Journal articles
Walls H, Johnston D, Matita M, Kamwanja T, Smith R, Nanama S (2023). The politics of agricultural policy and nutrition: a case study of Malawi's Farm Input Subsidy Programme (FISP).
PLOS Glob Public Health,
3(10).
Abstract:
The politics of agricultural policy and nutrition: a case study of Malawi's Farm Input Subsidy Programme (FISP).
The concept of food and nutrition policy has broadened from simply being an aspect of health policy, to policy interventions from across a wide range of sectors, but still with potentially important impact on nutritional outcomes. This wider and more complex conceptualisation involves policy with multiple objectives and stakeholder influences. Thus, it becomes particularly important to understand the dynamics of these policy processes, including policy design and implementation. To add to this literature, we apply the Kaleidoscope Model for understanding policy change in developing country contexts to the case-study of an agricultural input subsidy (AIS) programme in Malawi, the Farm Input Subsidy Programme (FISP), exploring the dynamics of the FISP policy process including nutritional impact. Over a three-month period between 2017 and 2019 we conducted in-depth interviews with key stakeholders at national and district levels, and focus groups with people from rural districts in Malawi. We also undertook a review of literature relating to the political economy of the FISP. We analysed the data thematically, as per the domains of the Kaleidoscope Model. The analysis across the FISP policy process including policy design and implementation highlights how stakeholders' ideas, interests and influence have shaped the evolution of FISP policy including constraints to policy improvement-and the nutritional impacts of this. This approach extends the literature on the tensions, contradictions and challenges in food and nutrition policy by examining the reasons that these occur in Malawi with the FISP. We also add to the political science and policy analysis literature on policy implementation, extending the concept of veto players to include those targeted by the policy. The findings are important for consideration by policymakers and other stakeholders seeking to address malnutrition in rural, food-insecure populations in Malawi and other low-income settings.
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Author URL.
Milsom P, Tomoaia-Cotisel A, Smith R, Modisenyane SM, Walls H (2023). Using System Dynamics to Understand Transnational Corporate Power in Diet-Related Non-communicable Disease Prevention Policy-Making: a Case Study of South Africa.
International Journal of Health Policy and Management,
12, 7641-7641.
Abstract:
Using System Dynamics to Understand Transnational Corporate Power in Diet-Related Non-communicable Disease Prevention Policy-Making: a Case Study of South Africa
Background: Complex interactions between political economy factors and corporate power are increasingly recognized to prevent transformative policy action on non-communicable disease (NCD) prevention. System science offers promising methods for analysing such causal complexity. This study uses qualitative system dynamics methods to map the political economy of diet-related NCD (DR-NCD) prevention policy-making aiming to better understand the policy inertia observed in this area globally. Methods: We interviewed 25 key policy actors. We analysed the interviews using purposive text analysis (PTA). We developed individual then combined casual loop diagrams to generate a shared model representing the DR-NCD prevention policy-making system. Key variables/linkages identified from the literature were also included in the model. We validated the model in several steps including through stakeholder validation interviews. Results: We identified several inter-linked feedback processes related to political economy factors that may entrench different forms of corporate power (instrumental, structural, and discursive) in DR-NCD prevention policy-making in South Africa over time. We also identified a number of feedback processes that have the potential to limit corporate power in this setting. Conclusion: Using complex system methods can be useful for more deeply understanding DR-NCD policy inertia. It is also useful for identifying potential leverage points within the system which may shift the existing power dynamics to facilitate greater political commitment for healthy, equitable, and sustainable food system transformation.
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Faccioli M, Law C, Caine C, Berger N, Yan X, Weninger F, Guell C, Day B, Smith R, Bateman I, et al (2022). Combined carbon and health taxes outperform single-purpose information or fiscal measures in designing sustainable food policies.
Nature Food,
3, 331-340.
Abstract:
Combined carbon and health taxes outperform single-purpose information or fiscal measures in designing sustainable food policies
The food system is a major source of both environmental and health challenges. Yet, the extent to which policy-induced changes in the patterns of food demand address these challenges remains poorly understood. Using a randomised-controlled survey of 5,912 respondents from the United Kingdom (UK), we evaluate the potential impact of carbon and/or health taxes, information and combined tax and information strategies on food purchase patterns and their resulting impact on greenhouse gas emissions and dietary health. Our results show that while information on the carbon and/or health characteristics of food is not irrelevant, it is the imposition of taxes which exerts the most substantial effects on food purchasing decisions. Furthermore, while carbon or health taxes are best at separately targeting emissions and health challenges respectively, a combined carbon and health tax policy maximises benefits both in terms of environmental and health outcomes. We show that such a combined policy could contribute to around one third of the residual emission reductions required to achieve the UK’s 2050 net zero commitments, while discouraging the purchase of unhealthy snacks, sugary drinks and alcohol and increasing the purchase of fruit and vegetables.
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Forde H, Boyland EJ, Scarborough P, Smith R, White M, Adams J (2022). Exploring the potential impact of the proposed UK TV and online food advertising regulations: a concept mapping study.
BMJ Open,
12(6), e060302-e060302.
Abstract:
Exploring the potential impact of the proposed UK TV and online food advertising regulations: a concept mapping study
ObjectivesIn July 2020 the UK Government announced an intention to restrict advertisements for products high in fat, salt or sugar on live broadcast, catch-up and on-demand television before 21:00 hours; and paid for online advertising. As no other jurisdiction has implemented similar regulations, there is no empirical evidence about how they might perturb the food system. To guide the regulations’ implementation and evaluation, we aimed to develop a concept map to hypothesise their potential consequences for the commercial food system, health and society.MethodsWe used adapted group concept mapping in four virtual workshops with food marketing and regulation experts across academia, civil society, government organisations, and industry (n=14), supported by Miro software. We merged concepts derived from the four workshops to develop a master map and then invited feedback from participants via email to generate a final concept map.ResultsThe concept map shows how the reactions of stakeholders to the regulations may reinforce or undermine the impact on the commercial food system, health and society. The map shows adaptations made by stakeholders that could reinforce, or undermine, positive impacts on public health. It also illustrates potential weaknesses in the design and implementation of the regulations that could result in little substantial difference to public health.ConclusionsPrior to the regulations’ initial implementation or subsequent iterations, they could be altered to maximise the potential for reinforcing adaptations, minimise the potential for undermining adaptations and ensure they cover a wide range of advertising opportunities and foods. The concept map will also inform the design of an evaluation of the regulations and could be used to inform the design and evaluation of similar regulations elsewhere.
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Hu X, Davies R, Morrissey K, Smith R, Fleming LE, Sharmina M, Clair R, Hopkinson P (2022). Single-use Plastic and COVID-19 in the NHS: Barriers and Opportunities.
Journal of Public Health Research,
11(1), jphr.2021.2483-jphr.2021.2483.
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Single-use Plastic and COVID-19 in the NHS: Barriers and Opportunities
Background Single-use personal protective equipment (PPE) has been essential to protect healthcare workers during the COVID-19 pandemic. However, intensified use of PPE could counteract the previous efforts made by the UK NHS Trusts to reduce their plastic footprint. Design and methods in this study, we conducted an in-depth case study in the Royal Cornwall Hospitals NHS Trust to investigate plastic-related issues in a typical NHS Trust before, during and after the pandemic. We first collected hospital routine data on both procurement and usage of single-use PPE (including face masks, aprons, and gowns) for the time period between April 2019 and August 2020. We then interviewed 12 hospital staff across a wide remit, from senior managers to consultants, nurses and catering staff, to gather qualitative evidence on the overall impact of COVID-19 on the Trust regarding plastic use. Results We found that although COVID-19 had increased the procurement and the use of single-use plastic substantially during the pandemic, it did not appear to have changed the focus of the hospital on implementing measures to reduce single-use plastic in the long term. We then discussed the barriers and opportunities to tackle plastic issues within the NHS in the post-COVID world, for example, a circular healthcare model. Conclusion Investment is needed in technologies and processes that can recycle and reuse a wider range of single-use plastics, and innovate sustainable alternatives to replace singleuse consumables used in the NHS to construct a fully operational closed material loop healthcare system.
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Matita M, Chirwa EW, Johnston D, Mazalale J, Smith R, Walls H (2021). Does household participation in food markets increase dietary diversity? Evidence from rural Malawi. Global Food Security, 28, 100486-100486.
Cuevas S, Patel N, Thompson C, Petticrew M, Cummins S, Smith R, Cornelsen L (2021). Escaping the Red Queen: Health as a corporate food marketing strategy. SSM - Population Health, 16, 100953-100953.
McGill E, Er V, Penney T, Egan M, White M, Meier P, Whitehead M, Lock K, Anderson de Cuevas R, Smith R, et al (2021). Evaluation of public health interventions from a complex systems perspective: a research methods review. Social Science & Medicine, 272, 113697-113697.
Berger N, Cummins S, Smith RD, Cornelsen L (2021). Have socio-economic inequalities in sugar purchasing widened? a longitudinal analysis of food and beverage consumer data from British households, 2014-2017.
Public Health Nutrition,
24(7), 1583-1594.
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Have socio-economic inequalities in sugar purchasing widened? a longitudinal analysis of food and beverage consumer data from British households, 2014-2017
Objective: to examine socio-economic inequalities in decreases in household sugar purchasing in Great Britain (GB). Design: Longitudinal, population-based study. Setting: Data were obtained from the GB Kantar Fast-Moving Consumer Goods (FMCG) panel (2014-2017), a nationally representative panel study of food and beverages bought and brought into the home. We estimated changes in daily sugar purchases by occupational social grade from twenty-three food groups, using generalised estimating equations (household-level clustering). Participants: British households who regularly reported food and beverages to the GB Kantar FMCG (n 28 033). Results: We found that lower social grades obtained a lower proportion of sugar from healthier foods and a greater proportion of sugar from less healthy foods and beverages. In 2014, differences in daily sugar purchased between the lowest and the highest social grades were 3·9 g/capita/d (95 % CI 2·9, 4·8) for table sugar, 2·4 g (95 % CI 1·8, 3·1) for sugar-sweetened beverages, 2·2 g (95 % CI 1·5, 2·8) for chocolate and confectionery and 1·0 g (95 % CI 0·7, 1·3) for biscuits. Conversely, the lowest social grade purchased less sugar from fruits (2·1 g (95 % CI 1·5, 2·8)) and vegetables (0·7 g (95 % CI 0·5, 0·8)) than the highest social grade. We found little evidence of change in social grade differences between 2014 and 2017. These results suggest that recent overall declines in sugar purchases are largely equally distributed across socio-economic groups. Conclusions: This suggests that recent population-level policy activity to reduce sugar consumption in GB does not appear to exacerbate or reduce existing socio-economic inequalities in sugar purchasing. Low agency, population-level policies may be the best solution to improving population diet without increasing inequalities.
