The UK government announced the ‘Soft Drinks Industry Levy’ (SDIL), a tiered tax on sugar-sweetened beverages (SSBs), in 2016 and implemented the tax in 2018. Traditional economic assessments of SSB tax interventions focus on assessing healthcare cost implications using standard Cost-of-Illness methodology. No studies have so far attempted to apply macroeconomic assessment methods to assess net macroeconomic impacts of SSB taxes, including anticipated standard tax-efficiency losses and macroeconomic gains from reduced diet-related illness, or to assess trade-offs between macroeconomic and health outcomes. We established a novel framework consisting of a dynamically-recursive sectoral macroeconomic Computable General Equilibrium (CGE) model of the UK economy linked to the nutrition-focused multi-state lifetable PRIMEtime epidemiological model, and applied this framework to estimate the future macroeconomic impacts of the SDIL, and trade-offs with future health gains, over 2018-2040. Overall, the SDIL is estimated to lead to future health gains of 86,951 Disability-Adjusted Life Years (DALYs) saved, and health-related macroeconomic gains of £2.49bn, including £1.33bn due to shifting consumer demand exposures, and £1.15bn due to SSB product reformulation. Due to additional tax-efficiency losses, the SDIL is estimated to result in a limited overall cumulative real GDP cost of £2.01bn (0.004%), and in an SDIL cost-effectiveness ratio of £23,116 per DALY saved, which suggests that the SDIL is cost-effective. Since product reformulation accounts for 46.2% of macroeconomic gains and makes up for 25.6% of overall tax-efficiency losses, this demonstrates the importance of SSB tax schemes to incentivize product reformulation to ensure that they maximize health impacts and cost-effectiveness.

Disappointingly few efficacious health interventions are successfully scaled up and implemented in real world settings. This represents an evidence-to-practice gap, with loss of opportunity to improve practice. Aiming to improve nutrition in the first 1000 days of life, we have combined four efficacious dietary interventions into a single adapted digital resource (Nutrition Now) for implementation in a Norwegian community setting. Nutrition Now targets pregnant women and parents of 0–2-year-olds with messages focusing on healthy dietary behaviours. Early childhood education and care (ECEC) staff are provided with pedagogical tools addressing healthy food exposure and child food acceptance. Objectives: a) evaluate the effectiveness of provision of the Nutrition Now resource on child diet and diet-related outcomes, with special attention to the influence of socio-economic position, b) gather information on the effectiveness of the implementation process to inform forthcoming scale-up and c) perform trial- and model-based economic evaluations. This is a hybrid type 1 implementation study, focusing on evaluation of effectiveness. A quasi-experimental design with pre- and post-tests, where one municipality gets access to the resource (n~800), while a matched non-equivalent control municipality (n~800) does not, will be used. Effectiveness will be assessed by examining e.g., diet outcomes, developmental outcomes, and feeding practices. The resource will be implemented in ECEC settings and made available to pregnant women and parents through the Norwegian system of maternal and child health (MCH) care. The implementation process includes iterative adjustments and implementation strategies from the implementation framework Expert Recommendations for Implementing Change (ERIC) informed by dialogues with stakeholders. Implementation outcomes (e.g., acceptability and adoption) will be assessed through questionnaires and interviews with parents, ECEC and MCH staff, with particular attention to ethnic diverse groups. Both within-trial and modelling-based economic evaluation will be performed. Nutrition Now will bridge the existing evidence-to-practice gap through rigorous scientific effectiveness evaluation of municipal scale up and inform subsequent county scale up. The study is the first to implement efficacious nutrition interventions in early life with potential for health improvement using technology to maximise the reach and impact of both parental and MCH dietary guidance and ECEC practice. Clinical Trial Registration https://www.isrctn.com/ , identified ISRCTN10694967.

Ten years ago, the report ‘Tackling obesities: future choices’1 was published. Commissioned under the then Labour government and prepared by the Foresight group within the Government Office for Science, it framed obesity as an emergent outcome of a complex system. This approach makes clear that there are multiple complex interacting influences on weight status—many of which lie outside the direct control of individuals or the health sector—that both drive and are driven by socioeconomic and other inequalities. The Foresight report has had a far-reaching impact on both obesity science and policy since its publication, and remains highly influential, with 60% of its citations occurring in the last 4 years.i The report has yet to be superseded in its scope of examining the underlying causes of obesity, encompassing a broad range of influences including individual, social, psychological, economic, commercial and environmental factors. A complex systems approach accounts …