In the UK, and more so in deprived areas, many people are dying earlier than they should from largely preventable chronic diseases such as cancer and heart disease. To prevent this and create communities where everyone can thrive, we need the right building blocks in place including jobs, good pay, and environments free of pollution and where it is easy to make healthy choices - eat the right food, exercise, and so on. In many communities these building blocks are missing. This project aims to address this. Local governments across England are responsible for many of these building blocks and can, therefore, significantly improve health and wellbeing. There are many ways to do this, for example, changing the focus of their local economy to consider population wellbeing alongside measures such as productivity, ensuring that organisations they contract have fair employment practices, using planning rules to reduce the density of fast-food outlets and implementing car-free cities. However, local governments face many barriers to implementing these measures including a lack of capacity and locally relevant evidence on the most important building blocks in their areas and how they can best be altered to improve health. One of the building blocks that remains poorly understood at local level is the commercial sector, despite growing evidence of its major impacts on health and equity. On one hand local businesses create jobs and contribute to the economy. On the other, 40% of chronic disease deaths are directly linked to transnational corporations manufacturing just four products - tobacco, ultra-processed foods, alcohol and fossil fuels (fossil fuel deaths primarily due to air pollution). These corporations actively oppose interventions that local governments could implement. They particularly oppose the most effective interventions - those that work at population or community level (e.g. restricting advertising of or outlets for their products). To ensure that local governments can harness the positive impacts of the commercial sector while mitigating the negative ones, it is essential to better understand these 'commercial determinants of health' (CDOH). Health Hub: Systems Approaches to Commercial Determinants of Health and Equity is an ambitious new research cluster that brings together local governments, researchers, and civil society groups to work with local populations to improve the health, wellbeing and equity of communities across England. They will do this by better understanding the building blocks - including the commercial factors- that impact on communities' health and use that knowledge to identify, implement and evaluate the population-level interventions most likely to improve health, wellbeing and equity at scale. It will do this through seven interconnected packages of work that, working at local government level, will: 1.Explore the building blocks influencing health in each area as part of a complex system in which building blocks and interventions can all impact on each other, using this to identify the most important points in the system to intervene to improve health; 2.Assess the evidence for population level interventions that can be applied locally to improve health at scale and reduce health inequities; 3.Identify the facilitators and barriers to implementing these interventions and develop resources and support systems to help overcome these barriers; 4.Model the anticipated health and economic impacts of the interventions, comparing different ways of estimating these impacts and compiling new large-scale data resources for local governments; 5.Support implementation of chosen interventions using the resources and support systems developed; 6.Evaluate the impacts of interventions, resources and support systems, whether and how they inter-link and vary with context; 7.Ensure the data, evidence, resources and support systems developed can be used to maximum effect well beyond the project.

This research project will measure change in the availability of alcohol and tobacco in Scottish neighbourhoods over time. We will explore how this change relates to health outcomes and how residents experience the availability of alcohol and tobacco in their neighbourhoods. The findings will be important because smoking and alcohol consumption are leading causes of illness and death. In Scotland smoking causes one in every 5 deaths and one in 20 deaths is related to alcohol. This harm is not equally shared; those on the lowest incomes suffer the greatest harm. These illnesses and deaths are preventable. The World Health Organisation recommends that nations prioritise interventions that reduce the supply of alcohol and tobacco. Why might neighbourhood supply of alcohol and tobacco matter? Research suggests that when there are a lot of outlets in a neighbourhood this impacts upon consumption in three ways. 1. The outlets may be more competitive and drive prices down to attract customers. 2. Oversupply may normalise the products when they are sold alongside everyday commodities, such as bread and milk. 3. Tobacco and alcohol may simply be easier to buy in areas where there are more outlets. In order to explore the relationship between supply, behaviour and harm we need data on the location of every outlet in Scotland selling tobacco and/or alcohol. Ideally, to be able to say something about whether the relationship may be causal, we need this data over time. We have already collected data on the specific location of every outlet selling tobacco and licensed to sell alcohol over multiple time periods (2012 and 2016 (nationwide alcohol and tobacco) and 2008 (alcohol in four cities)). As part of this project we will collect updated data for 2019/20. This will allow us to measure this change over time. Using an approach called trajectory modelling we will group neighbourhoods that have had a similar degree of change; some neighbourhoods may have lost, or gained, local shops or pubs, whereas some may not have changed at all. We will then identify features of these neighbourhoods that may be driving this change, for example the age profile of the population or poverty levels. This will help policy makers understand the drivers of change in our neighbourhoods. To measure the relationship between changing supply and harm we will link these trajectories, and our measures of availability at each time point, to alcohol and tobacco health outcomes (behaviour, illness and death). We will use statistical models to see whether areas experiencing an increase or decrease in outlets have seen a corresponding increase or decrease in these outcomes. This will allow us to get a better understanding of whether an over supply of alcohol and tobacco is related to smoking and alcohol consumption and harm. These findings will provide important evidence related to the provision of such commodities in our neighbourhoods. Although these statistics are important to report we also need to understand why an oversupply of alcohol and tobacco may influence behaviour and harm. Whilst the literature suggests the pathways listed above, we know little about the experiences of individuals living in neighbourhoods with contrasting availability. We don't understand the individual experience of these pathways. We will meet with groups of individuals, in neighbourhoods of contrasting trajectories, to talk to them about the supply of alcohol and tobacco. We will explore their experiences of neighbourhood and assess how their perceived notions of their neighbourhood availability contrast with our statistical measures. Finally, we will meet with residents, retailers and policy stake-holders to explore potential interventions related to supply. Policies at this level require public, retailer and political support. We will discuss the priorities held by various groups, present our empirical results and gauge attitudes towards potential interventions.

