Resources

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.

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.

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.

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.

20 years of the Wales Health Impact Assessment Support Unit (WHIASU) and the evolution of Health Impact Assessment (HIA) in Wales

The 20th anniversary of WHIASU marks two decades of advancing HIA as a vital tool for healthier decision-making and reducing health inequalities in Wales. Established in 2004, WHIASU has led the way in enabling the integration of HIA into policy at local, regional and national levels.

The timeline highlights key milestones, documents, and publications in WHIASU’s history and the practice of HIA in Wales. Looking ahead, WHIASU will continue to champion HIA and Health in All Policies (HiAP), supporting public bodies in implementing upcoming HIA regulations under the Public Health Act (Wales) Act 2017.

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).

Analysing the value, benefits and barriers to stakeholder and community participation in health impact assessments (HIAs) in Wales from 2005 to 2020

Health Impact Assessments (HIA) are undertaken to inform decision-making processes by assessing the potential health and health equity impacts of a programme, policy, or project and developing appropriate responses to mitigate harms and maximize benefits. Stakeholder and community participation is central to the impact assessment process. This research explores the experiences of stakeholders and community members who participated in HIA workshops in Wales between 2005 and 2020. Data were gathered through a questionnaire at the end of each HIA workshop session with stakeholder and community participants from diverse backgrounds reporting on the experience of their participation. The analysis reveals a range of perceived benefits of participation in the HIA process. The identified benefits included the opportunity to be heard, networking, and a view of participation as a community service. These findings reinforce the importance of stakeholder and community participation in HIA, through the perspective of participants themselves. This study contributes to the understanding of community and stakeholder participation in impact assessment processes and offers recommendations for improving the practice and impact of HIA in policy development. These findings have the potential to be transferable to other types of impact assessments, and other forms of community and stakeholder participation.

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.

Successfully creating the conditions for Health Impact Assessment in Wales: a case study. In: Impact Assessment Outlook Journal Volume 21: July 2024. Impact Assessment Frontiers Part 2: People, Health and Equality. Thought pieces from UK and International practice

Reflections from the Wales Health Impact Assessment Support Unit (WHIASU), Policy and International Health, World Health Organization (WHO) Collaborating Centre on Investment for Health and Well-being, Public Health Wales.

Assessing public health implications of free trade agreements: The Comprehensive and Progressive Trans-Pacific Partnership Agreement

In 2016, the United Kingdom voted to exit the European Union, which was surrounded by political and social uncertainty. The United Kingdom now negotiates its own trade agreements, and in March 2023, it agreed to join the Comprehensive and Progressive Trans-Pacific Partnership Agreement (CPTPP). A health impact assessment (HIA) was undertaken in 2022–23 to predict the potential impact of the CPTPP on the health and well-being of the Welsh Population. This paper explores the HIA findings and highlights the value of the approach in engaging with stakeholders and informing policymakers. This HIA followed a standard five-step approach which involved a literature review to identify potential health impacts, qualitative interviews with cross-sectoral stakeholders and the development of a community health profile. The HIA identified potential impacts across the wider determinants of health and specific vulnerable population groups. Investor state dispute settlement mechanisms, economic uncertainty and loss of regulatory policy space were identified as key pathways for health impacts. The findings have been beneficial in informing decision-makers to prepare for the CPTPP in Wales using an evidence-informed approach. This work has demonstrated the value of a HIA approach that uses a transparent process to mobilise a wide range of evidence, resulting in transferrable learning.

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.

Self-administered sexual health testing in an open prison setting in Wales: A Health Impact Assessment and Social Return on Investment analysis

This report outlines findings from a study that aims to understand the health impacts and social return on investment of a self-sampling service for Sexually Transmitted Infections (STIs) in an open prison setting in Wales. The study applies an innovative approach by using a Health Impact Assessment (HIA) lens and approach, in combination with the Social Return on Investment (SROI) framework.

The Impact of the COVID-19 Pandemic on Women, Employment and Health Inequalities

The infographic summarises the findings, looking at the Population Groups and Determinants of Health impacted, along with the key statistics, mitigating actions and potential areas of future research. The Explanatory Note goes into further detail on the above, giving a breakdown of the evidence that informed our positive and negative findings on women, employment and health inequalities. It also offers readers the chance to see the HIA methodology that was used by the team.

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.

