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91��ɫ Business School's Professor Franco Sassi interviews Leon co-founder Henry Dimbleby about the nation's relationship with UPFs and how to change it

Main image: Henry Dimbleby

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Why professional networks are vital to healthcare innovation

Marisa Miraldo — Mon, 20 Jan 2025 14:54:30 +0000

Why professional networks are vital to healthcare innovation

Marisa Miraldo Mon, 20/01/2025 - 14:54

21 January 2025

Back in 2000, English health authorities issued guidance for an innovative form of keyhole surgery. This promised a less invasive way of treating colorectal cancer, which is the third most common cancer in the world and responsible for hundreds of thousands of deaths. For decades, doctors had treated this condition with open surgery, but the new procedure carried a better survival rate, patients tended to recover faster and it cost less.

Despite this, doctors were reluctant to adopt it. As a procedure, it required new skills and the learning curve was steep. Even when England’s National Institute for Health & Care Excellence evaluated it as a cost-effective treatment alternative in 2006, uptake among surgeons remained sluggish.

An encouraging environment is critical for new methods and techniques to spread

We interviewed surgeons in the UK's National Health Service (NHS) and, while some were enthusiastic about the new procedure, others were reluctant. “We all like to stick with things we know work,” one surgeon, who’d persisted with conventional methods, told us. “I think there’s a lot of innate conservatives and we do require… an innovation to prove itself before we adopt it.”

Crucially, there was no easy way for surgeons to learn the new technique, which requires much practice to perfect. Could more have been done to encourage and inspire doctors to adopt the new approach? What governs the speed of uptake of novel techniques such as this among medical professionals? Were some doctors more influential than others?

Spreading healthcare innovation

It’s important we understand the different ways innovation spreads, because once a doctor reaches the senior status of consultant, there is no further formal NHS training for new procedures. If doctors are to innovate, they must often take the initiative themselves.

Colleagues can be important sources of encouragement, either by sharing their perceived value of the technology or their own experiences with it. An encouraging environment is critical for new methods and techniques to spread.

Our research, carried out by a team of academics from 91��ɫ's Centre for Health Economics & Policy Innovation, the University of Toulouse Capitole and University of Queensland, incorporates a vast quantity of data, all anonymised. These included details of all patients treated by the NHS between 2000 and 2014. We also used details on NHS doctors’ careers as they progressed to consultant level and their clinical choices, where they have practised and with whom, and their demographic and education details.

These data enabled us to characterise each consultant professional network and how it evolved as well as the uptake of the technology in each network. In all, we honed in on nearly 1,500 consultants responsible for more than nine in 10 colorectal cancer surgeries in England during the 14-year window.

These were our three key findings:

The larger doctors’ networks are, the more likely they are to use keyhole surgery.
The more often an innovative procedure is performed within an individual’s professional network, the more likely they are to use it too. This became more pronounced according to an individual surgeon’s experience: more experienced doctors were found to have a stronger effect on their colleagues.
We also spotted the role of those we’ve termed "key players" – influential doctors whose use of the procedure inspired a greater share of colleagues to follow suit.

The key players

While it is the more experienced doctors or the pioneers in the uptake of the innovation who are the most influential in their network, we found less experienced doctors are more likely to adopt the innovation as a result of peer influence. This means they develop into effective innovation ambassadors themselves. We also found "key players" are more likely to be working in the kinds of hospitals with greater regulatory freedom and which are more open to innovation.

When we ran an experiment to see whether a training campaign that targeted the most influential doctors would improve uptake, our simulation found this would have boosted use of the novel surgery by 20 per cent – with substantial health benefits for patients and cost savings for the NHS.

Our work shows that guidelines, in combination with ad-hoc training programmes that don’t factor network effects in their design, are not the most effective strategies to ensure uptake of cost effective innovation.

Our work also reveals a dearth of information about doctors themselves. Our health systems know all about the demand side, such as patients’ characteristics, but almost nothing about the doctors who treat them. If authorities want to improve health and lower costs, researchers need more detailed information about the professionals who deliver care and their characteristics, as well as their attitudes towards innovation.

This article draws on findings from "Innovation Diffusion among Coworkers: Evidence from Senior Doctors" by Eliana Barrenho (91��ɫ London), Eric Gautier (University of Toulouse Capitole), Marisa Miraldo (91��ɫ London), Carol Propper (91��ɫ London) and Christiern Rose (University of Queensland).

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Developing innovative healthcare practices is a big challenge, but getting doctors to adopt them once they exist is yet another barrier to improving patient healthcare.

Main image: elenabs/iStock via Getty Images Plus

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Are healthcare market reforms delivering better outcomes for patients?

Carol Propper — Wed, 15 Jan 2025 12:14:02 +0000

Are healthcare market reforms delivering better outcomes for patients?

Carol Propper Wed, 15/01/2025 - 12:14

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23 June 2026

Article at a glance:

Over the past 20 years, governments have turned to market reforms and competition to curb costs and raise standards in healthcare.
Patient choice has increased, but more support is needed to help those who are less able to exercise this choice.
Proactive scrutiny of mergers, alongside quality incentives and openness to new providers and modes of care, could ensure integration improves care rather than re-establishing local monopolies.