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Berger L, Berger N, Bosetti V, Gilboa I, Hansen LP, Jarvis C, Marinacci M, Smith RD (2021). Rational policymaking during a pandemic.
Proceedings of the National Academy of Sciences,
118(4).
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Rational policymaking during a pandemic
Policymaking during a pandemic can be extremely challenging. As COVID-19 is a new disease and its global impacts are unprecedented, decisions are taken in a highly uncertain, complex, and rapidly changing environment. In such a context, in which human lives and the economy are at stake, we argue that using ideas and constructs from modern decision theory, even informally, will make policymaking a more responsible and transparent process.
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Carriedo A, Koon AD, Encarnación LM, Lee K, Smith R, Walls H (2021). The political economy of sugar-sweetened beverage taxation in Latin America: lessons from Mexico, Chile and Colombia.
Globalization and Health,
17(1).
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The political economy of sugar-sweetened beverage taxation in Latin America: lessons from Mexico, Chile and Colombia
AbstractBackgroundIn Latin America, total sales of sugar-sweetened beverages (SSBs) continue to rise at an alarming rate. Consumption of added sugar is a leading cause of diet-related non-communicable diseases (NCDs). Coalitions of stakeholders have formed in several countries in the region to address this public health challenge including participation of civil society organizations and transnational corporations. Little is currently known about these coalitions – what interests they represent, what goals they pursue and how they operate. Ensuring the primacy of public health goals is a particular governance challenge. This paper comparatively analyses governance challenges involved in the adoption of taxation of sugar-sweetened beverages in Mexico, Chile and Colombia. The three countries have similar political and economic systems, institutional arrangements and regulatory instruments but differing policy outcomes.MethodsWe analysed the political economy of SSB taxation based on a qualitative synthesis of existing empirical evidence. We identify the key stakeholders involved in the policy process, identified their interests, and assess how they influenced adoption and implementation of the tax.ResultsCoalitions for and against the SSB taxation formed the basis of policy debates in all three countries. Intergovernmental support was critical to framing the SSB tax aims, benefits and implementation; and for countries to adopt it. A major constraint to implementation was the strong influence of transnational corporations (TNCs) in the policy process. A lack of transparency during agenda setting was notably enhanced by the powerful presence of TNCs.ConclusionNCDs prevention policies need to be supported across government, alongside grassroots organizations, policy champions and civil society groups to enhance their success. However, governance arrangements involving coalitions between public and private sector actors need to recognize power asymmetries among different actors and mitigate their potentially negative consequences. Such arrangements should include clear mechanisms to ensure transparency and accountability of all partners, and prevent undue influence by industry interests associated with unhealthy products.
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Robinson E, Marty L, Jones A, White M, Smith R, Adams J (2021). Will calorie labels for food and drink served outside the home improve public health?.
BMJ,
372 Author URL.
Law C, Cornelsen L, Adams J, Penney T, Rutter H, White M, Smith R (2020). An analysis of the stock market reaction to the announcements of the UK Soft Drinks Industry Levy.
Economics and Human Biology,
38Abstract:
An analysis of the stock market reaction to the announcements of the UK Soft Drinks Industry Levy
On 16th March 2016, the government of the United Kingdom announced the Soft Drinks Industry Levy (SDIL), under which UK soft-drink manufacturers were to be taxed according to the volume of products with added sugar they produced or imported. We use ‘event study’ methodology to assess the likely financial effect of the SDIL on parts of the soft drinks industry, using stock returns of four UK-operating soft-drink firms listed on the London Stock Exchange. We found that three of the four firms experienced negative abnormal stock returns on the day of announcement. A cross-sectional analysis revealed that the cumulative abnormal returns of soft drink stocks were not significantly less than that of other food and drinks-related stocks beyond the day of the SDIL announcement. Our findings suggest that the SDIL announcement was initially perceived as detrimental news by the market but negative stock returns were short-lived, indicating a lack of major concerns for industry. There was limited evidence of a negative stock market reaction to the two subsequent announcements: release of draft legislation on 5th December 2016, and confirmation of the tax rates on 8th March 2017.
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Pell D, Penney TL, Mytton O, Briggs A, Cummins S, Rayner M, Rutter H, Scarborough P, Sharp SJ, Smith RD, et al (2020). Anticipatory changes in British household purchases of soft drinks associated with the announcement of the Soft Drinks Industry Levy: a controlled interrupted time series analysis.
PLoS Medicine,
17(11).
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Anticipatory changes in British household purchases of soft drinks associated with the announcement of the Soft Drinks Industry Levy: a controlled interrupted time series analysis
Background Sugar-sweetened beverage (SSB) consumption is positively associated with obesity, type 2 diabetes, and cardiovascular disease. The World Health Organization recommends that member states implement effective taxes on SSBs to reduce consumption. The United Kingdom Soft Drinks Industry Levy (SDIL) is a two-tiered tax, announced in March 2016 and implemented in April 2018. Drinks with >8 g of sugar per 100 ml (higher levy tier) are taxed at £0.24 per litre, drinks with >5 to
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Biondi B, Cornelsen L, Mazzocchi M, Smith R (2020). Between preferences and references: Asymmetric price elasticities and the simulation of fiscal policies.
Journal of Economic Behavior and Organization,
180, 108-128.
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Between preferences and references: Asymmetric price elasticities and the simulation of fiscal policies
Canonical demand studies and fiscal policy simulations rest on the assumption that consumers react symmetrically to price increases and decreases. Such assumption has been challenged from both the empirical and theoretical points of view. We propose theoretically consistent empirical specifications to estimate discrete choice models (random utility DCM) and continuous demand systems (EASI and AIDS demand systems) that allow for reference prices and asymmetric own- and cross-price demand response. Our application focuses on the demand for sugar-sweetened beverages in Great Britain, using transaction-level household purchase data and different product aggregation levels. We find substantial evidence of asymmetric consumer response and loss aversion, with a stronger response when prices rise above their reference level. Our results hold for both DCMs on highly differentiated products and demand systems on aggregate product categories, and are robust to alternative model and reference price specifications. Simulations of taxes and subsidies on soft drinks shows that ignoring asymmetry may lead to biases, especially when predicting price cuts.
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Milsom P, Smith R, Baker P, Walls H (2020). Corporate power and the international trade regime preventing progressive policy action on non-communicable diseases: a realist review.
Health Policy and Planning,
36(4), 493-508.
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Corporate power and the international trade regime preventing progressive policy action on non-communicable diseases: a realist review
AbstractTransnational tobacco, alcohol and ultra-processed food corporations use the international trade regime to prevent policy action on non-communicable diseases (NCDs); i.e. to promote policy ‘non-decisions’. Understanding policy non-decisions can be assisted by identifying power operating in relevant decision-making spaces, but trade and health research rarely explicitly engages with theories of power. This realist review aimed to synthesize evidence of different forms and mechanisms of power active in trade and health decision-making spaces to understand better why NCD policy non-decisions persist and the implications for future transformative action. We iteratively developed power-based theories explaining how transnational health-harmful commodity corporations (THCCs) utilize the international trade regime to encourage NCD policy non-decisions. To support theory development, we also developed a conceptual framework for analysing power in public health policymaking. We searched six databases and relevant grey literature and extracted, synthesized and mapped the evidence against the proposed theories. One hundred and four studies were included. Findings were presented for three key forms of power. Evidence indicates THCCs attempt to exercise instrumental power by extensive lobbying often via privileged access to trade and health decision-making spaces. When their legitimacy declines, THCCs have attempted to shift decision-making to more favourable international trade legal venues. THCCs benefit from structural power through the institutionalization of their involvement in health and trade agenda-setting processes. In terms of discursive power, THCCs effectively frame trade and health issues in ways that echo and amplify dominant neoliberal ideas. These processes may further entrench the individualization of NCDs, restrict conceivable policy solutions and perpetuate policymaking norms that privilege economic/trade interests over health. This review identifies different forms and mechanisms of power active in trade and health policy spaces that enable THCCs to prevent progressive action on NCDs. It also points to potential strategies for challenging these power dynamics and relations.
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Milsom P, Smith R, Walls H (2020). Expanding Public Health Policy Analysis for Transformative Change: the Importance of Power and Ideas Comment on "What Generates Attention to Health in Trade Policy-Making? Lessons from Success in Tobacco Control and Access to Medicines: a Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership".
International Journal of Health Policy and ManagementAbstract:
Expanding Public Health Policy Analysis for Transformative Change: the Importance of Power and Ideas Comment on "What Generates Attention to Health in Trade Policy-Making? Lessons from Success in Tobacco Control and Access to Medicines: a Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership"
It is increasingly recognised within public health scholarship that policy change depends on the nature of the power relations surrounding and embedded within decision-making spaces. It is only through sustained shifts in power in all its forms (visible, hidden and invisible) that previously excluded perspectives have influence in policy decisions. Further, consideration of the underlying neoliberal paradigm is essential for understanding how existing power dynamics and relations have emerged and are sustained. In their analysis of political and governance factors, Townsend et al have provided critical insight into future potential strategies for increasing attention to health concerns in trade policy. In this commentary we explore how incorporating theories of power more rigorously into similar political analyses, as well as more explicit critical consideration of the neoliberal political paradigm, can assist in analysing if and how strategies can effectively challenge existing power relations in ways that are necessary for transformative policy change.
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Cornelsen L, Quaife M, Lagarde M, Smith RD (2020). Framing and signalling effects of taxes on sugary drinks: a discrete choice experiment among households in Great Britain.
Health Economics (United Kingdom),
29(10), 1132-1147.
