Title: “Integrating public health with high street revitalisation: A mixed methods analysis of local initiatives addressing the food environment”
Funder: Department of Health and Social Care

Abstract: Background Non-communicable diseases (NCDs) are the leading cause of years of life lost in England. Unhealthy diets are amongst the greatest risk factors for the development of obesity and NCDs, and are known to be determined by the availability, accessibility and affordability of (un)healthy food and beverages. While important, the implementation of local interventions aimed at promoting healthier food retail environments or 'high streets' can be challenging due diverging priorities between promoting health and stimulating economic growth. This has become particularly relevant in the context of the COVID-19 pandemic. Aims and objectives This fellowship aims to investigate the integration of public health objectives with efforts to revitalise high streets in England. It will focus on two research gaps: (1) how public health objectives can be achieved and prioritised in the context of increased incentives to support the local retail environment, and (2) how local authority practitioners and policymakers engage with private and third sector stakeholders in decision-making about the local food retail environment. The objective are to: Synthesise existing evidence on the public health impact of initiatives to revitalise the retail environment, and the mechanisms by which initiatives are theorised to impact health and health equity. Understand how the issue of high street revitalisation is framed by stakeholders in the public, private and third sector and the media in England. Undertake comparative case studies of the Childhood Obesity Trailblazer programme in five English local authorities to: Explore local authority objectives, decision-making processes and activities surrounding the food environment and high street revitalisation. Explore the extent to which Trailblazer initiatives integrate with objectives and activities aimed at supporting the high street, and the extent to which public health objectives are prioritised in each local authority context. Identify public, private and third sector stakeholders involved in the Trailblazer programme, and explore their priorities, interests and engagement. Synthesise findings from different research streams and develop a briefing document in collaboration with practitioners and the public.Members of the public will be involved throughout the research project to ensure that the research objectives and activities are relevant to the concerns and priorities of the public in England. Methods The fellowship objectives will be addressed using the following research methods: A mixed methods systematic review of primary research. A mixed methods framing analysis of documents and online materials relevant to the revitalisation of the food retail environment. Qualitative comparative case studies using documentary analysis, stakeholder interviews, stakeholder analysis and focus group discussions. An innovative application of meta-ethnography to synthesise research findings.Anticipated Impact and dissemination The fellowship findings are anticipated to inform and support strategies to create healthy and prosperous retail environments, which is expected to benefit the public's health by making healthier choices more widely available, accessible and affordable. Research outputs will also contribute to greater understanding of the optimal engagement between public, private and other stakeholders in decision-making that impacts health. Findings will be disseminated through co-produced lay summaries, a briefing document sharing best practices, presentations and peer-reviewed publications.

Lay abstract: Background Unhealthy diets are amongst the greatest contributors to disease in England. Eating an unhealthy diet does not only depend on individual choices but also on the availability, accessibility and affordability of (un)healthy food and beverages. In England, people living in economically deprived areas are more greatly exposed to unhealthy food, and the associated harms. Public health measures have increasingly focused on promoting health by changing the types of food sold on high streets. This strategy is controversial as it often involves attempting to balance public health goals with objectives to support local economies. Furthermore, the involvement of business representatives in local authority decision-making may lead to public health objectives being over-ridden by competing, profit-driven, interests. A study that examines the compatibility of public health and economic goals for local high street policies is particularly timely given the restrictions imposed in response to the COVID-19 pandemic, which have disproportionally affected high street businesses. Now that economic recovery is high on the political agenda, it is especially important to ensure that efforts to revitalise high streets do not overshadow public health goals, and negatively affect population health and healthcare services in the long term. In order to support local governments in their efforts to integrate public health with economic goals, more research is needed on: How public health objectives can be achieved and prioritised in the context of increased incentives to support the local high streets, and How local government can engage with business and other stakeholders to foster healthier environments.Project aims This project aims to investigate the integration of public health objectives with efforts to revitalise high streets in England, and to explore the priorities and influence of different public, private and other stakeholders in decision-making about the local retail environment. MethodsThe project aims will be addressed by four research components: A review of the existing evidence on the public health impact of initiatives to revitalise high streets, and the ways in which these initiatives are believed to promote or hinder health. An analysis of how different stakeholders in England describe and justify different approaches to supporting and regulating high streets. This analysis will assess how prominently public health features in the framing used by different stakeholders. A qualitative comparative case study analysis of the Childhood Obesity Trailblazer programme, currently being implemented in five English local authorities. The Trailblazer programme is a good example of a public health initiative that works with policymakers in all government sectors, businesses representatives and other stakeholders to promote healthier food retail environments and improve public health. I will collaborate with the involved local authorities to explore their objectives and activities surrounding the revitalisation of the (food) retail environment, and how the Childhood Obesity Trailblazer initiatives are prioritised and integrated with these objectives. I will also examine how business representatives, voluntary organisations and community members engage with the programme. The synthesis of all research findings to identify what helps and hinders local authorities in ensuring that support for local economies does not overshadow public health priorities. I will develop accessible guidance and research summaries for policymakers and community members, in collaboration with people from those sectors. Members of the public will be involved throughout the research project to ensure that the research objectives and activities are relevant to the concerns and priorities of the public in England. Public collaborators will also be involved in the dissemination of findings, ensuring that they become available to local governments and interested members of the public. This will be done through presentations, a briefing document, web resources and freely accessible publications.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE