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Article ; Online: The Complex Systems Challenge of Obesity.

Rutter, Harry

2017 Volume 64, Issue 1, Page(s) 44–46

MeSH term(s)	Body Mass Index ; Humans ; Obesity/complications ; Obesity/epidemiology ; Obesity/prevention & control ; Prevalence ; Social Discrimination ; Social Stigma ; World Health Organization
Language	English
Publishing date	2017-11-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80102-1
ISSN	1530-8561 ; 0009-9147
ISSN (online)	1530-8561
ISSN	0009-9147
DOI	10.1373/clinchem.2017.272831
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Article ; Online: A systems approach to scale-up for population health improvement.

Koorts, Harriet / Rutter, Harry

Health research policy and systems

2021 Volume 19, Issue 1, Page(s) 27

Abstract: Despite a number of important global public health successes, for many health behaviours there is a continued lack of interventions that have been sufficiently scaled up to achieve system-wide integration. This has limited sustainable and equitable ... ...

Abstract	Despite a number of important global public health successes, for many health behaviours there is a continued lack of interventions that have been sufficiently scaled up to achieve system-wide integration. This has limited sustainable and equitable population health improvement. Systems change plays a major role in the relation between implementation processes and at-scale institutionalisation of public health interventions. However, in research, systems approaches remain underutilised in scaling up. Public health scale-up models have typically centred on intervention replication through linear expansion. In this paper, we discuss current conceptualisations and approaches used when scaling up in public health, and propose a new perspective on scaling that shifts attention away from the intervention to focus instead on achieving the desired population-level health outcomes. In our view, 'scaling up' exists on a continuum. At one end, effective scaling can involve a linear, intervention-orientated expansive approach that prioritises the spread of evidence-based interventions into existing systems in order to drive expansion in the application of that intervention. At the other end, we contend that scale-up can sit within a complex systems paradigm in which interventions are conceptualised as events in systems. In this case, implementation and scale-up activities should focus on generating changes within the system itself to achieve the desired outcome. This we refer to as 'systems-orientated scale-up' to achieving population health improvement, which can complement traditional approaches in relevant situations. We argue that for some health behaviours, our proposed approach towards scaling up could enhance intervention implementation, sustainability and population health impact.
MeSH term(s)	Humans ; Population Health ; Public Health ; Systems Analysis
Language	English
Publishing date	2021-03-01
Publishing country	England
Document type	Letter
ZDB-ID	2101196-5
ISSN	1478-4505 ; 1478-4505
ISSN (online)	1478-4505
ISSN	1478-4505
DOI	10.1186/s12961-021-00679-0
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Article ; Online: Public health policies can reduce inequalities as we come out of lockdown.

Briggs, Adam / Rutter, Harry

BMJ (Clinical research ed.)

2020 Volume 369, Page(s) m1977

Keywords	covid19
Language	English
Publishing date	2020-05-18
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.m1977
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Article ; Online: Systems approaches to scaling up: a systematic review and narrative synthesis of evidence for physical activity and other behavioural non-communicable disease risk factors.

Koorts, Harriet / Ma, Jiani / Swain, Christopher T V / Rutter, Harry / Salmon, Jo / Bolton, Kristy A

The international journal of behavioral nutrition and physical activity

2024 Volume 21, Issue 1, Page(s) 32

Abstract: Background: Non-communicable diseases (NCDs) are the leading causes of death worldwide. Systems approaches have potential for creating sustainable outcomes at scale but have rarely been used to support scale up in physical activity/nutrition promotion ... ...

Abstract	Background: Non-communicable diseases (NCDs) are the leading causes of death worldwide. Systems approaches have potential for creating sustainable outcomes at scale but have rarely been used to support scale up in physical activity/nutrition promotion or NCD prevention more generally. This review aimed to: (i) synthesise evidence on the use of systems approaches in scaling up interventions targeting four behavioural risk factors for NCDs; and (ii) to explore how systems approaches have been conceptualised and used in intervention implementation and scale up. Method: Seven electronic databases were searched for studies published 2016-2021. Eligible studies targeted at least one of four NCD behavioural risk factors (physical inactivity, tobacco use, alcohol consumption, diet), or described evaluation of an intervention planned for or scaled up. Studies were categorised as having a (i) high, (ii) moderate, or (iii) no use of a systems approach. A narrative synthesis of how systems approaches had been operationalised in scale up, following PRISMA guidelines. Results: Twenty-one intervention studies were included. Only 19% (n = 4) of interventions explicitly used systems thinking to inform intervention design, implementation and scale up (targeting all four risk factors n = 2, diet n = 1, tobacco use n = 1). Five studies ('high use') planned and implemented scale up with an explicit focus on relations between system elements and used system changes to drive impact at scale. Seven studies ('moderate use') considered systems elements impacting scale-up processes or outcomes but did not require achieving system-level changes from the outset. Nine studies ('no use') were designed to work at multiple levels among multiple agencies in an intervention setting, but the complexity of the system and relations between system elements was not articulated. We synthesised reported barriers and facilitators to scaling up, and how studies within each group conceptualised and used systems approaches, and methods, frameworks and principles for scaling up. Conclusion: In physical activity research, and NCD prevention more broadly, the use of systems approaches in scale up remains in its infancy. For researchers, practitioners and policymakers wishing to adopt systems approaches to intervention implementation at scale, guidance is needed on how to communicate and operationalise systems approaches in research and in practice. Trial registration: PROSPERO (CRD42021287265).
MeSH term(s)	Humans ; Noncommunicable Diseases/prevention & control ; Risk Factors ; Diet ; Exercise ; Alcohol Drinking/prevention & control
Language	English
Publishing date	2024-03-21
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	2134691-4
ISSN	1479-5868 ; 1479-5868
ISSN (online)	1479-5868
ISSN	1479-5868
DOI	10.1186/s12966-024-01579-6
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Article ; Online: A systems approach to scale-up for population health improvement