Healthcare functions differently from other product markets due to the importance of maintaining equity in access to care and quality of care. As a result, government intervention is high and healthcare markets are heavily regulated.

However, the cost of healthcare has steadily risen worldwide. In 2000, the average healthcare expenditure in the OECD was 8.1 per cent of GDP, which has since risen to 9.3 per cent of GDP. In the UK, this has risen from around 7 per cent in 2000 to over 11 per cent in recent years. In a bid to reduce these cost increases, governments have introduced reforms to make use of markets in healthcare.

These focus on increasing the role of patient choice and promoting competition between providers, such as hospitals and primary care settings. But does choice and competition actually improve quality of care for patients? Our research reviews the evidence on market reforms in healthcare to shed light on this.

This is important as, even though market reforms featured more prominently in healthcare policy discussions in the past two decades, current priorities such as digitisation and moving healthcare into the community may also rely on competition and patient choice to succeed. Similarly, plans around integrated care and consolidation may benefit from a nuanced understanding of how competition and monopolies affect patient outcomes.

A mixed picture

What’s clear from the findings is that increased choice through market reforms can improve quality of care, but this is not a given. Evidence from the UK and Norway, for example, suggests that allowing patients to choose between providers (without any cost competition) can have a positive impact on patient mortality in emergency settings.

91��ɫ also suggests that patients respond to quality differences when choosing a provider. However, choice for some may be limited and there are demographic differences, with low-income patients more likely to register with poorly rated providers, partly because they lack the information networks of higher income peers.

Competition also introduces new modes of care. Deregulation has led to a rise in online provision, and in care being delivered by substitutes such as pharmacists and nurse practitioners. Evidence suggests these alternatives can provide similar outcomes to in-person care, offering greater convenience for patients and potential cost savings for providers. However, patients who use online consultations may also be more likely to require in-person follow-ups, partially offsetting those benefits.

Greater market freedom has also led to a wave of hospital mergers in some countries, reducing the number of providers and the competitive pressure between them. While concentrating some specialist services in larger centres can have benefits, mergers do not automatically improve quality, productivity or cost, and sometimes make healthcare more expensive. Without strong regulatory oversight, integration and consolidation could risk recreating the same local monopolies that market reforms aimed to reduce.

Areas for improvement

One important way to increase the benefits for patients is by improving access to clear, high-quality information. Rather than simply publishing information and hoping people read it, offering responsive, detailed comparison tools can help people to be better-informed, helping them reach decisions based on their individual needs. Community outreach programmes can help level the playing field, ensuring information does not only benefit those who are already better-informed.

On a macro level, many countries already have the power to scrutinise mergers that limit choice and offer little benefit, but this has often been underused. Using these powers more proactively would help ensure mergers add value, keep markets open to new entrants, and maintain competitive pressure on established providers.

"Increased choice through market reforms can improve quality of care, but this is not a given."

There is also a need to support integrated care while ensuring it does not recreate monopolies that deny patient choice. Regulators should prevent integrated providers from directing patients towards their own affiliated services regardless of quality. Where mergers are permitted, price regulation and quality incentives – such as shared savings models tied to measurable outcomes – can help ensure they genuinely benefit patients.

Regulation can also help keep markets open to new approaches. Allowing well-qualified substitutes such as nurse practitioners to deliver care, and new modes of care such as online consultations can expand choice and capacity, provided quality is closely monitored as the evidence base develops. This is particularly relevant in the context of the benchmarking approaches such as the updated NHS Performance Assessment Framework, where high-performing providers may be given more leeway to test innovative approaches.

Overall, market reforms have given patients greater choice and offer real potential for improvements in care. However, they have not yet fully delivered to the extent policymakers hoped. Better information for patients and stronger, more proactive regulation are the keys to changing this, preventing the re-emergence of monopolies and maximising the benefits of new options and approaches to care.

Find out more about the research

Read Professor Propper's paper

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Governments intend market reforms to boost efficiencies in healthcare while improving outcomes. While this has led to greater patient choice, stronger regulation is needed to prevent monopolies, keep markets open to new entrants and maximise gains.

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Opinion: “Good science” needs purpose, accountability and an explicit ethical stance

Marisa Miraldo — Wed, 15 Jan 2025 12:14:02 +0000

Opinion: “Good science” needs purpose, accountability and an explicit ethical stance

Marisa Miraldo Wed, 15/01/2025 - 12:14

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We like to pretend that science is neutral – that our work is insulated from politics, economics and power. But it isn’t. The funding we receive, the methods we choose and, crucially, the questions we ask – and those we never ask – are shaped by funding, performance metrics, history, social norms, and our own biases. To act as if science floats above these forces is not only naïve, it’s irresponsible.

From the 19th century onwards, scientific institutions were deeply entangled with military power, industrial productivity and colonial rule. Funding priorities were set around national prestige and economic gains. Universities adapted by building reward systems around publications, citations, patents and grants. Generations of researchers were trained to see themselves as specialists accountable primarily to peers and promotion committees not to the communities affected by their work. Within this system, a comforting narrative took hold: “I just do the science; what others do with it is not my responsibility.”