Predicted and observed impacts of COVID-19 lockdowns: two Health Impact Assessments in Scotland and Wales

Health Impact Assessment is a key approach used internationally to identify positive or negative impacts of policies, plans and proposals on health and well-being. In 2020, HIAs were undertaken in Scotland and Wales to identify the potential health and well-being impacts of the ‘stay at home’ and physical distancing measures implemented at the start of the coronavirus disease (COVID-19) pandemic. There is sparse evidence evaluating whether the impacts predicted in HIAs occur following policy implementation. This paper evaluates the impacts anticipated in the COVID-19 HIAs against actual observed trends.

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.

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.

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.

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.

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.

‘Health in All Policies’—A Key Driver for Health and Well-Being in a Post-COVID-19 Pandemic World

The COVID-19 pandemic has raised the profile of public health and highlighted the links between health and other policy areas. This paper describes the rationale for, and principles underpinning, HiAP mechanisms, including HIA, experiences, challenges and opportunities for the future.

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.

Adult support during childhood: a retrospective study of trusted adult relationships, sources of personal adult support and their association with childhood resilience resources

Adverse childhood experiences (ACEs) can affect health and well-being across the life course. Resilience is an individual characteristic that is known to help negate the effect of adversities and potentially transform toxic stress into tolerable stress. Having access to a trusted adult during childhood is critical to helping children build resiliency. This paper aims to understand the relationship between always having access to trusted adult support and childhood resilience resources, and examine which sources of personal adult support and the number of sources of adult support, best foster childhood resilience.

Welsh Health Equity Status Report – WHESRi

This report aims to help inform and support a sustainable response and recovery from Coronavirus (COVID-19) in Wales, placing health equity at its heart.
It reinforces our understanding of how interdependent individual and societal well-being, and the wider economy are, towards achieving prosperity for all. The report also contributes to strengthening the leading role of Wales at the forefront of the health equity and sustainable development agenda in Europe and globally.

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.

Health Impact and Social Value of Interventions, Services, and Policies: A Methodological Discussion of Health Impact Assessment and Social Return on Investment Methodologies

Assessing the positive and negative impact of policies, services and interventions on health and well-being is of great importance to public health. Health Impact Assessment (HIA) and Social Return on Investment (SROI) are established methodologies which assess potential effects on health and well-being, including social, economic and environmental factors, indicating synergies, and cross-over in their approach. Within this paper, we explore how HIA and SROI could complement each other to capture and account for the impact and social value of an assessed intervention or policy.

How to Make the Case for Sustainable Investment in Well-being and Health Equity: A Practical Guide

Health inequities are not inevitable. Coordinated policy action on the determinants of health combined with well designed and implemented governance approaches have a dual effect on reducing the health gap and improving overall population health. This guide is the first product developed under Public Health Wales’ WHO Collaborating Centre (WHO CC) on Investment for Health and Well-being work programme and outlines four key phases on how to synthesize, translate and communicate public health economics evidence into policy and practice. The interrelated four phases guide the reader through the process of developing evidence-informed products, which are context and target audience specific. The guide aims to (i) prevent disinvestment in health; (ii) increase investment in prevention (public health); and (iii) and mainstream cross-sectoral investment to address the wider determinants of health and equity, driving sustainable development for  prosperity for all. It has been developed based on a mixed-method approach including an evidence review, interviews with national and international experts, and a multisectoral stakeholder consultation which ensured relevance and transferability across sectors, contexts, settings and countries.

Driving Prosperity for All through Investing for Health and Well-being – An Evidence Informed Guide for Cross-sector Investment

This guide identifies ten key evidence-informed policy opportunities for investment in Wales. Opportunities identified in the report address areas of high burden and cost in Wales, delivering economic as well as social and environmental returns, and supporting sustainable inclusive economic growth. The guide will help decision-makers to implement the Welsh Government’s Prosperity for All national strategy.

Do emotions related to alcohol consumption differ by alcohol type? An international cross-sectional survey of emotions associated with alcohol consumption and influence on drink choice in different settings

This article examines the emotions associated with drinking different types of alcohol, whether these emotions differ by socio demographics and alcohol dependency and whether the emotions associated with different drink types influence people’s choice of drinks in different settings.

Developing a framework for managing the night-time economy in Wales: a Health Impact Assessment approach

This case study outlines the approach of a prospective Health Impact Assessment (HIA) to re-develop an existing reactive framework for managing the night-time economy in Wales. Inclusion of a range of stakeholders in the process enabled the reformulation of realistic proactive objectives which account for both health and well-being. This article highlights the benefits of HIA and can be used to inform future policy developments.