Helping policymakers stub out smoking

Impact case study for REF 2021: Allied Health Professions, Dentistry, Nursing and Pharmacy (UoA 03)

The year was 2012. Despite strong words from health professionals and stringent measures from governments around the world, tobacco-related illnesses were still claiming millions of lives and costing taxpayers billions.

statistics on tobacco costs in the world and the EU
Statistics on tobacco costs in the world and the EU

Policymakers started to wonder what the alternative strategy was. Whilst the number of smokers was falling, they weren’t falling fast enough – 20 per cent of Brits were still puffing away – with the resulting poor health creating a significant burden for health services. Was there a new strategy that would both get more people to quit, and be more cost-effective?

To help the policymakers develop their new strategies, researchers from Brunel University London’s Health Economics Research Group began to develop tools that would allow the policymakers to answer three key questions: What new areas should we invest in? What existing areas should we invest more in? And what areas do we disinvest from?

The Brunel team’s new tools allowed policy makers to gain a better understanding of what measures would give them a better Return on Investment (ROI):

Calculating Return on Investment (ROI) for smoking interventions
Calculating Return on Investment (ROI) for smoking interventions

The researchers worked with local, regional and national policymakers from around Europe to help them understand where they should be spending their money, and what each possible investment might recoup in the long term in the form of lower healthcare costs, increased productivity and reduced demand for social care.

The tools were adaptable and considered local conditions, such as the general make-up of the population and how many of them smoke or used to smoke, and what intervention measures were available to policymakers, how effective each one was, and how much each one cost.

Return on investment for smoking treatments
Return on investment for smoking treatments

The policymakers were able to develop a variety of successful measures thanks to the work of Brunel’s health economists, and there are now lives being saved because those that decide where the money gets spent have the tools to show them what works.


Meet the Principal Investigator(s) for the project

Professor Subhash Pokhrel
Professor Subhash Pokhrel - Generating evidence that helps governments invest better in public health Subhash Pokhrel is a Professor of Public Health Economics and Lead of the Health Economics Research Group (HERG) at Brunel University London. His research helps governments and health systems make evidence-informed investment decisions in public health - from tobacco control and breastfeeding promotion to physical activity and multimorbidity. With over 4,000 citations and experience across four continents, his work bridges rigorous economic analysis with real-world policy impact. Subhash's career spans more than two decades of research at the intersection of health economics, evidence synthesis, and public health policy - with work informing decisions at local, national, and international levels. His research is organised around two complementary themes: supporting health systems to deliver efficient, equitable healthcare, and strengthening health research systems to ensure research feeds into policymaking where it matters most. A key focus of his work has been the economic case for public health investment. He led the development of the NICE Public Health Return on Investment (ROI) Tools - practical, customisable models used by local authorities across England to justify investment in tobacco control. Building on this, he coordinated EQUIPT, a €2 million European Commission-funded, 11-country study that extended the ROI approach to tobacco control decisions across Europe. His contributions to public health policy are recognised in two REF2021 impact case studies: one on supporting tobacco control decision-making, and another on informing policies around breastfeeding promotion. He is the lead author of ROI in Public Health Policy: Supporting Decision Making (Palgrave Macmillan, 2017). Subhash has also contributed significantly to global health research. He has worked in multiple low- and middle-income countries - including Nepal, India, Bangladesh, Pakistan, Ghana, Burkina Faso, Brazil, and Indonesia - and collaborated with the World Health Organisation to strengthen National Health Research Systems. He co-produced a WHO review of evidence on policies and tools for strengthening national health research systems. As a member of external committees including NICE Technology Appraisal, NIHR PGfAHR, and SPI-B (the Scientific Pandemic Insights Group on Behaviours during COVID-19), he has contributed to decisions on medical technology funding, applied health research, and pandemic behavioural policy. Subhash has trained and supervised numerous doctoral researchers investigating topics from integrated care in the UK and obesity in West Africa to long-COVID in Ghana and the economics of physical activity in LMICs. Subhash would like to hear from you if you are interested in exploring: (a) what strengthens health systems to improve population health; or (b) how health research systems can be designed to generate and apply evidence more effectively. Find Subhash on: 🎓 Google Scholar  🔬 ORCID   🔗 ResearchGate   📚 BURA (Brunel Repository)   💼 LinkedIn

Related Research Group(s)

medic

Health Economics (HERG) - Our strategic focus is on economic evaluation and systematic reviews of a broad range of clinical and health service technologies by providing high-quality, applied, policy-relevant research, as well as developing and refining methods to increase the rigour and relevance of such studies.


Partnering with confidence

Organisations interested in our research can partner with us with confidence backed by an external and independent benchmark: The Knowledge Exchange Framework. Read more.


Project last modified 02/10/2023