Science that harmed

As a professor, I am painfully aware of the historical lessons that demonstrate how damaging scientific work framed as progress can be.

One example is the many leading scientists and physicians who believed they were helping society while promoting eugenics. In practice, it justified forced sterilisation, institutionalisation, and the brutalisation of disabled people, the impoverished, and racialised communities. Meanwhile, the science was wrapped in the language of public good, making it harder to challenge. The echoes of eugenic assumptions that some lives are less desirable persists today, reminding us of the lasting harm scientists can have on society.

Today, algorithmic systems and social media recommendation systems designed to “maximise engagement” have contributed to polarisation, harassment and mental distress. Built by people who may have wanted to “connect the world” or “democratise access” these systems operate in institutional settings that reward growth, not care.

A pattern emerges: decisions are made far from those most affected and the social, historical, and political dimensions of science are often treated as secondary, if they are acknowledged at all.

Ethical science requires governance that travels with the technology – from research question to deployment – and includes the people and communities most affected.

A manifesto for socially responsible science

If good intentions are not enough, what would it take to change? A manifesto is, by definition, unfinished – it is an invitation to collective work. But I would like to start the conversation by setting out some clear commitments.

1. Name the politics of science, openly and early. Make our values explicit in the design, conduct, and communication of research.

2. Redefine excellence. Treat equity, representation, and long-term social and environmental consequences as core criteria of quality.

3. Practice convergence, not siloed brilliance. Treat lived experience, social sciences and the arts as essential intelligence, not decorative.

4. Share power with those most affected. Move beyond token consultation. Communities and groups most affected by research hold real decision-making power over priorities, methods, data governance, and evaluation of impact.

5. Build systematic processes to surface potential harms, including those that fall outside our immediate field of view.

6. Align incentives with responsibility. Push institutions and funders to reward collaborative and justice-oriented science – in hiring, promotion and grant allocation.

7. Refuse institutional silence and require them to align their investments, partnerships, and policies accordingly.

8. Protect dissent and whistleblowing within science to create a culture that produces socially responsible knowledge.

9. Educate for responsibility, not just technique. Embed history, ethics, social theory, and critical reflection into scientific training. Students must learn not just how to generate but how to situate it in the world and be transformational leaders.

10. Hold ourselves accountable. When we invoke “science for humanity,” “precision health,” or “sustainability,” we treat those words as obligations, not slogans. We measure ourselves against the lived experiences of people and ecosystems, not just against citation counts and patents.

How ethical science is embedded in practice

At a time when “science” is simultaneously invoked to defend public policy and attacked as elitist, I believe good science needs purpose, accountability and an explicit ethical stance. These do not sit only in labs and universities: they run through funders, regulators, publishers, governments and yes, businesses that decide what gets built, scaled, and sold.

Initiatives like 91��ɫ’s School of Convergence Science, where I am Co-Director, the Good Science Project, and the “Science for Humanity” strategy, create spaces that prioritise impact and values, question incentives, and redesign how we judge excellence. They will matter insofar as they shift incentives and decision-making: who sits at the table, what counts as excellence, and how harms are identified and acted on.

The question now is whether we are prepared to turn those intentions into structures, commitments, and convergent practices that make responsibility – not just discovery – the organising principle of what counts as excellent science.

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Scientific research needs to extend beyond good intentions. This is my manifesto for socially responsible science – and why it is so desperately needed

Main image: sanjeri / iStock via Getty Images

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Jasmin Moshfegh on the economics of healthcare innovation

Shamita Harsh — Wed, 15 Jan 2025 12:14:02 +0000

Jasmin Moshfegh on the economics of healthcare innovation

Shamita Harsh Wed, 15/01/2025 - 12:14

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Understanding how new medical technologies diffuse through health systems, especially including who gets access to them, is central to Dr Jasmin Moshfegh’s research. Joining 91��ɫ Business School in 2025 as Assistant Professor of Economics & Public Policy, she brings a research agenda that sits at the intersection of health economics and healthcare innovation.

How precision medicine and health equity intersect

Her work examines the causes and consequences of healthcare innovation, with a focus on precision medicine, AI and assisted reproductive technologies. By combining quasi-experimental methods with large administrative datasets and cancer registries, she sheds light on how institutional and policy choices shape both efficiency and equity in healthcare delivery.

Her job market paper, supported by the US Agency for Healthcare 91��ɫ and Quality (AHRQ), studies the adoption of genomic testing in breast cancer care—showing that while precision medicine can reduce unnecessary treatments, it may also exacerbate racial disparities.

Dr Moshfegh completed her PhD in Health Policy (Economics) at Stanford University, where she was also a T32 Fellow and R36 awardee from AHRQ. She went on to hold a Postdoctoral Fellowship at Stanford, alongside appointments as a Fellow at the US Department of Veterans Affairs and the National Cancer Institute at the National Institutes of Health. Her research has been supported by grants from the Agency for Healthcare 91��ɫ and Quality, the SIEPR George P. Shultz Fund and the Sweden-America Foundation.