Harriet Koorts / Harry Rutter

Health Research Policy and Systems, Vol 19, Iss 1, Pp 1-

2021 Volume 5

Abstract: Abstract Despite a number of important global public health successes, for many health behaviours there is a continued lack of interventions that have been sufficiently scaled up to achieve system-wide integration. This has limited sustainable and ... ...

Abstract	Abstract Despite a number of important global public health successes, for many health behaviours there is a continued lack of interventions that have been sufficiently scaled up to achieve system-wide integration. This has limited sustainable and equitable population health improvement. Systems change plays a major role in the relation between implementation processes and at-scale institutionalisation of public health interventions. However, in research, systems approaches remain underutilised in scaling up. Public health scale-up models have typically centred on intervention replication through linear expansion. In this paper, we discuss current conceptualisations and approaches used when scaling up in public health, and propose a new perspective on scaling that shifts attention away from the intervention to focus instead on achieving the desired population-level health outcomes. In our view, ‘scaling up’ exists on a continuum. At one end, effective scaling can involve a linear, intervention-orientated expansive approach that prioritises the spread of evidence-based interventions into existing systems in order to drive expansion in the application of that intervention. At the other end, we contend that scale-up can sit within a complex systems paradigm in which interventions are conceptualised as events in systems. In this case, implementation and scale-up activities should focus on generating changes within the system itself to achieve the desired outcome. This we refer to as ‘systems-orientated scale-up’ to achieving population health improvement, which can complement traditional approaches in relevant situations. We argue that for some health behaviours, our proposed approach towards scaling up could enhance intervention implementation, sustainability and population health impact.
Keywords	Systems ; Scale-up ; Public health ; Global health ; Implementation ; Public aspects of medicine ; RA1-1270
Subject code	360 ; 306
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Changing behaviour: an essential component of tackling health inequalities.

Marteau, Theresa M / Rutter, Harry / Marmot, Michael

BMJ (Clinical research ed.)

2021 Volume 372, Page(s) n332

MeSH term(s)	COVID-19/mortality ; England/epidemiology ; Health Behavior ; Health Policy ; Health Status Disparities ; Humans ; Pandemics ; Social Determinants of Health
Language	English
Publishing date	2021-02-10
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.n332
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Article ; Online: Improving the health of adolescents: the Nordic countries can help fill the evidence gap.

Klepp, Knut-Inge / Helleve, Arnfinn / Fismen, Anne-Siri / Rutter, Harry

Scandinavian journal of public health

2022 Volume 50, Issue 7, Page(s) 887–891

Abstract: While in the Nordic countries we have well-developed welfare policies and several structural, statutory measures in place aiming to promote public health, studies from these countries are often absent from systematic reviews of research literature ... ...

Abstract	While in the Nordic countries we have well-developed welfare policies and several structural, statutory measures in place aiming to promote public health, studies from these countries are often absent from systematic reviews of research literature assessing the effects of policy measures designed to promote health. Using adolescent health promotion and efforts related to primary prevention of obesity as an example, this short commentary aims to illustrate the paucity of well-designed studies investigating the effects of public health policies affecting adolescents. This paper argues that the Nordic research community is in a good position to help fill this gap, and to contribute more widely to the international literature on evaluation of policy interventions.
MeSH term(s)	Adolescent ; Health Promotion ; Humans ; Public Health/education ; Public Policy ; Scandinavian and Nordic Countries ; Social Welfare
Language	English
Publishing date	2022-10-17
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	1475054-5
ISSN	1651-1905 ; 1403-4948
ISSN (online)	1651-1905
ISSN	1403-4948
DOI	10.1177/14034948221124675
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Article ; Online: The use of participatory systems mapping as a research method in the context of non-communicable diseases and risk factors: a scoping review.

van den Akker, Amber / Fabbri, Alice / Alardah, Dima I / Gilmore, Anna B / Rutter, Harry

Health research policy and systems

2023 Volume 21, Issue 1, Page(s) 69

Abstract: Context: Participatory systems mapping is increasingly used to gain insight into the complex systems surrounding non-communicable diseases (NCDs) and their risk factors.: Objectives: To identify and synthesize studies that used participatory systems ... ...

