Impact case study database

GHPU research has underpinned engagement with leading health actors in the UK and globally. This has advanced understanding of COI across complex policy communities, leading to new ways to address COI by framing tobacco, alcohol and nutrition policy-making as interlinked and promoting policy coherence.

Influencing governance arrangements: Managing COI across NCDs at the Scottish Parliament

In 2016 /2017, Collin’s research influenced the decision of three issue-specific Cross-Party Groups (CPGs) in the Scottish Parliament to combine. This resulted in the new CPG on Improving Scotland’s Health, which has 66 member organisations and high levels of engagement with MSPs and the Scottish Government, promoting coherence across public health risk factors such as alcohol, tobacco, and obesity. Collin’s research (3.1, 3.2) and engagement provided the CPG members with “ a greater understanding of international corporate activities and… of tobacco tactics and strategizing, helping us to build links with others working across unhealthy commodities” (5.1). Working with the CPG secretariat, Collin used his research insights to develop the group’s COI statement; this was challenging as these policy areas have had very different approaches to involving relevant industries in policy-making (5.2). He gave a presentation at the CPG’s first meeting in January 2017 on coherence across unhealthy commodity industries. Following this, the CPG unanimously adopted the COI statement, agreeing a policy by which “ [c]ommercial companies and their vested interests should be excluded from membership”, a policy that is distinctive among CPGs and welcomed by advocates as more robust than in many alcohol and food policy contexts (5.2). According the CEO of ASH Scotland, “ The terms of engagement and declaration of interests are unique for this CPG in how they acknowledge and seek to limit commercial influence on matters of public health. Our approach therefore provides additional protection for the alcohol and obesity groups for example, which generally have less protection than tobacco in terms of commercial influence in policy-making” (5.1).

Influencing the production of evidence: Public Health England and Cancer Research UK

The ESRC seminar series advanced discussions across policy areas and identified need for new governance tools, particularly with respect to the alcohol industry. Research following directly from this (3.5) attracted attention from Public Health England (PHE) and influenced their development of new “Principles for engaging with industry stakeholders”, in the aftermath of PHE’s highly controversial partnership with a charity funded by the alcohol industry. This research (3.5), is the only reference underpinning PHE’s decision to adopt a new strategic approach to managing COI across health-impacting industries, stating: “ given the structural links between companies and across industries, the priority was to develop a set of general guiding principles that PHE could adapt to specific topic areas” (5.4, section 5). This strategic decision and guidance document formally direct PHE’s 5,500 researchers and public health professionals, who provide professional scientific expertise to central and local government, the NHS, UK Parliament, industry and the general public, thus limiting commercial access to an influential evidence-producing and advisory organisation.

Through his research (3.1, 3.3) and as chair of both Cancer Research UK’s (CRUK) Tobacco Advisory Group (2014-19) and International Tobacco Advisory Group (2016-present), Collin shaped the development of CRUK’s Code of Practice on Tobacco Industry Funding to Universities through two revisions (2014 and 2018) with associated impacts on funding strategy (5.5). CRUK is the world’s largest independent funder of cancer research, investing an average of GBP500 million per year, and its Code has broader significance via a joint protocol with Universities UK and as an explicit reference point in COI governance in leading universities (5.6). His analysis of COI associated with a health philanthropy founded by Carlos Slim Helu (3.1) is described by CRUK’s then Cancer Prevention Director as having “ guided our decision making with respect to both … the Fundación Carlos Slim, and also to the [USD800m] Foundation for a Smoke-Free World”, in classifying recipients of such funding as ineligible for CRUK support (5.6). Collin’s input into adapting the Code to address e-cigarettes is presented by the Director as part of wider impact in managing international controversies around e-cigarettes in tobacco control: “[H]is analysis of the emergent e-cigarette industry for the Royal College of Physicians shaped the development of our funding Code in differentiating between independent e-cigarette manufacturers and those owned by the tobacco industry” (5.6).

Influencing global health governance: building international capacity and raising awareness of COI for health officials and NGOs

In 2017 WHO published a consultation on its first tool for managing COI in nutrition. However, research revealed concerns among Member States, international agencies and civil society organisations about the complexity of the proposed 6-step methodology, inadequate understandings of COI, and the lack of provision for testing the tool in country contexts (3.6).

Research and engagement by Collin, Hill, and Ralston subsequently aimed to address these concerns and advance use of the WHO tool. First, funded by an ESRC Impact Accelerator Grant, they collaborated with PAHO and ACT+, a leading Brazilian NGO, to pilot the tool at country level. This centred on a co-organised deliberative workshop in Brasilia in August 2018, involving 30 officials from key government agencies and civil society organizations. The event increased knowledge of COI tools, and developed suggestions on how to implement and adapt the tool for use within Brazil (5.7). The workshop helped participants to better understand COI, the WHO tool, and the need for supporting mechanisms. According to one attendee it “ expanded the perspective of conflict of institutional interests and presented perspectives on the need to implement tools that allow better identification and management possibilities”, with another attendee stating, “I started to believe a little more that there is the possibility of managing risks for conflicts of interest” (5.8).

Second, Collin, Hill, and Ralston collaborated with PAHO to develop a shorter ‘ triage tool’ to enable rapid engagement. This work built awareness, capacity, and understanding of COI, leading to the Brazilian Ministry of Health employing the ‘triage tool’ with five teams from Food and Nutrition Coordination (5.7). At a WHO Informal Technical Member State consultation in 2019, Brazil was the only country to report substantive use of the tool in policymaking. Brazil’s Ministry of Health acknowledged the contribution of the Edinburgh University researchers, proposed the PAHO collaboration in Brazil as a case study of successful engagement with COI mechanisms, recommended wider use of our triage tool, and stated that the “ model used in Brazil was very useful for us and can be adapted to other countries” (5.7, p.7).

Third, to advance awareness and management of COI in contexts with limited state capacity, Collin and Hill co-organised a workshop for small island developing states with PAHO and the Healthy Caribbean Coalition (HCC), the regional network for health NGOs. With 30 attendees from health ministries and agencies across six Caribbean states (Barbados, March 2019), Collin and Hill presented research insights and supported critical engagement with COI tools. This led to increased awareness and capacity building in the region, the development of a regional COI policy by HCC, and increased engagement with WHO and PAHO tools. Building on and endorsing the Brazilian approach, the workshop report concluded that “ a simple, user-friendly policy and associated tools to allow the HCC to better manage individual and institutional CoI related to engagement with industry in NCD prevention and control would be ideal” (5.9, p.56).

PAHO’s nutrition adviser identifies GHPU “publications, research expertise and collaborative engagement” as critical in underpinning these initiatives, confirming that their insights “have been essential in PAHO’s work to support member states in identifying and managing COI in nutrition policy, and in promoting coherent approaches to tackling non-communicable diseases across the Americas.” (5.10, p.1). Substantive outcomes include the development of new policy tools in collaboration with PAHO:

• the triage tool, with an online version linking to the full WHO resources to increase accessibility for health officials;

• a user-friendly protocol for piloting tools at country level for use by Member States

• a new ‘roadmap’ for PAHO’s work in supporting Member States in managing COI and implementing the WHO tool (5.10, p.2).

As PAHO’s adviser notes, the pandemic has significantly restricted opportunities for dissemination, and for uptake and engagement by Ministries of Health, including by delaying the launch of these outputs. This is now being planned for March-April 2021, with further work to focus on developing an online capacity-building course to support government officials and health advocacy organisations across the Americas (5.10).