brexit at the time of this research; not just around the logistics of if, when and how the UK might leave the EU but also what the implications of Brexit might be for the UK and for Wales – or even what effect the last few years might already have had.

Authors: Louisa Petchey, Angharad Davies+ 3 more
, Samuel Urbano, Sumina Azam, Alisha Davies

Improving winter health and well-being and reducing winter pressures in Wales – Technical Report

This technical report acknowledges the effects of traditional seasonal factors that cause poor health such as influenza and injuries due to falls, as well as finding wider issues such as poverty, poor housing and unhealthy behaviours having a significant impact on winter health and well-being.

Authors: Sumina Azam, Thomas Jones+ 4 more
, Sara Wood, Emily Bebbington, Louise Woodfine, Mark Bellis

The Public Health Implications of Brexit in Wales: A Health Impact Assessment approach – A Rapid Review and Update

This is a short supplementary follow up report and builds on a detailed analysis of The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach, originally published in January 2019, which examines the potential effects of Brexit on the short, medium and long-term health and well-being of people living in Wales.

Authors: Louisa Petchey, Liz Green+ 5 more
, Nerys Edmonds, Mischa Van Eimeren, Laura Morgan, Sumina Azam, Mark Bellis

Implementing the Sustainable Development Principle: Lessons from a Literature Review on Implementing the Five Ways of Working

This resource provides key learning and actions that public bodies, policy makers and practitioners can take to implement the sustainable development principle, as set out in the Well-being of Future Generations (Wales) Act 2015.

Authors: Victoria Hands, Radu Cinpoes+ 8 more
, Fatima Annan-Diab, Annette Boaz, Carol Hayden, Richard Anderson, Alisha Davies, Sumina Azam, Cathy Weatherup, William King

A Taxing Issue

The report focuses on contemporary population health concerns related to diets where taxation has been considered or implemented elsewhere, and/or is a viable innovation within the Welsh context. Excluded from the scope of this report are topic areas where taxation and other fiscal policy approaches are already in place by UK Government (for example, on alcohol and tobacco) and environmental-related taxation.

Authors: Adam Jones, Sumina Azam+ 1 more
, Mark Bellis

Making A Difference Housing and Health: A Case for Investment Main Report

This report is an extension of Public Health Wales’ Making a Difference publications and aims to inform, support and advocate for wider health policy and cross-sector approaches and interventions offering benefits to the public, health system, society and the economy. The report summarises the impact housing (across tenure) has on health and well-being across the life course; sets out the case for investing in housing as a determinant of health by identifying which interventions work and offer value for money; and identifies priority areas for preventative action within Wales.

Authors: Ian Watson, Fiona MacKenzie+ 2 more
, Louise Woodfine, Sumina Azam