The social return on investment of physical activity and nutrition interventions-a scoping review

Introduction

Scarcity of resources and mounting pressures on health systems make it critical to evaluate new and existing public health interventions related to physical activity and nutrition. The Social Return on Investment (SROI) framework has gained prominence for capturing traditional variables such as economic costs and returns, as well as wider beneficial social and environmental outcomes. A scoping review was conducted to present the existing evidence on the SROI of physical activity and nutrition interventions, demonstrating the wider benefits of these interventions.

Methodology

Existing peer-reviewed evidence and grey literature was collated to identify physical activity and nutrition interventions that were evaluated using the SROI framework between January 1996 up until February 2022. Only literature published in the English language, interventions that were conducted in high-income countries were considered for inclusion. Study information and economic data was entered into a pre-prepared data extraction sheet and eligible studies were quality assessed using a 12-point quality assessment framework for SROI studies.

Results

This review identified a total of 21 SROI studies, with only four deriving from peer-reviewed literature sources. In total, 18 studies evaluated physical activity interventions, one study was purely focused on nutrition, whereas the two remaining studies presented a mix of physical activity and nutrition. The majority of studies derived from the United Kingdom (n = 16) with very few of the studies published prior to 2010 (n = 1). In total, four studies were classified as low quality based on the 12-point quality assessment framework used for this review. Outcomes of the relevant studies show that the benefits of these interventions have added value to families, communities and the wider environments of the target groups.

Conclusion

This scoping review is adding to research conducted to understand the wider value of public health interventions such as physical activity and nutrition interventions using the SROI framework. This is important so that the development and implementation of public health interventions have the greatest value to people and society, which also benefits decision-makers to effectively and sustainably allocate scarce resources.

Social Return on Investment (SROI) of mental health related interventions-A scoping review

Background

There is a growing recognition of the need to effectively assess the social value of public health interventions through a wider, comprehensive approach, capturing their social, economic and environmental benefits, outcomes and impacts. Social Return on Investment (SROI) is a methodological approach which incorporates all three aspects for evaluating interventions. Mental health problems are one of the leading causes of ill health and disability worldwide. This study aims to map existing evidence on the social value of mental health interventions that uses the SROI methodology.

Methods

A scoping evidence search was conducted on Medline, PubMed, Google Scholar and relevant gray literature, published in English between January 2000 and March 2021 to identify studies which capture the SROI of mental health interventions in high- and middle-income countries. Studies that reported mental health outcomes and an SROI ratio were included in this review. The quality of included studies was assessed using Krlev's 12-item quality assessment framework.

Results

The search identified a total of 435 records; and 42 of them with varying quality met the study inclusion criteria. Most of the included studies (93%) were non-peer reviewed publicly available reports, predominantly conducted in the United Kingdom (88%); and majority (60%) of those studies were funded by charity/non-for-profit organizations. Out of 42 included studies, 22 were targeted toward individuals experiencing mental health problems and the remainder 20 were targeted to vulnerable groups or the general population to prevent, or reduce the risk of poor mental health. Eighty-one percent of included studies were graded as high quality studies based on Krlev's 12-item quality assessment framework. The reported SROI ratios of the included studies ranged from £0.79 to £28.00 for every pound invested.

Conclusion

This scoping review is a first of its kind to focus on SROI of mental health interventions, finding a good number of SROI studies that show a positive return on investment of the identified interventions. This review illustrates that SROI could be a useful tool and source of evidence to help inform policy and funding decisions for investment in mental health and wellbeing, as it accounts for the wider social, economic and environmental benefits of public health interventions. More SROI research in the area of public health is needed to expand the evidence base and develop further the methodology.

Presenting a Social Value Database and Simulator for Public Health

Background

There is increasing recognition that Public Health Institutes need to build on the traditional value for money approach, to find ways to capture, measure and show the full range of their outcomes, impacts and related value. As part of a drive to measure value and impact in public health and demonstrate how investment in health can contribute to an Economy of Well-being, Public Health Wales has developed an interactive database to capture and illustrate the social value of public health services and interventions.

Methods

Scoping reviews of both academic and grey literature were undertaken to populate a database of health economics evaluations of public health interventions, focusing on Social Return on Investment (SROI). In addition, a simulated methodology was developed which allows the evidence to be manipulated and made relevant to individual contexts to help inform investment decisions at a local level.

Results

To date, the database has accumulated an excess of 50 SROI evaluations of various public health interventions, across areas including mental health, behaviour change, physical activity, nutrition, employment and primary care. The evaluations are based on European and International contexts, are published in both grey and academic sources, and are of varying quality.

Conclusions

SROI is a credible method for measuring the value of wider social, economic and environment outcomes achieved from public health interventions. The Social Value Database and Simulator presents a collation of studies and analysis utilising innovative health economics methods.

Key messages

• Public Health Wales’ Social Value Database and Simulator collates economic evaluations of public health interventions, to be used by policy makers to enable improved investment in health and well-being.

• Social Return on Investment is a credible method for measuring the wider impact created by public health interventions.