Abstract	Context: Participatory systems mapping is increasingly used to gain insight into the complex systems surrounding non-communicable diseases (NCDs) and their risk factors. Objectives: To identify and synthesize studies that used participatory systems mapping in the context of non-communicable diseases. Design: Scoping review. Eligibility criteria: Peer-reviewed studies published between 2000 and 2022. Study selection: Studies that focused on NCDs and/or related risk factors, and included participants at any stage of their system's mapping process, were included. Categories for analysis: The main categories for analysis were: (1) problem definition and goal-setting, (2) participant involvement, (3) structure of the mapping process, (4) validation of the systems map, and (5) evaluation of the mapping process. Results: We identified 57 studies that used participatory systems mapping for a variety of purposes, including to inform or evaluate policies or interventions and to identify potential leverage points within a system. The number of participants ranged from 6 to 590. While policymakers and professionals were the stakeholder groups most often included, some studies described significant added value from including marginalized communities. There was a general lack of formal evaluation in most studies. However, reported benefits related mostly to individual and group learning, whereas limitations described included a lack of concrete actions following from systems mapping exercises. Conclusions: Based on the findings of this review, we argue that research using participatory systems mapping would benefit from considering three different but intertwined actions: explicitly considering how different participants and the power imbalances between them may influence the participatory process, considering how the results from a systems mapping exercise may effectively inform policy or translate into action, and including and reporting on evaluation and outcomes of the process, wherever possible.
MeSH term(s)	Humans ; Noncommunicable Diseases ; Risk Factors ; Exercise ; Policy
Language	English
Publishing date	2023-07-06
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2101196-5
ISSN	1478-4505 ; 1478-4505
ISSN (online)	1478-4505
ISSN	1478-4505
DOI	10.1186/s12961-023-01020-7
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Article ; Online: Managing uncertainty in the covid-19 era.

Rutter, Harry / Wolpert, Miranda / Greenhalgh, Trisha

BMJ (Clinical research ed.)

2020 Volume 370, Page(s) m3349

Keywords	covid19
Language	English
Publishing date	2020-09-01
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.m3349
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Article: Big food and the World Health Organization: a qualitative study of industry attempts to influence global-level non-communicable disease policy.

Lauber, Kathrin / Rutter, Harry / Gilmore, Anna B

BMJ global health

2021 Volume 6, Issue 6

Abstract: Introduction: There is an urgent need for effective action to address the over 10 million annual deaths attributable to unhealthy diets. Food industry interference with policies aimed at reducing non-communicable diseases (NCDs) is widely documented at ... ...

Abstract	Introduction: There is an urgent need for effective action to address the over 10 million annual deaths attributable to unhealthy diets. Food industry interference with policies aimed at reducing non-communicable diseases (NCDs) is widely documented at the national level but remains under-researched at the global level. Thus, this study explores how ultra-processed food industry actors have attempted to influence NCD policy at WHO. Methods: A combination of inductive and deductive thematic coding of internal industry documents, academic literature and interviews with key informants from international organisations and global civil society was used to identify action-based strategies ultra-processed food industry actors employ to influence global-level policy. Results: Ultra-processed food industry actors have attempted to influence WHO and its policies through three main action-based strategies: coalition management, involvement in policy formulation, and information management. Coalition management includes the creation and use of overt alliances between corporations-business associations-and more covert science-focused and policy-focused intermediaries, the hiring of former WHO staff and attempted co-option of civil society organisations. Industry involvement in policy formulation is operationalised largely through the lobbying of Member States to support industry positions, and business associations gaining access to WHO through formal consultations and hearings. Information management involves funding and disseminating research favourable to commercial interests, and challenging unfavourable evidence. Conclusion: We provide novel insights into how ultra-processed food industry actors shape global-level NCD policy and identify a clear need to guard against commercial interference to advance NCD policy. In their approach, the political behaviour of multinational food corporations bears similarities to that of the tobacco industry. Increased awareness of, and safeguarding against, commercial interference at the national as well as the global level have the potential to strengthen the crucial work of WHO.
MeSH term(s)	Food Industry ; Global Health ; Health Policy ; Humans ; Noncommunicable Diseases/epidemiology ; Noncommunicable Diseases/prevention & control ; Public Health
Language	English
Publishing date	2021-06-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2021-005216
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