Extending research into new frontiers

Dr Moshfegh studies the causes and consequences of healthcare innovation, with a particular focus on information technologies. She is extending her work to explore the impact of next-generation diabetes drugs in the US Veterans population and the role of AI tools in improving women’s health in India.

Reflecting on her move to London, she said: “What excites me most about joining 91��ɫ is the opportunity to be part of a department and institution that sits at the intersection of cutting-edge research, interdisciplinary collaboration, and real-world impact. 91��ɫ’s unique ecosystem brings these disciplines together in a way that few other places can.”

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Dr Moshfegh discusses how her research in precision medicine is aimed at reducing health inequalities

Main image: Jasmin Moshfegh

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Bold goals, missed levers: Will the NHS 10-Year Health Plan go far enough?

Jack Olney — Wed, 15 Jan 2025 12:14:02 +0000

Bold goals, missed levers: Will the NHS 10-Year Health Plan go far enough?

Jack Olney Wed, 15/01/2025 - 12:14

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Healthy diets, exercise and healthy habits – the goals are deceptively simple but persuading the public is complicated. The NHS’s new 10-Year Health Plan for England signals a welcome focus on prevention rather than cure, tackling tobacco, alcohol, junk food and other causes of ill health. But could the plan go further?

Could the UK build on its success with the pioneering "sugar tax" to help slash consumption of sugary foods – and extend a similar levy more widely? 91��ɫ by Professor Franco Sassi, Director of the Centre for Health Economics & Policy Innovation (CHEPI) at 91��ɫ Business School, indicates the government could be bolder still.

CHEPI’s research reveals that not all proposals within the plan are backed by research. A focus on low alcohol drinks for instance could be counterproductive as the advertising of branded low alcohol alternatives is fuelling appetites for their alcoholic counterparts.

But the plan heralds a welcome shift in mindset and an urgent attempt to nip health problems in the bud. Ending the obesity epidemic is a “moonshot”, but inaction already costs the NHS an estimated £19 billion a year.

Fiscal tools for prevention

Are policy makers neglecting fiscal tools in tackling the crisis?

The UK’s sugar tax showed how effective economic incentives can be. More than half of drink manufacturers cut sugar content before the levy was introduced, and sales of sugary drinks fell afterwards.

CHEPI’s research has shown that an expansion of a tax similar to the Soft Drinks Industry Levy to encompass sugary foods more widely could cut sugar purchases by as much as 38 per cent in some foods. Other fiscal measures identified by Professor Sassi and CHEPI’s research that the government could deploy — such as a tax based on nutrient thresholds— could cut purchases of sugar and calories by up to 15 per cent.

Companies that heavily advertise their low or no alcohol alternatives go on to increase sales of their same-brand alcoholic beer – in other words, encouraging low alcohol brands inadvertently fuels alcohol consumption, among light drinkers, according to research by Dr Stijn Maesen at 91��ɫ Business School.

Policy makers could avoid this “halo effect” by restricting ads for both low and high alcohol products, while emphasising genuine health benefits such as fewer calories. Low alcohol alternatives still play a role, particularly for anyone trying to cut back as it’s the heavy drinkers who are most likely to consume them.

But there are equity concerns: low alcohol drinks are often more expensive, meaning the heaviest health burdens – which fall on deprived groups – are not alleviated. Ensuring affordability must be part of the strategy if inequity is to be addressed.

Navigating the junk food market and corporate accountability

Proposed restrictions on the marketing of junk food and sale of caffeinated drinks to young people are overdue. Evidence shows that reducing exposure to unhealthy food and drink reduces consumption of these products, especially in young people. Regulation could be even more effective if it were to extend to brand marketing and digital media and incentivise the promotion of healthy products

In a world first, the plan requires large food companies to report the healthiness of the food they sell – this will inform new mandatory healthiness targets on food sales. This is ambitious and welcome – “Our research shows that policies must tackle both demand and supply factors behind poor diets,” says Professor Sassi, “which means not only educating and incentivising consumers but also mandating reformulation and responsible marketing by industry.”

Today, the poorest 20 per cent of households need to spend half of their disposable income to eat a recommended healthy diet, compared with just 11 per cent for the richest 20 per cent. Better access to free school meals, food vouchers and higher nutritional standards in schools outlined in the plan are a promising step towards redressing the imbalance.

Weight loss drugs for obesity embraced by the plan show strong short-term results but should only complement rather than replace policies such as encouraging physical activity and healthier diets which yield longer term benefits.

Digital tools and behaviour change

New health rewards and ambitious partnerships with fitness experts proposed in the plan could encourage people to become more active. CHEPI’s research reveals that the wearables and digital health technology embraced here do indeed help people get and stay fitter.

91��ɫ by Professor Marisa Miraldo shows that programmes that tap into peer support and existing social networks can amplify the impact of rewards for healthy choices. But these schemes must be accessible to the people who need them most – not just the healthy – with interventions designed for specific communities, or with higher rewards and incentives for those at greater risk of unhealthy lifestyles.

The reasons people choose to smoke, drink, or eat poorly are complex, and behavioural science reveals the risk that individuals will revert to former unhealthy habits once a scheme ends. This can be avoided with the careful design of a programme which draws on behavioural insights and fosters intrinsic motivation - gradually building stable habits by combining rewards with education and social recognition for instance, or by making healthy activities enjoyable.