International Horizon Scanning the impact of Covid-19 on increasing the health gap and vulnerability

 

The COVID-19 pandemic has caused unprecedented challenges for populations, health systems and governments worldwide, which have resulted in lasting economic, social and health impacts. The results of such have been felt disproportionately throughout society and existing vulnerabilities have been highlighted and heightened. A clear understanding of the extent of these vulnerabilities is needed in order to fully address the problem. The World Health Organization Collaborating Centre on Investment for Health and Well-being (WHOCC), Public Health Wales has developed a summary report focusing on the existing and emerging inequalities resulting from the pandemic, as identified through international evidence and learning from the International Horizon Scanning Reports. These reports, undertaken between May 2020 - August 2021, are based upon rapid evidence synthesis reviews of international literature. The summary report focuses on global learning and best practices in order to better understand and address the unequal impacts of the pandemic. The information has been categorised according to the five essential conditions required to enable a healthy life as presented within the WHO health equity conditions framework. The report provides evidence on groups most vulnerable to both direct and indirect impacts of the pandemic as well as promising practice to address the resulting inequity. Inequalities and related factors explored within the report include but are not limited to, level of deprivation and education. Taking a global perspective, this report summarises international evidence to support inclusive, sustainable, and equitable solutions, such as protecting economic well-being and taking an intergenerational lens in both response and recovery. To address and mitigate the impact of the pandemic upon vulnerable groups, collating and sharing international evidence and best practice has proven to support equitable long-term socio-economic and environmental recovery.

Key messages

• International learning provides vital insights to support recovery in Wales and beyond.

• Responses to the pandemic should address the needs of the vulnerable to reduce existing health gaps.

COVID-19 International Horizon Scanning – informing a response and recovery in Wales and beyond

Issue

The rapidly evolving nature and uncertainties of the COVID-19 pandemic have led to unprecedented challenges for health systems, as well as to wellbeing, social and economic impacts for individuals and communities across the globe. Effective, dynamic, innovative and evidence-based solutions are needed to address these challenges.

Description of Problem

The World Health Organization (WHO) Collaborating Centre on Investment for Health and Well-being, Public Health Wales, has initiated and continues to perform International Horizon Scanning work to inform the evolving COVID-19 public health response and recovery plans in Wales by learning from best practices from other countries. The learning and intelligence is systematically synthesized in rapid regular reports published every week/two weeks. The focus and scope vary, depending on the COVID-19 situation and public health and policy needs.

Results

The work stream has provided Welsh Government, the National Health Service (NHS), Public Health Wales and other key stakeholders with continuous and timely learning from the experience of other countries along with emerging evidence and guidance, provided by key international organisations. This includes international evidence, epidemiological data, experience, measures and recovery approaches, to understand and explore solutions. Reports have given a consistent overview of approaches across countries such as a comparative analysis of the vaccine roll-out or a systematic overview of the R-value and measures implemented accordingly.

Lessons

To understand, mitigate and address the impacts of the pandemic in Wales and beyond, a timely, dynamic and evidence-informed actionable intelligence has proven to be essential to inform and support decision-making on government and health system level to address the pandemic and mitigate harms from COVID-19.

Key messages

International learning has and continues to inform the evolving COVID-19 public health response in Wales.

Public Health Wales is contributing to an evidence-informed inclusive recovery from the pandemic in Wales and beyond.

Evidencing value of public health programmes to enable sustainable investment for health & wellbeing

Issue

Global sustainability challenges related to health, inequity, the environment and the economy require urgent innovative action and focus on prevention. Fair evidence-informed prioritisation of scarce resources is pivotal to ensure sustainable investment policies and practices. It is key to capture the value and return on investment of public health (prevention) programmes in order to show their wider benefit to people, communities, society, economy and our planet.

Description

The Evidencing Value project builds on a global and national drive towards measuring the value of health services and interventions. The World Health Organization Collaborating Centre for Investment in Health and Well-being (WHO CC) is developing an innovative approach and digital solution to assess the holistic (economic, social and environmental) value and return on investment of public health programmes. It uses a Social Return on Investment (SROI) approach, which involves key stakeholders from the beginning and measures what matters most. This helps to identify the wider impact and outcomes of different health protection, disease prevention and health promotion programmes. The evidence is embedded in an interactive digital database to inform investment prioritisation and quality improvement.

Results

Project outputs include: (i) structured evidence repository detailing the value of public health services and interventions; (ii) interactive digital database for storage, manipulation and presentation of data; (iii) SROI pilots; and (iv) generalised framework for investing in public health/prevention to be used by other public bodies and countries.

Lessons

It is essential to understand the wider impact and value of public health programmes to facilitate Universal Health Coverage and sustainable investment for health and wellbeing. This project uses an innovative approach and digital solution to enable evidence informed resource allocation and decision-making focused on prevention.

Key messages

Evidencing value of public health supports the case for investing in prevention. Using innovative methods and digital solutions is essential to inform sustainable investment for health.