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Framing and signalling effects of taxes on sugary drinks: a discrete choice experiment among households in Great Britain
Taxes on sugar-sweetened beverages (SSBs) are in place in many countries to combat obesity with emerging evidence that these are effective in reducing purchases of SSBs. In this study, we tested whether signalling and framing the price increase from an SSB tax explicitly as a health-related, earmarked measure reduces the demand for SSBs more than an equivalent price increase. We measured the demand for non-alcoholic beverages with a discrete choice experiment (DCE) administered online to a randomly selected group of n = 603 households with children in Great Britain (GB) who regularly purchase SSBs. We find a suggestive evidence that a price increase leads to a larger reduction in the probability of choosing SSBs when it is signalled as a tax and framed as a health-related and earmarked policy. Respondents who did not support a tax on SSBs, who were also more likely to choose SSBs in the first place, were on average more responsive to a price increase framed as an earmarked tax than those who supported the tax. The predictive validity of the DCE, to capture preferences for beverages, was confirmed using actual purchase data. The findings imply that a well-signalled and earmarked tax on SSBs could improve its effectiveness at reducing the demand.
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Hatefi A, Marten R, Smith RD (2020). Global-scale action in health: a common language is a critical starting point to bolster global health financing. Health Policy and Planning, 35(8), 1133-1136.
Vassall A, Sweeney S, Barasa E, Prinja S, Keogh-Brown MR, Tarp Jensen H, Smith R, Baltussen R, M Eggo R, Jit M, et al (2020). Integrating economic and health evidence to inform Covid-19 policy in low- and middle- income countries.
Wellcome Open Research,
5, 272-272.
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Integrating economic and health evidence to inform Covid-19 policy in low- and middle- income countries
Covid-19 requires policy makers to consider evidence on both population health and economic welfare. Over the last two decades, the field of health economics has developed a range of analytical approaches and contributed to the institutionalisation of processes to employ economic evidence in health policy. We present a discussion outlining how these approaches and processes need to be applied more widely to inform Covid-19 policy; highlighting where they may need to be adapted conceptually and methodologically, and providing examples of work to date. We focus on the evidential and policy needs of low- and middle-income countries; where there is an urgent need for evidence to navigate the policy trade-offs between health and economic well-being posed by the Covid-19 pandemic.
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Coutrot IP, Smith R, Cornelsen L (2020). Is the rise of crowdfunding for medical expenses in the United Kingdom symptomatic of systemic gaps in health and social care?.
Journal of Health Services Research & Policy,
25(3), 181-186.
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Is the rise of crowdfunding for medical expenses in the United Kingdom symptomatic of systemic gaps in health and social care?
Crowdfunding for medical care is a new phenomenon but increasingly used by individuals to seek financial help to cover the costs of health care. Ethical concerns have been raised about medical crowdfunding, including implications for equity, resource allocation, medical decision-making, the promotion of non-evidence based therapies, platforms’ lack of transparency and corporate interests. Medical crowdfunding efforts may point to shortcomings in health service provision, but they tend to have wider motivations and implications. However, there is no firm evidence base for establishing answers to even the most basic questions, such as who is seeking funds, for what, where and why. In this Essay, we provide an introduction to medical crowdfunding in the United Kingdom (UK). We synthesize what is currently known and the insights that might be gained from an exploratory review of 400 medical crowdfunding campaigns on the GoFundMe UK website: for instance, whether medical crowdfunding occurs in response to gaps in service provision, supports ‘queue jumping’ and how it relates to ‘medical tourism’. We conclude with a call for research on medical crowdfunding in the UK (and elsewhere) as a means to better understand patients’ perceived or actual unmet need for health and social care and inform policy development.
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Berger N, Cummins S, Allen A, Smith RD, Cornelsen L (2020). Patterns of beverage purchases amongst British households: a latent class analysis.
PLoS Medicine,
17(9).
Abstract:
Patterns of beverage purchases amongst British households: a latent class analysis
Background: Beverages, especially sugar-sweetened beverages (SSBs), have been increasingly subject to policies aimed at reducing their consumption as part of measures to tackle obesity. However, precision targeting of policies is difficult as information on what types of consumers they might affect, and to what degree, is missing. We fill this gap by creating a typology of beverage consumers in Great Britain (GB) based on observed beverage purchasing behaviour to determine what distinct types of beverage consumers exist, and what their socio-demographic (household) characteristics, dietary behaviours, and weight status are. Methods and findings: We used cross-sectional latent class analysis to characterise patterns of beverage purchases. We used data from the 2016 GB Kantar Fast-Moving Consumer Goods (FMCG) panel, a large representative household purchase panel of food and beverages brought home, and restricted our analyses to consumers who purchase beverages regularly (i.e. >52 l per household member annually) (n = 8,675). Six categories of beverages were used to classify households into latent classes: SSBs; diet beverages; fruit juices and milk-based beverages; beer and cider; wine; and bottled water. Multinomial logistic regression and linear regression were used to relate class membership to household characteristics, self-reported weight status, and other dietary behaviours, derived from GB Kantar FMCG. Seven latent classes were identified, characterised primarily by higher purchases of 1 or 2 categories of beverages: 'SSB' (18% of the sample; median SSB volume = 49.4 l/household member/year; median diet beverage volume = 38.0 l), 'Diet' (16%; median diet beverage volume = 94.4 l), 'Fruit & Milk' (6%; median fruit juice/milk-based beverage volume = 30.0 l), 'Beer & Cider' (7%; median beer and cider volume = 36.3 l; median diet beverage volume = 55.6 l), 'Wine' (18%; median wine volume = 25.5 l; median diet beverage volume = 34.3 l), 'Water' (4%; median water volume = 46.9 l), and 'Diverse' (30%; diversity of purchases, including median SSB volume = 22.4 l). Income was positively associated with being classified in the Diverse class, whereas low social grade was more likely for households in the classes SSB, Diet, and Beer & Cider. Obesity (BMI > 30 kg/m2) was more prevalent in the class Diet (41.2%, 95% CI 37.7%-44.7%) despite households obtaining little energy from beverages in that class (17.9 kcal/household member/day, 95% CI 16.2-19.7). Overweight/ obesity (BMI > 25 kg/m2) was above average in the class SSB (66.8%, 95% CI 63.7%-69.9%). When looking at all groceries, households from the class SSB had higher total energy purchases (1,943.6 kcal/household member/day, 95% CI 1,901.7-1,985.6), a smaller proportion of energy from fruits and vegetables (6.0%, 95% CI 5.8%-6.3%), and a greater proportion of energy from less healthy food and beverages (54.6%, 95% CI 54.0%-55.1%) than other classes. A greater proportion of energy from sweet snacks was observed for households in the classes SSB (18.5%, 95% CI 18.1%-19.0%) and Diet (18.8%, 95% CI 18.3%-19.3%). The main limitation of our analyses, in common with other studies, is that our data do not include information on food and beverage purchases that are consumed outside the home. Conclusions: Amongst households that regularly purchase beverages, those that mainly purchased high volumes of SSBs or diet beverages were at greater risk of obesity and tended to purchase less healthy foods, including a high proportion of energy from sweet snacks. These households might additionally benefit from policies targeting unhealthy foods, such as sweet snacks, as a way of reducing excess energy intake.
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Watt TLS, Beckert W, Smith RD, Cornelsen L (2020). Reducing consumption of unhealthy foods and beverages through banning price promotions: What is the evidence and will it work?.
Public Health Nutrition,
23(12), 2228-2233.
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Reducing consumption of unhealthy foods and beverages through banning price promotions: What is the evidence and will it work?
Objective: Increasing prevalence of overweight and obese people in England has led policymakers to consider regulating the use of price promotions on foods high in fat, sugar and salt content. In January 2019, the government opened a consultation programme for a policy proposal that significantly restricts the use of price promotions that can induce consumers to buy higher volumes of unhealthy foods and beverages. These proposed policies are the first of their kind in public health and are believed to reduce excess purchasing and, therefore, overconsumption of unhealthy products. This study summarises evidence relating price promotions to the purchasing of food and drink for home consumption and places it in the context of the proposed policy.Design: Non-systematic review of quantitative analyses of price promotions in food and drink published in peer-reviewed journals and sighted by PubMed, ScienceDirect & EBSCOhost between 1980 and January 2018.Results: While the impact of price promotions on sales has been of interest to marketing academics for a long time with modelling studies showing that its use has increased food and drink sales by 12-43 %, it is only now being picked up in the public health sphere. However, existing evidence does not consider the effects of removing or restricting the use of price promotions across the food sector. In this commentary, we discuss existing evidence, how it deals with the complexity of shoppers' behaviour in reacting to price promotions on foods and, importantly, what can be learned from it in this policy context.Conclusions: the current evidence base supports the notion that price promotions increase purchasing of unhealthy food, and while the proposed restriction policy is yet to be evaluated for consumption and health effects, there is arguably sufficient evidence to proceed. This evidence is not restricted to volume-based promotions. Close monitoring and proper evaluation should follow to provide empirical evidence of its intended and unintended effects.
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Keogh-Brown MR, Jensen HT, Edmunds WJ, Smith RD (2020). The impact of Covid-19, associated behaviours and policies on the UK economy: a computable general equilibrium model.
SSM - Population Health,
12Abstract:
The impact of Covid-19, associated behaviours and policies on the UK economy: a computable general equilibrium model
We estimate the potential impact of COVID-19 on the United Kingdom economy, including direct disease effects, preventive public actions and associated policies. A sectoral, whole-economy macroeconomic model was linked to a population-wide epidemiological demographic model to assess the potential macroeconomic impact of COVID-19, together with policies to mitigate or suppress the pandemic by means of home quarantine, school closures, social distancing and accompanying business closures. Our simulations indicate that, assuming a clinical attack rate of 48% and a case fatality ratio of 1.5%, COVID-19 alone would impose a direct health-related economic burden of £39.6bn (1.73% of GDP) on the UK economy. Mitigation strategies imposed for 12 weeks reduce case fatalities by 29%, but the total cost to the economy is £308bn (13.5% of GDP); £66bn (2.9% of GDP) of which is attributable to labour lost from working parents during school closures, and £201bn (8.8% of GDP) of which is attributable to business closures. Suppressing the pandemic over a longer period of time may reduce deaths by 95%, but the total cost to the UK economy also increases to £668bn (29.2% of GDP), where £166bn (7.3% of GDP) is attributable to school closures and 502bn (21.9% of GDP) to business closures. Our analyses suggest Covid-19 has the potential to impose unprecedented economic costs on the UK economy, and whilst public actions are necessary to minimise mortality, the duration of school and business closures are key to determining the economic cost. The initial economic support package promised by the UK government may be proportionate to the costs of mitigating Covid-19, but without alternative measures to reduce the scale and duration of school and business closures, the economic support may be insufficient to compensate for longer term suppression of the pandemic which could generate an even greater health impact through major recession.
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Law C, Cornelsen L, Adams J, Pell D, Rutter H, White M, Smith R (2020). The impact of UK soft drinks industry levy on manufacturers' domestic turnover.
Econ Hum Biol,
37Abstract:
The impact of UK soft drinks industry levy on manufacturers' domestic turnover.
In March 2016, the UK government announced the Soft Drinks Industry Levy (SDIL) which came into effect in April 2018. In common with the reaction to sugar-sweetened beverage (SSB) taxes in other countries, the SDIL announcement was met with strong industry opposition, with claims that it would harm their profits. The SDIL was designed to incentivise reformulation of SSBs by providing a 2-year delay between the announcement and the enforcement of the levy, and adopting a two-tiered rate based on the sugar content of the drinks. Using interrupted time series analysis, this paper examines how the domestic turnover of UK soft drinks manufacturers changed after the announcement and the implementation of the SDIL. Our results show some evidence of a short-term negative impact of the SDIL announcement on the domestic turnover of the UK soft drinks manufacturers. This effect, however, did not continue post-implementation. These findings suggest that manufacturers were, to a large extent, able to mitigate the effects of levy before it came into effect.
Abstract.
Author URL.
White M, Aguirre E, Finegood DT, Holmes C, Sacks G, Smith R (2020). What role should the commercial food system play in promoting health through better diet?.
BMJ,
368Abstract:
What role should the commercial food system play in promoting health through better diet?
Martin White and coauthors consider that the commercial food system has the potential to show leadership and support for dietary public health, but systemic change is needed first and this is likely to require governmental action
Abstract.
Author URL.
Smith RD, Keogh-Brown MR, Chico RM, Bretscher MT, Drakeley C, Jensen HT (2020). Will More of the Same Achieve Malaria Elimination? Results from an Integrated Macroeconomic Epidemiological Demographic Model. The American Journal of Tropical Medicine and Hygiene, 103(5), 1871-1882.
Milsom P, Smith R, Walls H (2019). A Systems Thinking Approach to Inform Coherent Policy Action for NCD Prevention Comment on "How Neoliberalism is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention".
International Journal of Health Policy and ManagementAbstract:
A Systems Thinking Approach to Inform Coherent Policy Action for NCD Prevention Comment on "How Neoliberalism is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention"
Lencucha and Thow tackle the enormous public health challenge of developing non-communicable disease (NCD) policy coherence within a world structured and ruled by neoliberalism. Their work compliments scholarship on other causal mechanisms, including the commercial determinants of health, that have contributed to creating the risk commodity environment and barriers to NCD prevention policy coherence. However, there remain significant gaps in the understanding of how these causal mechanisms interact within a whole system. As such, public health researchers’ suggestions for how to effectively prevent NCDs through addressing the risk commodity environment tend to remain fragmented, incomplete and piecemeal. We suggest this is, in part, because conventional policy analysis methods tend to be reductionist, considering causal mechanisms in relative isolation and conceptualizing them as linear chains of cause and effect. This commentary discusses how a systems thinking approach offers methods that could help with better understanding the risk commodity environment problem, identifying a more comprehensive set of effective solutions across sectors and its utility more broadly for gaining insight into how to ensure recommended solutions are translated into policy, including though transformation at the paradigmatic level.
Abstract.
Cuevas García-Dorado S, Cornselsen L, Smith R, Walls H (2019). Economic globalization, nutrition and health: a review of quantitative evidence. Globalization and Health, 15(1).
Keogh-Brown MR, Jensen HT, Basu S, Aekplakorn W, Cuevas S, Dangour AD, Gheewala SH, Green R, Joy EJM, Rojroongwasinkul N, et al (2019). Evidence on the magnitude of the economic, health and population effects of palm cooking oil consumption: an integrated modelling approach with Thailand as a case study. Population Health Metrics, 17(1).
Yerushalmi E, Hunt P, Hoorens S, Sauboin C, Smith R (2019). Exploring the Use of a General Equilibrium Method to Assess the Value of a Malaria Vaccine: an Application to Ghana.
MDM Policy & Practice,
4(2), 238146831989434-238146831989434.
Abstract:
Exploring the Use of a General Equilibrium Method to Assess the Value of a Malaria Vaccine: an Application to Ghana
Background. Malaria is an important health and economic burden in sub-Saharan Africa. Conventional economic evaluations typically consider only direct costs to the health care system and government budgets. This paper quantifies the potential impact of malaria vaccination on the wider economy, using Ghana as an example. Methods. We used a computable general equilibrium model of the Ghanaian economy to estimate the macroeconomic impact of malaria vaccination in children under the age of 5, with a vaccine efficacy of 50% against clinical malaria and 20% against malaria mortality. The model considered changes in demography and labor productivity, and projected gross domestic product (GDP) over a time frame of 30 years. Vaccine coverage ranging from 20% to 100% was compared with a baseline with no vaccination. Results. Malaria vaccination with 100% coverage was projected to increase the GDP of Ghana over 30 years by US$6.93 billion (in 2015 prices) above the baseline without vaccination, equivalent to an increase in annual GDP growth of 0.5%. Projected GDP per capita would increase in the first year due to immediate reductions in time lost from work by adults caring for children with malaria, then decrease for several years as reductions in child mortality increase the number of dependent children, then show a sustained increase after Year 11 due to long-term productivity improvements in adults resulting from fewer malaria episodes in childhood. Conclusion. Investing in improving childhood health by vaccinating against malaria could result in substantial long-term macroeconomic benefits when these children enter the workforce as adults. These macroeconomic benefits are not captured by conventional economic evaluations and constitute an important potential benefit of vaccination.
Abstract.
Cornelsen L, Mazzocchi M, Smith RD (2019). Fat tax or thin subsidy? How price increases and decreases affect the energy and nutrient content of food and beverage purchases in Great Britain. Social Science & Medicine, 230, 318-327.
Walls H, Smith R, Cuevas S, Hanefeld J (2019). International trade and investment: still the foundation for tackling nutrition related non-communicable diseases in the era of Trump?. BMJ, l2217-l2217.
Jensen HT, Keogh-Brown MR, Shankar B, Aekplakorn W, Basu S, Cuevas S, Dangour AD, Gheewala SH, Green R, Joy E, et al (2019). International trade, dietary change, and cardiovascular disease health outcomes: Import tariff reform using an integrated macroeconomic, environmental and health modelling framework for Thailand. SSM - Population Health, 9, 100435-100435.
Hanefeld J, Smith R (2019). Is the NHS really “off the table” in post-Brexit talks with the US?. BMJ, l6898-l6898.
Tarp Jenson H, Keogh-Brown MR, Shankar B, Aekplakorn W, Basu S, Cuevas S, Dangour AD, Gheewala SH, Green R, Joy EJM, et al (2019). Palm oil and dietary change: Application of an integrated macroeconomic, environmental, demographic, and health modelling framework for Thailand. Food Policy (Elsevier)
Scheelbeek PFD, Cornelsen L, Marteau TM, Jebb SA, Smith RD (2019). Potential impact on prevalence of obesity in the UK of a 20% price increase in high sugar snacks: modelling study.
BMJ, l4786-l4786.
Abstract:
Potential impact on prevalence of obesity in the UK of a 20% price increase in high sugar snacks: modelling study
AbstractObjectiveTo estimate the potential impact on body mass index (BMI) and prevalence of obesity of a 20% price increase in high sugar snacks.DesignModelling study.SettingGeneral adult population of the United Kingdom.Participants36 324 households with data on product level household expenditure from UK Kantar FMCG (fast moving consumer goods) panel for January 2012 to December 2013. Data were used to estimate changes in energy (kcal, 1 kcal=4.18 kJ=0.00418 MJ) purchase associated with a 20% price increase in high sugar snacks. Data for 2544 adults from waves 5 to 8 of the National Diet and Nutrition Survey (2012-16) were used to estimate resulting changes in BMI and prevalence of obesity.Main outcome measuresThe effect on per person take home energy purchases of a 20% price increase for three categories of high sugar snacks: confectionery (including chocolate), biscuits, and cakes. Health outcomes resulting from the price increase were measured as changes in weight, BMI (not overweight (BMI <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30)), and prevalence of obesity. Results were stratified by household income and BMI.ResultsFor income groups combined, the average reduction in energy consumption for a 20% price increase in high sugar snacks was estimated to be 8.9×103kcal (95% confidence interval −13.1×103to −4.2×103kcal). Using a static weight loss model, BMI was estimated to decrease by 0.53 (95% confidence interval −1.01 to −0.06) on average across all categories and income groups. This change could reduce the UK prevalence of obesity by 2.7 percentage points (95% confidence interval −3.7 to −1.7 percentage points) after one year. The impact of a 20% price increase in high sugar snacks on energy purchase was largest in low income households classified as obese and smallest in high income households classified as not overweight.ConclusionsIncreasing the price of high sugar snacks by 20% could reduce energy intake, BMI, and prevalence of obesity. This finding was in a UK context and was double that modelled for a similar price increase in sugar sweetened beverages.
Abstract.
Berger N, Cummins S, Smith RD, Cornelsen L (2019). Recent trends in energy and nutrient content of take-home food and beverage purchases in Great Britain: an analysis of 225 million food and beverage purchases over 6 years.
BMJ Nutrition, Prevention & Health,
2(2), 63-71.