Preventative healthcare investment can result in a more productive workforce

Poor health is a human tragedy but also an economic drain. Obesity and related diseases cut the UK’s economic output by 3.4 per cent of GDP - that’s equivalent to an annual tax per person of £409.

Investing in prevention is not just good for health; it strengthens the economy by creating a more productive workforce and reducing healthcare costs. But prevention requires sustained funding, political will and collaboration across sectors – all of which have too often been sidelined by short-term crises.

The NHS 10-Year Health Plan heralds a significant shift of mindset from reactive care to proactive prevention, but the question is not whether the UK can afford to invest in prevention, but whether it can afford not to.

This piece brings expertise from across CHEPI and 91��ɫ Business School, including Professor Franco Sassi, Professor Marisa Miraldo and Dr Stijn Maesen.

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The Health Plan can help build a stronger NHS provided policymakers have access to the latest evidence in order to make informed decisions and address inequalities.

Main image: sturti /iStock via Getty Images Plus

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Shaping smarter healthcare decisions through economic evaluation at 91��ɫ

Shamita Harsh — Wed, 15 Jan 2025 12:14:02 +0000

Shaping smarter healthcare decisions through economic evaluation at 91��ɫ

Shamita Harsh Wed, 15/01/2025 - 12:14

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Professor Anita Patel, Provost's Visiting Professor of Health Economics at 91��ɫ, talks about the thinking behind the recently launched 91��ɫ Health Economic Evaluation (IHEE).

IHEE is a new joint initiative between 91��ɫ Business School and the School of Public Health to build a flagship institutional capability in health economic evaluation. Its aim is to embed robust economic analysis at every stage of health innovation and research, supporting both internal projects and eventually external partnerships.

Q: What inspired the creation of the 91��ɫ Health Economic Evaluation initiative?
In any resource-constrained system, any ‘new’ programme or innovation - be it a medicine, medical device or a different way of delivering a care pathway - often requires robust economic and outcomes data to demonstrate value for money, either to justify new investment or to understand the implications of redirecting existing resources. Throughout my career, I’ve worked on economic evaluations for health interventions across national and global settings, so I understand well the methods, process and value of generating such evidence robustly.

91��ɫ is home to outstanding health-related research across all faculties, from basic sciences through to translational (research that is concerned with facilitating the practical application of scientific discoveries to the development and implementation of new ways to prevent, diagnose, and treat disease). But embedding economic evaluation into research has often been challenging due to underdeveloped capacity at 91��ɫ in this area of health economics.

Health economists and other related capabilities are dispersed across faculties and departments at the university – with some critical masses at the Business School and the School of Public Health. However, they have tended to converge around specific areas of research, e.g. infectious diseases, which entail specific methodological focuses.

While such expertise is helpful for specific areas there is a wider need that draws on a whole mix of approaches across different clinical contexts and this kind of generalisable economic evaluation within an organised structure has been a long-standing gap area at 91��ɫ, leading to those needing economic evaluation expertise to frequently look for this outside the institution.

IHEE directly addresses this fragmentation and gap by consolidating expertise within a centralised collaborative hub that strengthens 91��ɫ’s capacity in this crucial area.

Ultimately, it’s about embedding economic insight into every step of health innovation across all of 91��ɫ’s health-related ecosystem, so that great ideas don’t just remain ideas - they become sustainable, impactful solutions.

We hosted a launch event in June 2025 to introduce this new initiative designed to strengthen 91��ɫ’s capacity for economic evaluation in health research. IHEE embodies 91��ɫ’s strategy of scientifically grounded interdisciplinary research.

During my time at 91��ɫ so far, I have been mapping the economic evaluation landscape across the college and have spent many hours speaking individually with people who have any interest in economic evaluation, whether in undertaking this kind of research, or needing support in it. As a next phase, the event was focussed on bringing people in a room together to have open conversations about who needs what kind of support so that the shape and nature of IHEE fits the need.

We intentionally brought together the “supply” of economic expertise and the “demand” from researchers and clinicians in one space. We are committed to engage in a way that includes all staffing levels for socially impactful collaboration. So the event intentionally drew on early career researcher involvement to widen the ownership of the initiative and allow it to evolve to meet the needs of future health challenges. It’s an opportunity to map capability, build relationships, and start thinking strategically about how to embed this across 91��ɫ’s health research legacy.

Q: How do you plan to engage with external stakeholders interested in health economic evaluation?

The first step is visibility. Creating a named entity - 91��ɫ Health Economic Evaluation - gives funders, partners, and all stakeholders something concrete to connect with. There are obviously some basic administrative prerequisites e.g. an email point of contact, a dedicated webpage, directory of expertise and support mechanisms to make collaboration easier.

But it’s really about building meaningful connections and a track record. Isolated successful projects don’t in themselves signal long-term capability. A structured network with active and invested members, strong and impactful outputs, and shared goals does. Other researchers and funders want to engage with teams that are credible, diverse, and strategically aligned.

