The QUEST for Effective and Equitable Policies to Prevent Non-communicable Diseases: Co-Production Lessons From Stakeholder Workshops

Document Type : Short Communication


Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK


Non-communicable diseases (NCDs) account for some 90% of premature UK deaths, most being preventable. However, the systems driving NCDs are complex. This complexity can make NCD prevention strategies difficult to develop and implement. We therefore aimed to explore with key stakeholders the upstream policies needed to prevent NCDs and related inequalities.
We developed a theory-based co-production process and used a mixed methods approach to engage with policy- and decision-makers from across the United Kingdom in a series of 4 workshops, to better understand and respond to the complex systems in which they act. The first and fourth workshops (London) aimed to better understand the public health policy agenda and effective methods for co-production, communication and dissemination. In workshops 2 and 3 (Liverpool and Glasgow), we used nominal group techniques to identify policy issues and equitable prevention strategies, we prioritised emerging policy options for NCD prevention, using the MoSCoW approach.
We engaged with 43 diverse stakeholders. They identified ‘healthy environment’ as an important emerging area. Reducing NCDs and inequalities was identified as important, underpinned by a frustration relating to the evidence/policy gap. Evidence for NCD risk factor epidemiology was perceived as strong, the evidence underpinning the best NCD prevention policy interventions was considered patchier and more contested around the social, commercial and technological determinants of health. A comprehensive communications strategy was considered essential. The contribution of ‘elite actors’ (ministers, public sector leaders) was seen as key to the success of NCD prevention policies.
NCDs are generated by complex adaptive systems. Early engagement of diverse stakeholders in a theory-based co-production process can provide valuable context and relevance. Subsequent partnership-working will then be essential to develop, disseminate and implement the most effective NCD prevention strategies.