Abstract:
Recent trends in energy and nutrient content of take-home food and beverage purchases in Great Britain: an analysis of 225 million food and beverage purchases over 6 years
IntroductionIn recent years, there has been an increased focus on developing a coherent obesity policy in the UK, which has led to various national policy initiatives aimed at improving population diet. We sought to determine whether there have been concurrent changes in trends in the nutrient content of take-home food and beverage purchases within this policy environment.MethodsWe used 2012–2017 data from the UK Kantar Fast-Moving Consumer Goods (FMCG) panel, a nationally representative panel study of food and beverages bought by British households and brought into the home (n≈32 000 per year). Households used hand-held barcode scanners to report over 225 million product-level purchases of food and beverages, for which nutritional information was obtained. We estimated daily per capita purchases of energy and nutrients from 32 healthier and less healthy food groups defined using the nutrient profiling model used by the UK Department of Health.ResultsFrom 2012 to 2017, daily purchases of energy from food and beverages taken home decreased by 35.4 kcal (95% CI 25.5 to 45.2) per capita. This is explained by moderate decreases in the purchase of products with high contents in carbohydrate (−13.1 g (−14.4 to –11.8)) and sugar (−4.4 g (−5.1 to –3.7)), despite small increases in protein (1.7 g (1.4 to 2.1)) and saturated fat (0.4 g (0.2 to 0.6)). Food and beverage purchases exceeded daily reference intake values in fat (on average +6%), saturated fat (+43%), sugar (+16%) and protein (+28%) across all years. Although substitutions between individual food groups were large in energy and nutrients purchased, the heterogeneity of these patterns resulted in modest overall changes.ConclusionThere have been small declines in the purchase of less healthy food products, which translated to a small reduction of total energy and sugar purchases taken home. However, the rate of change needs to be accelerated in order to substantially reduce the health risks of poor diets, suggesting that more radical policies may be needed to attain larger population effects.
Abstract.
Cornelsen L, Berger N, Cummins S, Smith RD (2019). Socio-economic patterning of expenditures on ‘out-of-home’ food and non-alcoholic beverages by product and place of purchase in Britain. Social Science & Medicine, 235, 112361-112361.
Roope LSJ, Smith RD, Pouwels KB, Buchanan J, Abel L, Eibich P, Butler CC, Tan PS, Walker AS, Robotham JV, et al (2019). The challenge of antimicrobial resistance: What economics can contribute.
Science,
364(6435).
Abstract:
The challenge of antimicrobial resistance: What economics can contribute.
As antibiotic consumption grows, bacteria are becoming increasingly resistant to treatment. Antibiotic resistance undermines much of modern health care, which relies on access to effective antibiotics to prevent and treat infections associated with routine medical procedures. The resulting challenges have much in common with those posed by climate change, which economists have responded to with research that has informed and shaped public policy. Drawing on economic concepts such as externalities and the principal-agent relationship, we suggest how economics can help to solve the challenges arising from increasing resistance to antibiotics. We discuss solutions to the key economic issues, from incentivizing the development of effective new antibiotics to improving antibiotic stewardship through financial mechanisms and regulation.
Abstract.
Author URL.
Hanefeld J, Smith R (2019). The upside of trade in health services. BMJ, l2208-l2208.
Suzana M, Walls H, Smith R, Hanefeld J (2018). Achieving universal health coverage in small island states: could importing health services provide a solution?.
BMJ Global Health,
3(1), e000612-e000612.
Abstract:
Achieving universal health coverage in small island states: could importing health services provide a solution?
BackgroundUniversal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option.MethodsAnalysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003–2013, together with in-depth review of medical travel schemes for the two highest importing SIDS—the Maldives and Tuvalu.FindingsMedical travel from SIDS is accelerating. The SIDS studied generally lacked health infrastructure and technologies, and the majority of them had lower than the recommended number of physicians in a country, which limits their capacity for achieving UHC. Tuvalu and the Maldives were the highest importers of healthcare and notably have public schemes that facilitate medical travel and help lower the out-of-pocket expenditure on medical travel. Although different in approach, design and performance, the medical travel schemes in Tuvalu and the Maldives are both examples of measures used to increase access to health services that cannot feasibly be provided in SIDS.InterpretationOur findings suggest that importing health services (through schemes to facilitate medical travel) is a potential mechanism to help achieve universal healthcare for SIDS but requires due diligence over cost, equity and quality control.
Abstract.
Smith RD, Cornelson L, Quirmbach D, Jebb SA, Marteau TM (2018). Are sweet snacks more sensitive to price
increases than sugar-sweetened
beverages: analysis of British food
purchase data. BMJ Open
Quirmbach D, Cornelsen L, Jebb SA, Marteau T, Smith R (2018). Effect of increasing the price of sugar-sweetened beverages on alcoholic beverage purchases: an economic analysis of sales data.
Journal of Epidemiology and Community Health,
72(4), 324-330.
Abstract:
Effect of increasing the price of sugar-sweetened beverages on alcoholic beverage purchases: an economic analysis of sales data
BackgroundTaxing soft-drinks may reduce their purchase, but assessing the impact on health demands wider consideration on alternative beverage choices. Effects on alcoholic drinks are of particular concern, as many contain similar or greater amounts of sugar than soft-drinks and have additional health harms. Changes in consumption of alcoholic drinks may reinforce or negate the intended effect of price changes for soft-drinks.MethodsA partial demand model, adapted from the Almost Ideal Demand System, was applied to Kantar Worldpanel data from 31 919 households from January 2012 to December 2013, covering drink purchases for home consumption, providing ~6 million purchases aggregated into 11 groups, including three levels of soft-drink, three of other non-alcoholic drinks and five of alcoholic drinks.ResultsAn increase in the price of high-sugar drinks leads to an increase in the purchase of lager, an increase in the price of medium-sugar drinks reduces purchases of alcoholic drinks, while an increase in the price of diet/low-sugar drinks increases purchases of beer, cider and wines. Overall, the effects of price rises are greatest in the low-income group.ConclusionIncreasing the price of soft-drinks may change purchase patterns for alcohol. Increasing the price of medium-sugar drinks has the potential to have a multiplier-effect beneficial to health through reducing alcohol purchases, with the converse for increases in the price of diet-drinks. Although the reasons for such associations cannot be explained from this analysis, requiring further study, the design of fiscal interventions should now consider these wider potential outcomes.
Abstract.
Suzana M, Walls H, Smith R, Hanefeld J (2018). Evaluation of public subsidy for medical travel: does it protect against household impoverishment?. International Journal for Equity in Health, 17(1).
Marten R (2018). How states exerted power to create the Millennium Development Goals and how this shaped the global health agenda: Lessons for the sustainable development goals and the future of global health. Global Public Health, 14(4), 584-599.
Waage J, Cornelsen L, Dangour AD, Green R, Häsler B, Hull E, Johnston D, Kadiyala S, Lock K, Shankar B, et al (2018). Integrating Agriculture and Health Research for Development: LCIRAH as an Interdisciplinary Programme to Address a Global Challenge.
Global Challenges,
3(4).
Abstract:
Integrating Agriculture and Health Research for Development: LCIRAH as an Interdisciplinary Programme to Address a Global Challenge
AbstractThe multiple burdens of persistent undernutrition and micronutrient deficiencies, along with the rapidly growing rates of overweight, obesity, and associated chronic diseases, are major challenges globally. The role of agriculture and the food system in meeting these challenges is very poorly understood. Achieving food security and addressing malnutrition in all its forms, a Sustainable Development Goal, requires an understanding of how changing food systems affect health outcomes and the development of new tools to design and evaluate interventions. An interinstitutional programme to address this interdisciplinary research challenge is described. Over the past seven years, the Leverhulme Centre for Integrative Research on Agriculture and Health has built a portfolio of successful and innovative research, trained a new cadre of interdisciplinary researchers in “Agri‐Health,” and built an international research community with a particular focus on strengthening research capacity in low‐ and middle‐income countries. The evolution of this programme is described, and key factors contributing to its success are discussed that may be of general value in designing interdisciplinary research programmes directed at supporting global development goals.
Abstract.
Kadandale S, Marten R, Smith R (2018). The palm oil industry and noncommunicable diseases. Bulletin of the World Health Organization, 97(2), 118-128.
Cornelsen L, Smith RD (2018). Viewpoint: Soda taxes – Four questions economists need to address. Food Policy, 74, 138-142.
Cornelson L, Mytton OT, Adams J, Gasparrini A, Iskander D, Knai C, Petticrew M, Scott C, Smith RD, Thompson C, et al (2017). Change in non-alcoholic beverage sales following a 10-pence levy on sugar-sweetened beverages within a national chain of restaurants in the UK: interrupted time series analysis of a natural experiment. Journal of Epidemiology and Community Health, 71(11), 1107-1112.
Walls HL, Cornelsen L, Lock K, Smith RD (2016). How much priority is given to nutrition and health in the EU Common Agricultural Policy?.
FOOD POLICY,
59, 12-23.
Author URL.
Smith R, Irwin R (2016). Measuring success in global health diplomacy: lessons from marketing food to children in India.
GLOBALIZATION AND HEALTH,
12 Author URL.
Noree T, Hanefeld J, Smith R (2016). Medical tourism in Thailand: a cross-sectional study.
BULLETIN OF THE WORLD HEALTH ORGANIZATION,
94(1), 30-36.
Author URL.
Keogh-Brown MR, Jensen HT, Arrighi HM, Smith RD (2016). The Impact of Alzheimer's Disease on the Chinese Economy.
EBIOMEDICINE,
4, 184-190.
Author URL.
Walls HL, Vearey J, Modisenyane M, Chetty-Makkan CM, Charalambous S, Smith RD, Hanefeld J (2016). Understanding healthcare and population mobility in southern Africa: the case of South Africa.
SAMJ SOUTH AFRICAN MEDICAL JOURNAL,
106(1), 14-15.
Author URL.
Sheppard P, Smith R (2016). What students want: using a choice modelling approach to estimate student demand.
JOURNAL OF HIGHER EDUCATION POLICY AND MANAGEMENT,
38(2), 140-149.
Author URL.
Kinghorn P, Robinson A, Smith RD (2015). Developing a Capability-Based Questionnaire for Assessing Well-Being in Patients with Chronic Pain.
SOCIAL INDICATORS RESEARCH,
120(3), 897-916.
Author URL.