The social value of investing in public health across the life course: a systematic scoping review

Background

Making the case for investing in public health by illustrating the social, economic and environmental value of public health interventions is imperative. Economic methodologies to help capture the social value of public health interventions such as Social Return on Investment (SROI) and Social Cost-Benefit Analysis (SCBA) have been developed over past decades. The life course approach in public health reinforces the importance of investment to ensure a good start in life to safeguarding a safe, healthy and active older age. This novel review maps an overview of the application of SROI and SCBA in the existing literature to identify the social value of public health interventions at individual stages of the life course.

Methods

A systematic scoping review was conducted on peer-reviewed and grey literature to identify SROI and SCBA studies of public health interventions published between January 1996 and June 2019. All primary research articles published in the English language from high-income countries that presented SROI and SCBA outputs were included. Studies were mapped into stages of the life course, and data on the characteristics of the studies were extracted to help understand the application of social value methodology to assess the value of public health interventions.

Results

Overall 40 SROI studies were included in the final data extraction, of which 37 were published in the grey literature. No SCBA studies were identified in the search. Evidence was detected at each stage of the life course which included; the birth, neonatal period, postnatal period and infancy (n = 2); childhood and adolescence (n = 17); adulthood (main employment and reproductive years) (n = 8); and older adulthood (n = 6). In addition, 7 studies were identified as cross-cutting across the life course in their aims.

Conclusion

This review contributes to the growing evidence base that demonstrates the use of social value methodologies within the field of public health. By mapping evidence across stages of the life course, this study can be used as a starting point by public health professionals and institutions to take forward current thinking about moving away from traditional economic measures, to capturing social value when investing in interventions across the life course.

A practical guide to make the case for sustainable investment in well-being and health

Key messages

Investing in well-being and health equity drives and enables sustainable development. Making the case for investment in health equity requires a well-planned, evidence-informed approach.

Capturing the social value and return on investment of public health services and interventions

Key messages

Making the case for investing in public health by illustrating its social, economic and environmental value is vital. Social Return on Investment is an innovative and useful method to estimate the wider value of public health interventions.

The social and economic benefit of health literacy interventions in the WHO EURO region

Background

Health literacy (HL) allows people to make informed decisions regarding their health, enabling them to understand health promotion activities and to self-manage their disease or complication without requiring support from healthcare services. HL has the potential to support sustainability in health systems by decreasing healthcare spendings stemming from lowered disease occurrence and progression, it can also impact on the rest of peoples’ lives and their surroundings by allowing them to be more independent. This study researched the evidence for return on investment and the social return on investment for health literacy interventions within the WHO EURO region.

Methods

A narrative literature review on published peer-reviewed reviews and grey literature was conducted by use of keywords and MeSH terms. Google, Google Scholar and PubMed were used find literature. The search on PubMed was restricted to reviews, published within the last 10 years (2009-2019), in English.

Results

In total, 450 publications were screened 12 publications that analysed the economic or social aspect of HL interventions were identified. Five discussed the cost-effectiveness of health literacy, three the return on investment (ROI) and the remaining three the social return on investment (SROI) of HL. Types of HL interventions ranged from health promotion campaigns, web-based HL programs, prevention systems to education-based interventions. Cost-effectiveness differed between studies and fields. Evidence for ROI was found, the return ratios ranged from 0.62 to 27.4. Findings show SROI between 4.41 and 7.25, indicating additional value of social benefit next to improved health.

Conclusions

A link between cost-effectiveness and HL interventions was established and ROI and SROI showed positive ratios. Further research is required in order to investigate whether HL interventions consistently achieve a positive returns.

Key messages

A link between health literacy interventions and positive investment returns has been established. Health literacy interventions show potential for sustainable development of health systems.

Step-by-step process of making the case for sustainable investment in wellbeing and health equity

Issue

Urgent action is needed to address the growing health, inequity, economic and planetary challenges that threaten the wellbeing of present and future generations. Business as usual has proven unsustainable with high human, social, economic and environmental costs. Coordinated policy action on the determinants of health combined with well-designed and implemented governance and innovative investment approaches can have a dual effect: a) reducing the health gap; and b) improving overall population health.

Description

The WHO Collaborating Centre on Investment for Health and Wellbeing has developed a practical step-by-step guide, outlining the process of how to synthesise, translate and communicate public health and economics evidence into policy and practice, in order to make the case for investment in wellbeing and health equity. It aims to: 1) prevent disinvestment in health; 2) increase investment in prevention / public health; and 3) mainstream cross-sector investment to address the wider determinants of health and equity, driving prosperity for all.

Building on the Knowledge-to-Action framework and an extensive international multi-disciplinary consultation, four key phases are described: 1) Project scoping and planning; 2) Evidence gathering, synthesis and design; 3) Dissemination and communication; and 4) Monitoring and evaluation. Key messages, different products and a number of practical tools and tips are highlighted. An essential element is using health economics approaches and tools to build the case, showing the burden of inaction in parallel with available sustainable solutions, which can bring ‘social return on investment’.

Results/Lessons

The result of the above-described process is the development of evidence-informed, context-tailored advocacy documents and tools, enabling healthy policy- and decision-making across different sectors, levels of government and country settings.