Public policies, implemented by local, regional and national governments, have a key role to play in changing the physical, social and economic determinants of health behaviours. However, the evidence base for which policies will work in which settings is currently limited – particularly in low and middle income countries.

We are contributing to improving this situation by informing and evaluating specific interventions and wider policy. We are using public health modelling to estimate the health impact and interaction of different interventions, and we provide scientific advice to global policy bodies.

Studies and initiatives

• Mobile technology and diabetes risk, Chennai, India. Recent estimates suggest there are 68 million people living with diabetes in India, the majority with type 2 diabetes. A mixture of poor diet and lack of exercise, low birth weight followed by rapid growth, and genetic pre-disposition – Indians tend to develop diabetes at a lower body-mass index (BMI) than Caucasians – means that diabetes is twice as common in India as it is in the UK. At the Unit, we are collaborating with the India Diabetes Research Foundation in a trial of a mobile phone based intervention design to change people’s behaviour and reduce their diabetes risk. Results so far have found that almost a third fewer men in the high risk group went on to develop diabetes if they received between two and four texts a week giving advice on diet and exercise. Read more in University of Cambridge Research Horizons magazine (pdf).

• Evaluation of NCD prevention and control policies in the Caribbean. The University of the West Indies (UWI) with the Support from Dr Cornelia Guell, who was based at the Centre for Diet and Activity Research until 2017, is leading an evaluation of a major Caribbean policy initiative on the prevention and control of non-communicable diseases (NCDs). The initiative is the 2007 Port of Spain Declaration, in which the 20 Heads of Government of the Caribbean Community committed to a range of actions on NCDs. The Caribbean summit was a forerunner to the 2011 United Nations High Level Meeting on NCDs.

• Public health modelling. The potential cots and health effects of policy changes can be informed through public health modelling. By simulating how systems work under different scenarios, modelling can help to ask questions that no single empirical study. It enables us to estimate longer term and population wide health effects of interventions, integrate evidence from different domains, consider hypothetical situations, and address issues of cost and cost-effectiveness. The Unit’s Public Health Modelling group is a key collaborator on a project, funded by the Wellcome Trust and Medical Research Council, that is evaluating the use of system dynamics modelling to guide policy making on diabetes prevention and control in three middle income countries in the Caribbean.

Scientific advice and collaboration

• WHO Physical Activity Technical Working Group.
• Scientific advice to WHO Eastern Mediterranean Regional Office. More about WHO EMRO at www.emro.who.int
• WHO Screening & Diagnosis Committees.
• WHO mHealth Initiative. The World Health Organization is promoting and evaluating the use of apps and text messaging to support the prevention and control of NCDs in low and middle income countries. Nigel Unwin is part of the advisory team on the projects concerning diabetes.
• WHO World Health Report 2016. The forthcoming World Health Report will be devoted to diabetes. Several members of CEDAR and the MRC Epi Unit are contributing to the report, including Nick Wareham, James Woodcock and Nigel Unwin.