Coast J, Smith RD (2015). Distributional Considerations in Economic Responses to Antimicrobial Resistance.
PUBLIC HEALTH ETHICS,
8(3), 225-237.
Author URL.
Hordijk PM, Broekhuizen BDL, Butler CC, Coenen S, Godycki-Cwirko M, Goossens H, Hood K, Smith R, Van Vugt SF, Little P, et al (2015). Illness perception and related behaviour in lower respiratory tract infections-a European study.
Family Practice,
32(2), 152-158.
Abstract:
Illness perception and related behaviour in lower respiratory tract infections-a European study
Background. Lower respiratory tract infection (LRTI) is a common presentation in primary care, but little is known about associated patients' illness perception and related behaviour. Objective. To describe illness perceptions and related behaviour in patients with LRTI visiting their general practitioner (GP) and identify differences between European regions and types of health care system. Methods. Adult patients presenting with acute cough were included. GPs recorded co morbidities and clinical findings. Patients filled out a diary for up to 4 weeks on their symptoms, illness perception and related behaviour. The chi-square test was used to compare proportions between groups and the Mann-Whitney U or Kruskal Wallis tests were used to compare means. Results. Three thousand one hundred six patients from 12 European countries were included. Eighty-one per cent (n = 2530) of the patients completed the diary. Patients were feeling unwell for a mean of 9 (SD 8) days prior to consulting. More than half experienced impairment of normal or social activities for at least 1 week and were absent from work/school for a mean of 4 (SD 5) days. On average patients felt recovered 2 weeks after visiting their GP, but 21% (n = 539) of the patients did not feel recovered after 4 weeks. Twenty-seven per cent (n = 691) reported feeling anxious or depressed, and 28% (n = 702) re-consulted their GP at some point during the illness episode. Reported illness duration and days absent from work/school differed between countries and regions (North-West versus South-East), but there was little difference in reported illness course and related behaviour between health care systems (direct access versus gatekeeping). Conclusion. Illness course, perception and related behaviour in LRTI differ considerably between countries. These finding should be taken into account when developing International guidelines for LRTI and interventions for setting realistic expectations about illness course.
Abstract.
Walls HL, Smith RD, Drahos P (2015). Improving regulatory capacity to manage risks associated with trade agreements.
GLOBALIZATION AND HEALTH,
11 Author URL.
Lunt N, Exworthy M, Hanefeld J, Smith RD (2015). International patients within the NHS: a case of public sector entrepreneurialism.
SOCIAL SCIENCE & MEDICINE,
124, 338-345.
Author URL.
Shemilt I, Marteau TM, Smith RD, Ogilvie D (2015). Use and cumulation of evidence from modelling studies to inform policy on food taxes and subsidies: biting off more than we can chew?.
BMC PUBLIC HEALTH,
15 Author URL.
Hanefeld J, Lunt N, Smith R, Horsfall D (2015). Why do medical tourists travel to where they do? the role of networks in determining medical travel.
SOCIAL SCIENCE & MEDICINE,
124, 356-363.
Author URL.
Marten R, Hanefeld J, Smith R (2014). Commission on Global Governance for Health: what about power?.
LANCET,
383(9936), 2207-2207.
Author URL.
Lunt N, Horsfall D, Smith R, Exworthy M, Hanefeld J, Mannion R (2014). Market size, market share and market strategy: three myths of medical tourism.
POLICY AND POLITICS,
42(4), 597-614.
Author URL.
Noree T, Hanefeld J, Smith R (2014). UK medical tourists in Thailand: they are not who you think they are.
GLOBALIZATION AND HEALTH,
10 Author URL.
Hanefeld J, Smith R, Horsfall D, Lunt N (2014). What Do We Know About Medical Tourism? a Review of the Literature with Discussion of its Implications for the UK National Health Service as an Example of a Public Health Care System.
JOURNAL OF TRAVEL MEDICINE,
21(6), 410-417.
Author URL.
Cornelsen L, Green R, Dangour A, Smith R (2014). Why fat taxes won't make us thin. Journal of Public Health, 37(1), 18-23.
Smith R, Lagarde M, Blaauw D, Goodman C, English M, Mullei K, Pagaiya N, Tangcharoensathien V, Erasmus E, Hanson K, et al (2013). Appealing to altruism: an alternative strategy to address the health workforce crisis in developing countries?.
JOURNAL OF PUBLIC HEALTH,
35(1), 164-170.
Author URL.
Coenen S, Francis N, Kelly M, Hood K, Nuttall J, Little P, Verheij TJM, Melbye H, Goossens H, Butler CC, et al (2013). Are Patient Views about Antibiotics Related to Clinician Perceptions, Management and Outcome? a Multi-Country Study in Outpatients with Acute Cough. PLoS ONE, 8(10), e76691-e76691.
Lyons NA, Smith RP, Rushton J (2013). Cost-effectiveness of farm interventions for reducing the prevalence of VTEC O157 on UK dairy farms.
EPIDEMIOLOGY AND INFECTION,
141(9), 1905-1919.
Author URL.
Oppong R, Jit M, Smith RD, Butler CC, Melbye H, Mölstad S, Coast J (2013). Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions.
British Journal of General Practice,
63(612).
Abstract:
Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions
Background Point-of-care C-reactive protein (POCCRP) is a biomarker of inflammation that offers clinicians a rapid POC test to guide antibiotic prescribing decisions for acute cough and lower respiratory tract infections (LRTI). However, evidence that POCCRP is cost-effective is limited, particularly outside experimental settings. Aim to assess the cost-effectiveness of POCCRP as a diagnostic tool for acute cough and LRTI from the perspective of the health service. Design and setting Observational study of the presentation, management, and outcomes of patients with acute cough and LRTI in primary care settings in Norway and Sweden. Method Using hierarchical regression, data were analysed in terms of the effect on antibiotic use, cost, and patient outcomes (symptom severity after 7 and 14 days, time to recovery, and EQ-5D), while controlling for patient characteristics (self-reported symptom severity, comorbidities, and health-related quality of life) at first attendance. Results POCCRP testing is associated with non-significant positive reductions in antibiotic prescribing (P = 0.078) and increased cost (P = 0.092). Despite the uncertainty, POCCRP testing is also associated with a cost per quality-adjusted life year (QALY) gain of €9391. At a willingness-to-pay threshold of €30 000 per QALY gained, there is a 70% probability of CRP being cost-effective. Conclusion POCCRP testing is likely to provide a cost-effective diagnostic intervention both in terms of reducing antibiotic prescribing and in terms of QALYs gained. © British Journal of General Practice.
Abstract.
Ghinai I, Hla TTW, Smith R (2013). Global health priorities and research funding.
LANCET INFECTIOUS DISEASES,
13(8), 653-653.
Author URL.
Chalkidou K, Marten R, Cutler D, Culyer T, Smith R, Teerawattananon Y, Cluzeau F, Li R, Sullivan R, Huang Y, et al (2013). Health technology assessment in universal health coverage.
LANCET,
382(9910), E48-E49.
Author URL.
Smith RD, Keogh-Brown MR (2013). Macroeconomic impact of pandemic influenza and associated policies in Thailand, South Africa and Uganda.
INFLUENZA AND OTHER RESPIRATORY VIRUSES,
7, 64-71.
Author URL.
Hanefeld J, Horsfall D, Lunt N, Smith R (2013). Medical Tourism: a Cost or Benefit to the NHS?.
PLOS ONE,
8(10).
Author URL.
Tusting LS, Willey B, Lucas H, Thompson J, Kafy HT, Smith R, Lindsay SW (2013). Socioeconomic development as an intervention against malaria: a systematic review and meta-analysis.
LANCET,
382(9896), 963-972.
Author URL.
Rassy D, Smith RD (2013). The economic impact of H1N1 on Mexico's tourist and pork sectors.
HEALTH ECONOMICS,
22(7), 824-834.
Author URL.
Oppong R, Kaambwa B, Nuttall J, Hood K, Smith RD, Coast J (2013). The impact of using different tariffs to value EQ-5D health state descriptions: an example from a study of acute cough/lower respiratory tract infections in seven countries.
EUROPEAN JOURNAL OF HEALTH ECONOMICS,
14(2), 197-209.
Author URL.
Jensen HT, Keogh-Brown MR, Smith RD, Chalabi Z, Dangour AD, Davies M, Edwards P, Garnett T, Givoni M, Griffiths U, et al (2013). The importance of health co-benefits in macroeconomic assessments of UK Greenhouse Gas emission reduction strategies.
CLIMATIC CHANGE,
121(2), 223-237.
Author URL.
Liverani M, Waage J, Barnett T, Pfeiffer DU, Rushton J, Rudge JW, Loevinsohn ME, Scoones I, Smith RD, Cooper BS, et al (2013). Understanding and Managing Zoonotic Risk in the New Livestock Industries.
ENVIRONMENTAL HEALTH PERSPECTIVES,
121(8), 873-877.
Author URL.
Smith R (2012). Why a Macroeconomic Perspective is Critical to the Prevention of Noncommunicable Disease.
SCIENCE,
337(6101), 1501-1503.
Author URL.
Oppong R, Kaambwa B, Nuttall J, Hood K, Smith RD, Coast J (2011). Assessment of the Construct Validity of the EQ-5D in Patients with Acute Cough/Lower Respiratory Tract Infections.
APPLIED RESEARCH IN QUALITY OF LIFE,
6(4), 411-423.
Author URL.
Smith RD, Keogh-Brown MR, Barnett T (2011). Estimating the economic impact of pandemic influenza: an application of the computable general equilibrium model to the UK.
SOCIAL SCIENCE & MEDICINE,
73(2), 235-244.
Author URL.
Alvarez MM, Chanda R, Smith RD (2011). How is Telemedicine perceived? a qualitative study of perspectives from the UK and India.
GLOBALIZATION AND HEALTH,
7 Author URL.
Myint PK, Smith RD, Luben RN, Surtees PG, Wainwright NWJ, Wareham NJ, Khaw K-T (2011). Lifestyle behaviours and quality-adjusted life years in middle and older age.
AGE AND AGEING,
40(5), 589-595.
Author URL.