Background and context: There is no safe level of exposure to second-hand smoke (also known as passive smoking), which causes increased health risks for babies and children, including more severe asthma attacks, chest and ear infections, and sudden infant death syndrome. In the UK, second-hand smoke exposure costs the NHS about £23 million each year, causing over 300, 000 GP consultations and nearly 10,000 hospital admissions. Children who grow up homes where smoking takes place are more likely than other children to experience delays in development, require time off school because of illness, and become smokers themselves. Nearly 20 years since smoke-free public places were introduced in the UK and Ireland, most exposure to second-hand smoke now takes place in homes, in poorer areas. In Scotland, for example, 15% of children living in poorer areas are exposed to second-hand smoke, compared to 1% of children living in wealthier areas. There is no recommended approach to tackle this challenge. Parents want to protect their children's health, but housing constraints (i.e. living in a 3rd floor flat), having friends and family who smoke, sole-parenting and lack of access to safe outdoor space are just some of the wider challenges that make this more difficult. Smoking can be seen as a way of coping with poverty and hardship (though in reality it often adds to financial stress). Creative approaches are required to better support families living in poorer areas, which take better account of the additional challenges they face in trying to create a smoke-free home. Aim: The SHINE network aims to increase our knowledge and understanding of the reasons why people in Ireland and the UK continue to smoke in the home. How we will go about this: The SHINE network will bring together researchers, policy makers, organisations and parents, providing a unique opportunity to develop plans for future research that are relevant and meaningful to families living in poorer areas. We will come together through a series of online meetings and workshops, sharing knowledge, experience and ideas. We will begin to develop future work that takes into account the barriers caused by education, housing and wider life circumstances that can make it particularly difficult for families to create a smoke-free home.We will hold several discussions with parents in the UK and in Ireland to find out more about the reasons why, when and where people smoke in the home, and the types of support that would help them to change their home smoking behaviours. These findings will feed back into network discussions, to make sure that our ideas for future work are relevant to families living in poorer areas of the UK and Ireland. From the beginning, we will develop ways to keep SHINE running after the 12 months of funding has finished, so that we can keep working to find ways to better support parents who want to protect their family from second-hand smoke and create a smoke-free family home. The information the network will provide: The network will develop ideas for new, creative approaches to tackling the challenge of reducing the number of people who smoke in the home in the UK and ROI. Including families in discussions will ensure that ideas for future research, policy and practice are tailored to the needs of people living in poorer areas. SHINE will provide new scientific understanding of how best to support families to create a smoke-free home. We hope that many of the networks findings will be of relevant to professionals working in other countries around the world, where second-hand smoke exposure levels remain high. We will share our findings widely through presentations to various audiences, attendance at conferences, a lay summary of findings, through SHINE webpages we will develop, and through social media, to make sure they have wide reach and impact.