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  1. World Health Organisation.  Risk of Premature Death due to NCD’s; UK.   Accessed November 4, 2019.
  2. Murray CJ, Richards MA, Newton JN, et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet. 2013;381(9871):997-1020. doi:10.1016/s0140-6736(13)60355-4
  3. Fenton K. Tackling the Epidemic of Non-Communicable Diseases. Public Health England; 2014.  Accessed November 4, 2019.
  4. Dahlgren G, Whitehead M. Policies and Strategies to Promote Social Equity in Health. Stockholm, Sweden: Institute for Futures Studies; 1991.
  5. Capewell S, Lloyd-Williams F. The role of the food industry in health: lessons from tobacco? Br Med Bull. 2018;125(1):131-143. doi:10.1093/bmb/ldy002
  6. Gielen AC, Green LW. The impact of policy, environmental, and educational interventions: a synthesis of the evidence from two public health success stories. Health Educ Behav. 2015;42(1 Suppl):20S-34S. doi:10.1177/1090198115570049
  7. Espina C, Soerjomataram I, Forman D, Martín-Moreno JM. Cancer prevention policy in the EU: best practices are now well recognised; no reason for countries to lag behind. J Cancer Policy. 2018;18:40-51. doi:10.1016/j.jcpo.2018.09.001
  8. Rutter H, Savona N, Glonti K, et al. The need for a complex systems model of evidence for public health. Lancet. 2017;390(10112):2602-2604. doi:10.1016/s0140-6736(17)31267-9
  9. Knai C, Petticrew M, Mays N, et al. Systems thinking as a framework for analyzing commercial determinants of health. Milbank Q. 2018;96(3):472-498. doi:10.1111/1468-0009.12339
  10. Cairney P, Oliver K. Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy? Health Res Policy Syst. 2017;15(1):35. doi:10.1186/s12961-017-0192-x
  11. World Health Organisation (WHO). Sustainable Development Goals SDG 3: Ensure Healthy Lives and Promote Wellbeing for all at all Ages.  Accessed March 20, 2020.
  12. Slunge D, Drakenberg O, Ekbom A, Göthberg M, Knaggård Å, Salin U. Stakeholder Interaction in Research Processes-A Guide for Researchers and Research Groups. University of Gothenberg; 2017.  Accessed March 20, 2020.
  13. Hennessy M, Byrne M, Laws R, Mc Sharry J, O'Malley G, Heary C. Childhood obesity prevention: priority areas for future research and barriers and facilitators to knowledge translation, coproduced using the nominal group technique. Transl Behav Med. 2019;9(4):759-767. doi:10.1093/tbm/iby074
  14. Mulder P. MoSCoW Method.  Accessed June 1, 2020. Published 2017.
  15. Scottish Co-Production Network. Scottish Co-Production Network: Co-produced evidence and robust methodologies.  Accessed March 20, 2020.
  16. Bussu S, Tullia Galanti M. Facilitating coproduction: the role of leadership in coproduction initiatives in the UK. Policy Soc. 2018;37(3):347-367. doi:10.1080/14494035.2018.1414355
  17. Bagnall AM, Radley D, Jones R, et al. Whole systems approaches to obesity and other complex public health challenges: a systematic review. BMC Public Health. 2019;19(1):8. doi:10.1186/s12889-018-6274-z
  18. Cairney P, Oliver K, Wellstead A. To bridge the divide between evidence and policy: reduce ambiguity as much as uncertainty. Public Adm Rev. 2016;76(3):399-402. doi:10.1111/puar.12555
  19. Wehrens R. Beyond two communities–from research utilization and knowledge translation to co-production? Public Health. 2014;128(6):545-551. doi:10.1016/j.puhe.2014.02.004
  20. Best A, Holmes B. Systems thinking, knowledge and action: towards better models and methods. Evid Policy. 2010;6(2):145-159. doi:10.1332/174426410x502284
  21. Lewis-Beck MS, Bryman A, Liao TF. The SAGE Encyclopedia of Social Science Research Methods. Thousand Oaks, Ca: Sage; 2004.
  22. American Society for Quality the Quality Toolbox, 2nd ed. ASQ Quality Press.  Accessed March 20, 2020.
  23. Oliver K, Kothari A, Mays N. The dark side of coproduction: do the costs outweigh the benefits for health research? Health Res Policy Syst. 2019;17(1):33. doi:10.1186/s12961-019-0432-3
  24. Hovmand P, Rouwette EA, Andersen D, et al. Scriptapedia: A Handbook of Scripts for Developing Structured Group Model Building Sessions.  Accessed March 2, 2020. Published 2011.
  25. Braun V, Clarke V. How to Use Thematic Analysis.   Accessed March 20, 2020. Published 2006.
  26. Hastings G. Why corporate power is a public health priority. BMJ. 2012;345:e5124. doi:10.1136/bmj.e5124
  27. Petticrew M, McKee M, Marteau TM. Partnerships with the alcohol industry at the expense of public health. Lancet. 2018;392(10152):992-993. doi:10.1016/s0140-6736(18)32320-1
  28. Capewell S, Capewell A. An effectiveness hierarchy of preventive interventions: neglected paradigm or self-evident truth? J Public Health (Oxf). 2018;40(2):350-358. doi:10.1093/pubmed/fdx055
  29. Kypridemos C, Collins B, McHale P, et al. Future cost-effectiveness and equity of the NHS Health Check cardiovascular disease prevention programme: microsimulation modelling using data from Liverpool, UK. PLoS Med. 2018;15(5):e1002573. doi:10.1371/journal.pmed.1002573 
  30. Jones BD. Bounded rationality. Ann Rev Polit Sci. 1999;2(1): 297-321. doi:10.1146/annurev.polisci.2.1.297
  31. Cairney P, Russell S, St Denny E. The 'Scottish approach' to policy and policymaking: what issues are territorial and what are universal? Policy Polit. 2016;44(3):333-350. doi:10.1332/030557315x14353331264538
  32. World Health Organisation (WHO). Health, environment and climate change Draft WHO global strategy on health, environment and climate change: the transformation needed to improve lives and well-being sustainably through healthy environments. Seventy-second World Health Assembly  A72/15 Provisional agenda item 11.6, April 18, 2019.  Accessed March 20, 2020.
  33. Cairney P, Heikkila T, Wood M. Making Policy in a Complex World. Cambridge: Cambridge University Press; 2019.
  34. Oliver K, Cairney P. The dos and don’ts of influencing policy: a systematic review of advice to academics. Palgrave Commun. 2019;5(1):21. doi:10.1057/s41599-019-0232-y
  35. Breda J, Wickramasinghe K, Peters DH, et al. One size does not fit all: implementation of interventions for non-communicable diseases. BMJ. 2019;367:l6434. doi:10.1136/bmj.l6434
  36. Isaranuwatchai W, Teerawattananon Y, Archer RA, et al. Prevention of non-communicable disease: best buys, wasted buys, and contestable buys. BMJ. 2020;368:m141. doi:10.1136/bmj.m141
  37. Langley J, Wolstenholme D, Cooke J. 'Collective making' as knowledge mobilisation: the contribution of participatory design in the co-creation of knowledge in healthcare. BMC Health Serv Res. 2018;18(1):585. doi:10.1186/s12913-018-3397-y
  38. Ward V. Why, whose, what and how? a framework for knowledge mobilisers. Evid Policy. 2017;13(3):477-497. doi:10.1332/174426416x14634763278725
  39. Kreuter MW, De Rosa C, Howze EH, Baldwin GT. Understanding wicked problems: a key to advancing environmental health promotion. Health Educ Behav. 2004;31(4):441-454. doi:10.1177/1090198104265597
  40. Hawkesworth S. Facilitating Complex Systems Research for Public Health. Published 2018.
Volume 10, Issue 10
October 2021
Pages 638-646
  • Receive Date: 30 March 2020
  • Revise Date: 08 June 2020
  • Accept Date: 09 June 2020
  • First Publish Date: 01 October 2021