Q: How important is it to deal with the complexity of health economics before solving challenges at large scale?
Health challenges are rarely isolated. They sit within wider structural contexts that involve social, behavioural, political, commercial, environmental, and technological dimensions. Economic evaluation of potential solutions would ideally account for such context in understanding value – although in reality the extent to which this happens is driven by the nature of decision-making frameworks, both explicitly and implicitly.

Nevertheless, interdisciplinary approaches are often necessary even when not allowing for the full scale of complexity.

For example, if assessing a robotic surgical tool, it is relevant to account for engineering insights, clinical outcomes, patient and professional experiences, and market potential. Or in evaluating post-heart-attack behavioural interventions, it may be important to consider patient psychology, caregiver burden, and long-term cost implications including impacts on work productivity.

We want IHEE to be a diverse and versatile collection of expertise that not just undertakes economic analysis for others but offers informed ideas and contributions to help frame these interdisciplinary questions in a way that leads to meaningful, actionable and scalable insights.

Health, innovation and improvement is not just about the human body but also people's behaviour and the conditions in which illness arises and the conditions in which illness can be solved.

Q: What kind of projects can drive innovation in this space?
We’re already seeing engagement across domains: engineers developing health tech, clinicians designing care models, and social scientists working on behavioural interventions. Projects might range from national policy evaluations to local, community-based studies.

Crucially, we want evaluations to reflect real-world impact - not just system efficiency but also the lived experience of patients and carers. Embedding economic evaluation from the outset ensures research has both scientific and societal relevance.

Q: What does the initiative need to succeed and what is its long-term vision?
Strong foundations are essential for growing capabilities that are relevant and sustainable. Initially, we need a few key ingredients like resourcing for key posts, and commitment to a growth plan. Along with the initial investment, we need people who can dedicate energy to drive this forward with a truly collaborative spirit that can move beyond siloed thinking. A centralised hub is important for facilitating this.

A few high-quality grant wins can change everything. They enable us to recruit dedicated researchers who can embed economic thinking into everyday research. We also can't achieve a long-term roadmap that is simply led by senior academics - PhD students and early-career researchers are critical for giving the initiative life through initiating ideas and projects, contributing to training and development, and ultimately sustaining the work and human connections.

In an organisation as large and diverse as 91��ɫ, that might well entail tricky internal conversations about sharing credit, rethinking collaboration and funding allocation mechanisms, and embracing new ways of working – but these are all just processes and it is important to keep a clear view that they merely exist to support the end goal of producing excellent research that informs policy and practice. 91��ɫ has world-leading expertise.

But to realise our full potential, we need to act as one - cohesive, connected, and committed to collaboration.

Note: This Q & A was updated ton 04.04.2025 to better reflect the outcomes of the IHEE launch.

In conversation with Professor Anita Patel to learn about the strategic launch of 91��ɫ Health Economic Evaluation

Main image: Launch of the 91��ɫ Health Economic Evaluation initiative | 91��ɫ

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Key lessons from Costa Rica’s attempt to use taxation to boost healthy eating

Maxime Roche — Wed, 15 Jan 2025 12:14:02 +0000

Key lessons from Costa Rica’s attempt to use taxation to boost healthy eating

Maxime Roche Wed, 15/01/2025 - 12:14

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In 2023, Costa Rica became the first country in the world to link the rates of value-added tax (VAT) on food with nutritional goals. This reform revised the basic tax basket – the list of items taxed at the lowest rate of VAT – and was intended, in the government’s words, to ‘guarantee a balanced diet’.

But it may have misfired. In a recent study, using the latest two waves of the national household budget survey linked with nutritional composition data, I’ve found the reform to be associated with the purchase of more calories, sugar, and saturated fat. What’s gone wrong?

Impacts of the reform

Costa Rica has some of the highest rates of overweightness and obesity in Central America, especially among children. At the same time, healthy diets are the second most expensive in Latin America.

Discounted food items were pre-selected according to the purchasing patterns of the poorest 30 per cent of households. While previously not involved in this process, the reform mandated that the Ministry of Health assess the nutritional suitability of the identified list. Items included in the basic tax basket were ultimately selected in agreement between the economy, finance, and health ministries.

But the curation of the reformed list was opaque, with an apparent lack of nutritional criteria. While the list has more healthy staples and approximately double the number of fruits and vegetables under the lower VAT rate of one per cent, unhealthy and highly processed foods such as ketchup, mayonnaise, sweet biscuits and more have also crept in, avoiding the higher VAT rate of 13 per cent. Overall, 26 highly processed savoury food items – representing 68 per cent of the total quantity consumed in that food group – are now effectively discounted, up from 15 items before the reform.

As a result, the reform is associated with the purchase of 0.7 per cent more calories, 0.4 per cent more sugar, and 1.2 per cent more saturated fat, and no overall improvement in the nutritional content of Costa Rican diets.

What could be done differently?

By simulating alternative policy designs, I find that VAT discounts applied according to clear nutritional criteria could instead reduce the purchase of sodium (-1.0 per cent), saturated fat (-0.6 per cent), and calories (-0.2 per cent), with greater benefits for lower-income households, without increasing household spending.