Hargreaves JR, Greenwood B, Clift C, Goel A, Roemer-Mahler A, Smith R, Heymann DL (2011). Making new vaccines affordable: a comparison of financing processes used to develop and deploy new meningococcal and pneumococcal conjugate vaccines.
LANCET,
378(9806), 1885-1893.
Author URL.
Oppong R, Coast J, Hood K, Nuttall J, Smith RD, Butler CC (2011). Resource use and costs of treating acute cough/lower respiratory tract infections in 13 European countries: results and challenges.
EUROPEAN JOURNAL OF HEALTH ECONOMICS,
12(4), 319-329.
Author URL.
Alvarez MM, Chanda R, Smith RD (2011). The potential for bi-lateral agreements in medical tourism: a qualitative study of stakeholder perspectives from the UK and India.
GLOBALIZATION AND HEALTH,
7 Author URL.
Donaldson C, Baker R, Mason H, Jones-Lee M, Lancsar E, Wildman J, Bateman I, Loomes G, Robinson A, Sugden R, et al (2011). The social value of a QALY: Raising the bar or barring the raise?.
BMC Health Services Research,
11Abstract:
The social value of a QALY: Raising the bar or barring the raise?
Background: Since the inception of the National Institute for Health and Clinical Excellence (NICE) in England, there have been questions about the empirical basis for the cost-per-QALY threshold used by NICE and whether QALYs gained by different beneficiaries of health care should be weighted equally. The Social Value of a QALY (SVQ) project, reported in this paper, was commissioned to address these two questions. The results of SVQ were released during a time of considerable debate about the NICE threshold, and authors with differing perspectives have drawn on the SVQ results to support their cases. As these discussions continue, and given the selective use of results by those involved, it is important, therefore, not only to present a summary overview of SVQ, but also for those who conducted the research to contribute to the debate as to its implications for NICE. Discussion. The issue of the threshold was addressed in two ways: first, by combining, via a set of models, the current UK Value of a Prevented Fatality (used in transport policy) with data on fatality age, life expectancy and age-related quality of life; and, second, via a survey designed to test the feasibility of combining respondents' answers to willingness to pay and health state utility questions to arrive at values of a QALY. Modelling resulted in values of £10,000-£70,000 per QALY. Via survey research, most methods of aggregating the data resulted in values of a QALY of £18,000-£40,000, although others resulted in implausibly high values. An additional survey, addressing the issue of weighting QALYs, used two methods, one indicating that QALYs should not be weighted and the other that greater weight could be given to QALYs gained by some groups. Summary. Although we conducted only a feasibility study and a modelling exercise, neither present compelling evidence for moving the NICE threshold up or down. Some preliminary evidence would indicate it could be moved up for some types of QALY and down for others. While many members of the public appear to be open to the possibility of using somewhat different QALY weights for different groups of beneficiaries, we do not yet have any secure evidence base for introducing such a system. © 2011 Donaldson et al; licensee BioMed Central Ltd.
Abstract.
Lorgelly PK, Coast J, Smith RD (2010). CONCEPTS OF CAPABILITY AND OVERLOOKED APPLICATIONS.
AMERICAN JOURNAL OF PUBLIC HEALTH,
100(10), 1823-1824.
Author URL.
Lock K, Smith RD, Dangour AD, Brown MK, Pigatto G, Hawkes C, Fisberg RM, Chalabi Z (2010). Chronic Diseases: Chronic Diseases and Development 2 Health, agricultural, and economic effects of adoption of healthy diet recommendations.
LANCET,
376(9753), 1699-1709.
Author URL.
Smith RD, Sach TH (2010). Contingent valuation: has the debate begun?.
HEALTH ECONOMICS POLICY AND LAW,
5(1), 133-134.
Author URL.
Smith RD, Petticrew M (2010). Public health evaluation in the twenty-first century: time to see the wood as well as the trees.
JOURNAL OF PUBLIC HEALTH,
32(1), 2-7.
Author URL.
Myint PK, Smith RD, Luben RN, Surtees PG, Wainwright NWJ, Wareham NJ, Bingham SA, Khaw K-T (2010). The Short-Form Six-Dimension utility index predicted mortality in the European Prospective Investigation into Cancer-Norfolk prospective population-based study.
JOURNAL OF CLINICAL EPIDEMIOLOGY,
63(2), 192-198.
Author URL.
Keogh-Brown MR, Smith RD, Edmunds JW, Beutels P (2010). The macroeconomic impact of pandemic influenza: estimates from models of the United Kingdom, France, Belgium and the Netherlands.
EUROPEAN JOURNAL OF HEALTH ECONOMICS,
11(6), 543-554.
Author URL.
Baker R, Bateman I, Donaldson C, Jones-Lee M, Lancsar E, Loomes G, Mason H, Odejar M, Pinto Prades JL, Robinson A, et al (2010). Weighting and valuing quality-adjusted life-years using stated preference methods: Preliminary results from the social value of a QALY project.
Health Technology Assessment,
14(27).
Abstract:
Weighting and valuing quality-adjusted life-years using stated preference methods: Preliminary results from the social value of a QALY project
Objectives: to identify characteristics of beneficiaries of health care over which relative weights should be derived and to estimate relative weights to be attached to health gains according to characteristics of recipients of these gains (relativities study); and to assess the feasibility of estimating a willingness-topay (WTP)-based value of a quality-adjusted life-year (QALY) (valuation study). Design: Two interview-based surveys were administered - one (for the relativities study) to a nationally representative sample of the population in England and the other (for the valuation study) to a smaller convenience sample. Setting: the two surveys were administered by the National Centre for Social Research (NatCen) in respondents' homes. Participants: 587 members of the public were interviewed for the relativities study and 409 for the valuation study. Methods: in the relativities study, in-depth qualitative work and considerations of policy relevance resulted in the identification of age and severity of illness as relevant characteristics. Scenarios reflecting these, along with additional components reflecting gains in QALYs, were presented to respondents in a series of pairwise choices using two types of question: discrete choice and matching. These questions were part of a longer questionnaire (including attitudinal and sociodemographic questions), which was administered face to face using a computer-assisted personal interview. In the valuation study, respondents were asked about their WTP to avoid/prevent different durations of headache or stomach illness and to value these states on a scale (death = 0; full health = 1) using standard gamble (SG) questions. Results: Discrete choice results showed that age and severity variables did not have a strong impact on respondents' choices over and above the health (QALY) gains presented. In contrast, matching showed age and severity impacts to be strong: depending on method of aggregation, gains to some groups were weighted three to four times more highly than gains to others. Results from the WTP and SG questions were combined in different ways to arrive at values of a QALY. These vary from values which are in the vicinity of the current National Institute for Health and Clinical Excellence (NICE) threshold to extremely high values. Conclusions: with respect to relative weights, more research is required to explore methodological differences with respect to age and severity weighting. On valuation, there are particular issues concerning the extent to which 'noise' and 'error' in people's responses might generate extreme and unreliable figures. Methods of aggregation and measures of central tendency were issues in both weighting and valuation procedures and require further exploration. © 2010 Queen's Printer and Controller of HMSO.
Abstract.
Smith RD, Sach TH (2009). CONTINGENT VALUATION: (STILL) ON THE ROAD TO NOWHERE?.
HEALTH ECONOMICS,
18(8), 863-866.
Author URL.
Nabel EG, Stevens S, Smith R (2009). Combating chronic disease in developing countries.
LANCET,
373(9680), 2004-2006.
Author URL.
Beutels P, Jia N, Zhou Q-Y, Smith R, Cao W-C, de Vlas SJ (2009). The economic impact of SARS in Beijing, China.
TROPICAL MEDICINE & INTERNATIONAL HEALTH,
14, 85-91.
Author URL.
Smith RD, Keogh-Brown MR, Barnett T, Tait J (2009). The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment.
BMJ,
339Abstract:
The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment.
OBJECTIVES: to estimate the potential economic impact of pandemic influenza, associated behavioural responses, school closures, and vaccination on the United Kingdom. DESIGN: a computable general equilibrium model of the UK economy was specified for various combinations of mortality and morbidity from pandemic influenza, vaccine efficacy, school closures, and prophylactic absenteeism using published data. SETTING: the 2004 UK economy (the most up to date available with suitable economic data). MAIN OUTCOME MEASURES: the economic impact of various scenarios with different pandemic severity, vaccination, school closure, and prophylactic absenteeism specified in terms of gross domestic product, output from different economic sectors, and equivalent variation. RESULTS: the costs related to illness alone ranged between 0.5% and 1.0% of gross domestic product ( pound8.4bn to pound16.8bn) for low fatality scenarios, 3.3% and 4.3% ( pound55.5bn to pound72.3bn) for high fatality scenarios, and larger still for an extreme pandemic. School closure increases the economic impact, particularly for mild pandemics. If widespread behavioural change takes place and there is large scale prophylactic absence from work, the economic impact would be notably increased with few health benefits. Vaccination with a pre-pandemic vaccine could save 0.13% to 2.3% of gross domestic product ( pound2.2bn to pound38.6bn); a single dose of a matched vaccine could save 0.3% to 4.3% ( pound5.0bn to pound72.3bn); and two doses of a matched vaccine could limit the overall economic impact to about 1% of gross domestic product for all disease scenarios. CONCLUSION: Balancing school closure against "business as usual" and obtaining sufficient stocks of effective vaccine are more important factors in determining the economic impact of an influenza pandemic than is the disease itself. Prophylactic absence from work in response to fear of infection can add considerably to the economic impact.
Abstract.
Author URL.
Smith RD, Chanda R, Tangcharoensathien V (2009). Trade and Health 4 Trade in health-related services.
LANCET,
373(9663), 593-601.
Author URL.
Smith RD, Correa C, Oh C (2009). Trade and Health 5 Trade, TRIPS, and pharmaceuticals.
LANCET,
373(9664), 684-691.
Author URL.
Smith RD, Lee K, Drager N (2009). Trade and Health 6 Trade and health: an agenda for action.
LANCET,
373(9665), 768-773.
Author URL.
Smith RD (2008). Contingent valuation in health care: Does it matter how the 'Good' is described?.
HEALTH ECONOMICS,
17(5), 607-617.
Author URL.
Smith R (2008). Globalization: the key challenge facing health economics in the 21st century.