Cigarette smoking and harmful use of alcohol are major preventable causes of early death, disease, accidents and injury in the UK. Although the health effects of smoking have been widely recognised for decades, active and passive smoking still kill over 100,000 people and cause over 160,000 new cases of illness in children each year. Half of the 10 million smokers in the UK today will be killed by their smoking unless they stop. In contrast to smoking, alcohol consumption in the UK has increased markedly in the last thirty years. Ten million people in the UK now drink alcohol to harmful levels, and alcohol causes over 15,000 deaths, 1 million hospital admissions, and accidents and violence that together cost our society more than £20 billion each year. Like the effects of smoking, these harms affect the poorest in society most. Also like tobacco, alcohol consumption is driven by very powerful multinational industries with substantial political influence. It is therefore essential to find better ways to prevent smoking and harmful use of alcohol, now and in the future, and to prevent commercial interests from undermining these actions. Much has been learnt from the successes of reducing smoking prevalence, and many successful tobacco strategies can be applied to prevent alcohol harm. However, alcohol strategies must also take account of the fact that while smoking is dangerous at all levels, low levels of alcohol consumption do not have equivalent health harms to tobacco. So while tobacco policy can be pursued with the aim of eradicating smoking from society, alcohol policy has to aim to prevent consumption to levels that cause significant harm to the user, or to others. This proposal aims to address these problems by bringing together leading tobacco and alcohol researchers to build on success in tobacco research over the past five years by creating a new research centre, the UK Centre for Tobacco and Alcohol Studies (UKCTAS), to study new ways to prevent tobacco and alcohol-related harm, and promote their implementation. Since 2008 we have applied this approach in smoking prevention through the existing UK Centre for Tobacco Control Studies (UKCTCS), and achieved significant impacts on tobacco policy and practice (see www.ukctcs.org). We now propose to continue our tobacco work and to establish a major new focus on alcohol, by incorporating leading international alcohol researchers into the new Centre. Our work will aim to: 1. Understand and identify preventable reasons why people smoke or use alcohol to a harmful degree, and improve understanding of the health impacts of these behaviours 2. Understand and develop better population measures to to reduce smoking and harmful use of alcohol 3. Develop and implement better individual health interventions to prevent smoking and harmful use of alcohol 4. Develop and apply harm reduction strategies for those otherwise likely to continue to smoke or sustain harm from alcohol 5. Understand the tactics of the industry to encourage tobacco and alcohol consumption and thus undermine health policy and practice 6. Use the outcomes of our research to work, with other professional and public groups and individuals, to improve UK and international action to prevent smoking and harm from alcohol We will also aim to further develop our training and development of academic, policymaker and practitioner capacity for tobacco and alcohol work in the future, and to establish UKCTAS as a self sustaining Centre by the end of the five-year funding period. The main benefits of the Centre will be the achievement of sustained reductions in harms to individuals and society from tobacco and alcohol use.

PETRA will be a unique UK expert and user research and development network. It will examine the evidence on the links between trade and health in respect of the prevention of Non Communicable Diseases (NCDs). It will look at how international trade can improve human health and prevent avoidable harm. It will achieve this by reviewing the existing knowledge on trade and health. PETRA will develop research on the trade measures and policies that will have the highest impact on promoting health and reducing harms, especially where these are caused by trade in unhealthy foods, alcohol and tobacco. This will be achieved through bringing together trade experts with the academic disciplines of public health, economics, environmental sciences (sustainable development/prosperity), public policy and law. The Network will be guided by views from key policy people in the civil service and third sector as well as innovations and learning from other countries and other areas of linked public benefit. The benefits of PETRA will be in addressing a major gap in NCD prevention research. Trade policies and systems have the potential to reduce avoidable harms and make significant improvements to human health. PETRA aims to ensure that there is a solid base of applied research and development to inform public policy and funded research priorities. The beneficiaries and benefits of PETRA will be: General public: by achieving progressive improvements in the public's health especially for future generations. PETRA will seek to improve public understanding of: the impact of trade on human health and the environment, the wider impacts on current and future generations, and the public policy solutions that will improve the public's health. UK Government policy makers: in trade, environment, public health, transport, agriculture, food etc. They will be better informed about the underpinning research and development on the links between trade and health and on practical policy solutions that can be incorporated within trade policy and trade and investment agreements. Charities and professional groups: PETRA will work with respected and evidence-based advocacy groups. The benefits to them will be research informed advocacy for progressive social and environmentally beneficial trade policies and trade and investment agreements. Other countries: there will also be potential benefits for other countries. Trade is governed by reciprocal agreements which should contain common standards. Academics in trade, public health, law, environmental sciences, public policy and economics: the potential benefits to academia will be: being linked into a dedicated community of interest, potential interdisciplinary research collaborations, ability to achieve research impact, research ideas and innovations, and professional development opportunities. Research funders: will have a clear case for short and longer term research priorities for high impact NCD prevention trade measures. Public health professionals: - PETRA aims to increase interest, involvement and literacy in the public health community in health and trade. There is potential to incorporate learning from PETRA's discussions in training and development events and curricula. Due to the long term nature of trade and investment agreements, PETRA will aim to become a self sustaining and interlinked research and development community on the trade and health aspects of the prevention of NCDs. By developing research collaborations PETRA will aim to persuade research funders of the need to fund high impact trade and health research. PETRA will become a national expert resource and seek to establish interdisciplinary centres of academic excellence on trade and health. There will be a demand for this expert capacity as the UK needs to develop trade policy and trade and investment agreements rapidly over at least the next decade.