The most effective approach involves differentiating VAT rates according to a nutrient profile model – in this study, I considered the model established by the Pan American Health Organisation (the World Health Organization Regional Office for the Americas). These standards provide evidence-based nutrient content limits to identify healthier and less healthy foods, set evidence-based nutrient content thresholds to identify healthier and less healthy foods. They are increasingly used in food policy, such as regulating the marketing of foods to children in the UK.

The research also reveals that while lower-income households are more sensitive to price changes, the demand for highly processed foods is inelastic in Costa Rica - it doesn’t fall away to the same extent as prices increase. For instance, a one per cent price rise results in a less than one per cent drop in consumption. This means prices would have to rise more steeply to discourage Costa Ricans from unhealthy foods.

Costa Rica now has an opening to amend the reform – by law, the government is obliged to review the list of discounted items in the event of a new household expenditure survey, and one took place in 2024 with results due later this year. This presents a timely opportunity to revise the basic tax basket according to evidence-based quantitative nutritional criteria in order to encourage better diets.

Policy implications

Taxation has already emerged as one of the most powerful tools to improve public health. Governments have applied it to harmful products such as tobacco and alcohol for decades, and more recently to sugary drinks – more than half the world’s population is now covered by a tax on sugary drinks. But foods high in fat, salt, or sugar represent a larger tax base – any tax targeting these items without lowering the tax burden on healthier alternatives may raise equity concerns.

Countries with existing varying VAT or sales tax rates on foods have an opportunity to align these rates with nutritional objectives to make healthy foods more affordable while discouraging consumption of junk foods. However, taxing foods based on nutritional content may incur tax administration and compliance costs. There are also largely unknown implications for tax revenue efficiency.

In addition to this work in Costa Rica, researchers at the Centre for Health Economics & Policy Innovation have previously systematised the evidence around taxes for healthy eating. They are currently evaluating options for India and the UK to reform existing differentiated VAT rates to promote healthier diets using an in-house microsimulation tool, Health-GPS, to simulate future health and economic outcomes.

Now, all eyes are on Colombia, where lawmakers have recently introduced a tax on ultra-processed foods high in salt, sugar, and saturated fat, albeit with some exceptions. But taxation is only part of the solution. As is underway in Colombia, a combination of tax increases and clear label warnings on unhealthy foods, as identified using nutrient profiling, could help further shift the dial towards healthier choices, with lasting impacts on public health.

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5 ways the UK can stimulate the biopharma sector

James Barlow — Wed, 15 Jan 2025 12:14:02 +0000

5 ways the UK can stimulate the biopharma sector

James Barlow Wed, 15/01/2025 - 12:14

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31 March 2025

Biopharma R&D and manufacturing is one of the UK’s leading sectors, responsible for around 140,000 jobs and contributing £20 billion per year to the economy. Over the past 15 years, though, the sector has faced significant challenges.

Biopharma gross value added peaked in 2008 and then declined for the next 10 years. Although it has picked up in recent years, it remains below 2008 levels, with the UK dropping behind competitor countries in international rankings and domestic companies often struggling to convert cutting-edge research into financial success.

Our research sets out steps to help bring the UK biopharma sector back to a globally competitive position in the years to come. This article highlights five of these steps.

1. Stimulate R&D productivity

The UK public sector spends little on pharmaceutical R&D, leaving it to the biopharma industry to pick up around £3.8 billion of the total £5 billion spend, with a further £1 billion from non-UK companies. Overall, the UK ranks fourth in total biopharma R&D spending and third for R&D activity if we measure it by the location of inventors of patentable innovations.

There are three challenges for biopharma R&D: flat or declining public and charitable sector funding for medical and health sciences since 2009; increasing costs for discovering, developing and commercialising new drugs; and the UK becoming unattractive for conducting drug trials.

To address this, we recommend R&D tax credits and funding for research, which can reduce the cost of innovation, boost investment, and stimulate patent registrations. We have two separate schemes, due to the previous government’s decision to cut R&D tax credits for SMEs and boost the rate for larger companies, which the current government is planning to evaluate sector by sector.

2. Ensure targeted support for early-stage biopharma companies

While UK biopharma companies outperform European peers in securing early-stage funding, they raise less late-stage growth financing. This means small UK companies with promising products are often acquired by foreign investors – there were 130 mergers and acquisitions in the UK pharmaceutical sector in 2023/24, valued at $15 billion.

To help mitigate this, we suggest industry and government explore ways to improve transparency and reporting on SME R&D investment, making more data and pipeline information available. Additionally, support – e.g. mentorship and small grants – would be useful to help companies articulate their value proposition, develop clear business models, and demonstrate how they will generate revenue.

3. Continue improvements in clinical trial capacity through enhancements to data infrastructure

The UK has the potential to be a global leader in terms of the breadth and depth of data available for life sciences research and innovation. To reach that point, we recommend that funding is made available to assess the feasibility of a centralised information resource on biopharma assets, ownership and patent status, listing potential collaborating organisations.

Start-ups and smaller companies, as well as drug researchers and developers, also often lack the required skills to navigate health data access processes and constraints. With this in mind, we also recommend strengthening support for navigating and analysing health and other data through the Medicines Discovery Catapult.