HEALTH ECONOMICS,
17(1), 1-3.
Author URL.
Hanson K, Gilson L, Goodman C, Mills A, Smith R, Feachem R, Feachem NS, Koehlmoos TP, Kinlaw H (2008). Is Private Health Care the Answer to the Health Problems of the World's Poor?.
PLOS MEDICINE,
5(11), 1528-1532.
Author URL.
Beutels P, Edmunds WJ, Smith RD (2008). PARTIALLY WRONG? PARTIAL EQUILIBRIUM AND THE ECONOMIC ANALYSIS OF PUBLIC HEALTH EMERGENCIES OF INTERNATIONAL CONCERN.
HEALTH ECONOMICS,
17(11), 1317-1322.
Author URL.
Coast J, Smith R, Lorgelly P (2008). Should the capability approach be applied in health economics?.
HEALTH ECONOMICS,
17(6), 667-670.
Author URL.
Keogh-Brown MR, Smith RD (2008). The economic impact of SARS: How does the reality match the predictions?.
HEALTH POLICY,
88(1), 110-120.
Author URL.
Coast J, Smith RD, Lorgelly P (2008). Welfarism, extra-welfarism and capability: the spread of ideas in health economics.
SOCIAL SCIENCE & MEDICINE,
67(7), 1190-1198.
Author URL.
Schroter S, Black N, Evans S, Godlee F, Osorio L, Smith R (2008). What errors do peer reviewers detect, and does training improve their ability to detect them?.
JOURNAL OF THE ROYAL SOCIETY OF MEDICINE,
101(10), 507-514.
Author URL.
Sach TH, Smith RD, Whynes DK (2007). A 'league table' of contingent valuation results for pharmaceutical interventions a hard pill to swallow?.
PHARMACOECONOMICS,
25(2), 107-127.
Author URL.
Holland R, Brooksby L, Lenaghan E, Ashton K, Hay L, Smith R, Shepstone L, Lipp A, Daly C, Howe A, et al (2007). Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial.
BRITISH MEDICAL JOURNAL,
334(7603), 1098-1101.
Author URL.
Myint PK, Welch AA, Bingham SA, Surtees PG, Wainwright NWJ, Luben RN, Wareham NJ, Smith RD, Harvey IM, Day NE, et al (2007). Fruit and vegetable consumption and self-reported functional health in men and women in the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk): a population-based cross-sectional study.
PUBLIC HEALTH NUTRITION,
10(1), 34-41.
Author URL.
Smith RD, MacKellar L (2007). Global public goods and the global health agenda: problems, priorities and potential.
GLOBALIZATION AND HEALTH,
3 Author URL.
Pacini M, Smith RD, Wilson ECF, Holland R (2007). Home-based medication review in older people - is it cost effective?.
PHARMACOECONOMICS,
25(2), 171-180.
Author URL.
Myint PK, Surtees PG, Wainwright NWJ, Wareham NJ, Bingham SA, Luben RN, Welch AA, Smith RD, Harvey IM, Khaw K-T, et al (2007). Modifiable lifestyle behaviors and functional health in the European Prospective Investigation into Cancer (EPIC)-Norfolk population study.
PREVENTIVE MEDICINE,
44(2), 109-116.
Author URL.
Whynes DK, Frew EJ, Philips ZN, Covey J, Smith RD (2007). On the numerical forms of contingent valuation responses.
JOURNAL OF ECONOMIC PSYCHOLOGY,
28(4), 462-476.
Author URL.
Sadique MZ, Edmunds WJ, Smith RD, Meerding WJ, de Zwart O, Brug J, Beutels P (2007). Precautionary behavior in response to perceived threat of pandemic influenza.
EMERGING INFECTIOUS DISEASES,
13(9), 1307-1313.
Author URL.
Myint PK, Luben RN, Surtees PG, Wainwright NWJ, Welch AA, Bingham SA, Wareham NJ, Smith RD, Harvey IM, Khaw K-T, et al (2007). Self-reported mental health-related quality of life and mortality in men and women in the European prospective investigation into cancer (EPIC-Norfolk): a prospective population study.
PSYCHOSOMATIC MEDICINE,
69(5), 410-414.
Author URL.
Smith RD (2007). The relationship between reliability and size of willingness-to-pay values: a qualitative insight.
HEALTH ECONOMICS,
16(2), 211-216.
Author URL.
Smith RD (2007). The role of 'reference goods' in contingent valuation: Should we help respondents to 'construct' their willingness to pay?.
HEALTH ECONOMICS,
16(12), 1319-1332.
Author URL.
Yeung RYT, Smith RD, Ho L-M, Johnston JM, Leung GM (2006). Empirical implications of response acquiescence in discrete-choice contingent valuation.
HEALTH ECONOMICS,
15(10), 1077-1089.
Author URL.
Covey J, Smith RD (2006). How common is the 'prominence effect'?: Additional evidence to Whynes <i>et al</i>.
HEALTH ECONOMICS,
15(2), 205-210.
Author URL.
Smith RD (2006). It's not just what you do, it's the way that you do it: the effect of different payment card formats and survey administration on willingness to pay for health gain.
HEALTH ECONOMICS,
15(3), 281-293.
Author URL.
Smith R (2006). Measuring the globalization of health services: a possible index of openness of country health sectors to trade.
HEALTH ECONOMICS POLICY AND LAW,
1(4), 323-342.
Author URL.
Myint PK, Welch AA, Luben RN, Wainwright NWJ, Surtees PG, Bingham SA, Wareham NJ, Smith RD, Harvey IM, Khaw K-T, et al (2006). Obesity indices and self-reported functional health in men and women in the EPIC-Norfolk.
OBESITY,
14(5), 884-893.
Author URL.
Smith R, Roberts I (2006). Patient safety requires a new way to publish clinical trials.
PLOS CLINICAL TRIALS,
1(1).
Author URL.
Barrett A, Roques T, Small M, Smith RD (2006). Rationing - How much will Herceptin really cost?.
BRITISH MEDICAL JOURNAL,
333(7578), 1118-1120A.
Author URL.
Smith RD (2006). Responding to global infectious disease outbreaks: Lessons from SARS on the role of risk perception, communication and management.
SOCIAL SCIENCE & MEDICINE,
63(12), 3113-3123.
Author URL.
Smith RD (2006). Trade and public health: facing the challenges of globalisation.
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH,
60(8), 650-651.
Author URL.
Holland R, Smith R, Harvey I (2006). Where now for pharmacist led medication review?.
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH,
60(2), 92-93.
Author URL.
Smith RD, Yago M, Millar M, Coast J (2005). Assessing the macroeconomic impact of a healthcare problem: the application of computable general equilibrium analysis to antimicrobial resistance.
JOURNAL OF HEALTH ECONOMICS,
24(6), 1055-1075.
Author URL.
Smith RD, Richardson J (2005). Can we estimate the 'social' value of a QALY? Four core issues to resolve.
HEALTH POLICY,
74(1), 77-84.
Author URL.
Holland R, Lenaghan E, Harvey I, Smith R, Shepstone L, Lipp A, Christou M, Evans D, Hand C (2005). Does home based medication review keep older people out of hospital? the HOMER randomised controlled trial.
BMJ-BRITISH MEDICAL JOURNAL,
330(7486), 293-295.
Author URL.
Smith RD (2005). Sensitivity to scale in contingent valuation: the importance of the budget constraint.
JOURNAL OF HEALTH ECONOMICS,
24(3), 515-529.
Author URL.
Smith R, Woodward D, Acharya A, Beaglehole R, Drager N (2004). Communicable disease control: a 'Global Public Good' perspective.
HEALTH POLICY AND PLANNING,
19(5), 271-278.
Author URL.
Raithatha N, Smith RD (2004). Disclosure of genetic tests for health insurance: is it ethical not to?.
LANCET,
363(9406), 395-396.
Author URL.
Smith RD (2004). Foreign direct investment and trade in health services: a review of the literature.
SOCIAL SCIENCE & MEDICINE,
59(11), 2313-2323.
Author URL.
Smith RD, Thorsteinsdóttir H, Daar AS, Gold ER, Singer PA (2004). Genomics knowledge and equity:: a global public goods perspective of the patent system.
BULLETIN OF THE WORLD HEALTH ORGANIZATION,
82(5), 385-389.
Author URL.
Raithatha N, Smith RD (2004). Paying for statins.
BMJ-BRITISH MEDICAL JOURNAL,
328(7436), 400-402.
Author URL.
Smith RD (2003). Construction of the contingent valuation market in health care: a critical assessment.
HEALTH ECONOMICS,
12(8), 609-628.
Author URL.
Thorsteinsdóttir H, Daar AS, Smith RD, Singer PA (2003). Genomics -: a global public good?.
LANCET,
361(9361), 891-892.
Author URL.
Smith RD (2003). Global public goods and health.
BULLETIN OF THE WORLD HEALTH ORGANIZATION,
81(7), 475-475.
Author URL.
Coast J, Smith RD (2003). Solving the problem of antimicrobial resistance: is a global approach necessary?.
DRUG DISCOVERY TODAY,
8(1), 1-2.
Author URL.
Smith RD, Coast J (2002). Antimicrobial resistance: a global response.
BULLETIN OF THE WORLD HEALTH ORGANIZATION,
80(2), 126-133.
Author URL.
Coast J, Smith R, Karcher AM, Wilton P, Millar M (2002). Superbugs II: How should economic evaluation be conducted for interventions which aim to contain antimicrobial resistance?.
HEALTH ECONOMICS,
11(7), 637-647.
Author URL.
Olsen JA, Smith RD (2001). <i>Theory</i> <i>versus practice</i>:: a review of 'willingness-to-pay' in health and health care.
HEALTH ECONOMICS,
10(1), 39-52.
Author URL.
Wilton P, Smith RD, Coast J, Millar M, Karcher A (2001). Directly observed treatment for multidrug-resistant tuberculosis: an economic evaluation in the United States of America and South Africa.
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE,
5(12), 1137-1142.
Author URL.
Smith RD (2001). The relative willingness-to-pay and time-trade-off to changes in health status: an empirical investigation.
HEALTH ECONOMICS,
10(6), 487-497.
Author URL.
