PS15: What do we know about the strengths and weakness of ...

1 POLICY SUMMARY 15. What do we know about the strengths and weakness of different policy mechanisms to influence health behaviour in the population? David McDaid, Adam Oliver, Sherry Merkur Keywords: World Health Organization 2014 (acting as the host organization for, and secretariat of, the European BURDEN OF ILLNESS. Observatory on Health Systems and Policies). CHRONIC DISEASE. COST EFFECTIVENESS Address requests about publications of the WHO. Regional Office for Europe to: DELIVERY OF HEALTH CARE, INTEGRATED Publications WHO Regional Office for Europe HEALTH CARE ECONOMICS UN City, Marmorvej 51, AND ORGANIZATIONS DK-2100 Copenhagen , Denmark HEALTH POLICY Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site ( ).

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5 To policy options and implementation. POLICY SUMMARY 15. What do we know about the strengths and weakness of different policy mechanisms to influence health behaviour in the population? David McDaid, Adam Oliver, Sherry Merkur What do we know about the strengths and weakness of different policy mechanisms to influence health behaviour in the population? Contents Page Prelims v Editors 1 Background 1. WHO Regional Office 2 Focus of the policy summary 3 for Europe and European 3 What factors influence why people do or Observatory on Health do not change their behaviour?

6 4 Systems and Policies 4 What mechanisms have been used to help Editor influence health behaviours? 7 Govin Permanand 5 What do we know about the effectiveness Editorial Board and cost effectiveness of these mechanisms? 13. Josep Figueras 6 How can the evidence base, including Hans Kluge different modes of implementation, John Lavis be strengthened? 23 David McDaid 7 Conclusions and summary of key themes 27 Elias Mossialos References 29 Managing Editors Jonathan North Caroline White Authors The authors and editors are grateful to the reviewers David McDaid is Senior Research Fellow in Health who commented on this Policy and Health Economics, European Observatory on Health Systems and Policies and Personal Social publication and contributed Services Research Unit (PSSRU), LSE Health and Social their expertise.

7 Care, London School of Economics and Political Science, United Kingdom of Great Britain and Northern Ireland. Adam Oliver is Reader, Department of Social Policy, London School of Economics and Political Science, United Kingdom of Great Britain and Northern Ireland. Sherry Merkur is Research Fellow and Health Policy Analyst, European Observatory on Health Systems and Policies and LSE Health, London School of No: 15. Economics and Political Science, United Kingdom of Great Britain and Northern Ireland. ISSN 2077-1584.

8 Policy mechanisms to influence health behavior List of abbreviations ACE Assessing the Cost Effectiveness of prevention programmes DALY disability-adjusted life-year EU European Union GDP gross domestic product GP general practitioner NICE National Institute for Health and Care Excellence (previously National Institute for Health and Clinical Excellence). UK United Kingdom of Great Britain and Northern Ireland USA United States of America US$ United States dollar WWW Walking for Wellbeing in the West v Policy summary List of figures and boxes Figures Figure 1 Mechanisms used to influence health behaviours Figure 2 Example of a framework for action for behaviour change to promote physical activity Boxes Box 1 Two approaches to influencing food-purchasing patterns of supermarket customers Box 2 Dissemination of information on traffic injuries in Norway

9 Box 3 Assessing the economic case for scaling up a community pedometer walking programme in Scotland Box 4 Evaluation: using commitment contracts to encourage extended weight loss Box 5 Health-promoting children's television programme and subsequent food product branding in Iceland Box 6 Modelling the cost effectiveness of interventions to promote physical activity in Australia Box 7 Questions to consider when planning to implement an intervention for behaviour change Box 8 Example of issues to be considered in the design and implementation of a behaviour-change intervention.

10 Framing a commitment contract Box 9 The benefits of partnership working: the Change4 Life campaign vi Policy mechanisms to influence health behavior Executive summary Many health problems are potentially avoidable and governments have long had powerful tools at their disposal to influence population health and change individual behaviours, directed both upstream' at some of the underlying causes of poor health, as well as at downstream' challenges when poor health behaviours are already manifest. But how effective are these different actions?