4. Ensure NHS integrated care systems work to promote and adopt innovations

The UK National Health Service (NHS) holds ‘cradle to grave’ records on more or less the entire UK population, providing a real opportunity for efficient, high-quality research that can be translated into mainstream healthcare practice. However, operational pressures and funding constraints limit NHS research and innovation capacity.

These pressures will not be alleviated in the short term, but positive steps have been taken through the introduction of NHS Integrated Care Systems (ICSs) in 2022. These offer the ability to spread and adopt best practice efficiently, helping to diminish the challenges in implementing and embedding innovations which result from siloed thinking.

To continue to serve this purpose, ICSs will need to communicate and collaborate to develop more consistent approaches to sharing experience and best practice and experience. This will require them to develop shared metrics, in order to best promote and support promising biopharma innovations.

5. Strengthen the biopharma manufacturing base

In recent years, there has been a move to reshore UK healthcare manufacturing. To best serve the sector, however, this needs to focus on strategic aims, not just on increasing domestic production.

In line with the British Generic Manufacturers Association, we recommend offering capital grants for flexible advanced manufacturing facilities, alongside establishing common international quality standards for manufacturing to ensure fair competition between countries. At the same time, we need better evidence on where support should be targeted, in order to maximise the investment efficiency.

These five steps will not instantly help government and industry to bring UK biopharma back to global leadership, but they offer a clear pathway to boosting competitiveness, robustness and modernisation throughout the sector. In support of this, 91��ɫ’s Centre for Sectoral Economic Performance is currently working on research projects to explore changes in R&D productivity and business support for biopharma SMEs.

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Does the internet put people off vaccines?

Carol Propper — Wed, 11 Dec 2024 09:39:47 +0000

Does the internet put people off vaccines?

Carol Propper Wed, 11/12/2024 - 09:39

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Measuring impact on vaccine uptake

Gauging this is challenging. Previous research suggests online information has a positive impact on vaccine uptake rates, but this is difficult to prove. As internet access is pretty much ubiquitous in most developed economies, there is not a large enough group of internet non-users to compare against.

To examine this further, our research looks back to the early 2000s, when home internet was still being rolled out. This allows us to explore the effects of online information by comparing the behaviour of those with access and those without, as well as the impact of socioeconomic factors such as deprivation and education levels.

It’s vital we have a proper understanding of the net effect of online information on attitudes to vaccines

Specifically, we look at how online information affected uptake of the vaccine against measles, mumps and rubella (MMR) between 2000 and 2011 – the most rapid period of growth in internet access. A 1998 study, which was found to be false and later retracted, linked the MMR vaccine to autism in children, causing a decline in vaccine uptake and a general rise in vaccine hesitancy.

But did the online spread of information, at least in part, facilitate this effect? To test this, we compared vaccination rates in children aged 0-1 and 0-5 against gradually rising internet access across our time range. The results show that internet access did decrease MMR vaccine uptake. Specifically, we found that a 25 per cent increase in internet penetration reduced vaccination rates in children aged 0-1 and 0-5 by 23.8 per cent and 19.1 per cent respectively.

Demographic differences

However, this effect is not consistent across society, as we know internet access is not random. In general, vaccination uptake is higher in less deprived areas with a higher proportion of high-skilled individuals. These areas also tended to gain internet access earlier, and we found that access to the internet is more likely to reduce vaccine uptake in these areas, compared with more deprived, less highly educated areas.

The impact is significant: our results show that a 25 per cent increase in internet access in the most affluent areas in the UK caused a 22.4 per cent reduction in the vaccination rate for children aged 0-5. This is compared to an average decline across all areas of 19 per cent – in other words, the overall response to an increase in internet access in more affluent areas is approximately 3.4 per cent larger than the average.

Societal effect

This is consistent with what we know about people’s behaviour more broadly – that greater online access exposes them to great quantities of potentially misleading information, and that this information is more understandable to those who are more highly educated. Our findings also match what we know about attitudes to parenting, with wealthier parents tending to be the first to take action that they perceive to be protective of their children.

Interestingly, however, there is evidence to suggest that internet access might have different effects in different countries. In Indonesia, for example, access to 3G broadband was found to have reduced COVID cases by approximately 45 per cent, with a more pronounced effect on those with higher education levels. While this is not specific to vaccine uptake (or the lack thereof), it highlights that the impact of online information is complex.

The results show that internet access did decrease MMR vaccine uptake

The findings reported here are specific to the UK. They demonstrate that here, at least, increasing access to the internet has led to decreases in vaccination rates. Changing this state of affairs could be key to preparing society to better deal with future health crises.

That means interventions from social media platforms, public health campaigns, and access to high-quality health information will be vital in getting a positive, factually accurate message out both quickly and widely. Combining these approaches, through policy and investment, will give us the best chance of overcoming health misinformation.

This article draws on findings from "Information and Vaccine Hesitancy: The Role of Broadband Internet" by Sofia Amaral-Garcia (Université Libre De Bruxelles), Mattia Nardotto (Université Libre De Bruxelles), Carol Propper (91��ɫ London) and Tommaso Valletti (91��ɫ London).

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