Skip to main content

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 - Subhash Pokhrel, PhD is a professor of health economics and the Lead, Health Economics Research Group (HERG). Most recently, he was the Head of Department of Health Sciences (2018-2023), an academic department comprising allied health professions, nursing, social work, health economics and public health. Prior to that, he was the Founding Divisional Lead of (now) the Division of Global Public Health (2016-18). From 2013-16, he developed and led a large-scale, multi-country (n=11), multi-disciplinary research project, EQUIPT, providing European policymakers with the decision-support evidence and tools around tobacco control.  In addition to the UK and EU, Subhash has research experience in several low- and middle-income countries (LMICs) including Nepal, India, Bangladesh, Pakistan, Burkina Faso, Ghana, Brazil and Indonesia. Working together with the World Health Organisation, Subhash co-designed and is currently leading the implementation of the WHO-Brunel Framework Agreement to strengthen National Health Research Systems (NHRSs), particularly in LMICs.      Subhash's research is focussed on two complementary themes: supporting 'health systems' to deliver efficient healthcare as well as strengthening 'health research systems' to support more research into healthcare. As such, his research has contributed to several public health policies. The two REF2021 impact case studies - Supporting tobacco control decision making for improved health and economic productivity and Informing policies and debates on breastfeeding promotion describe Subhash's approach to developing a programme of research and generate significant impact from them. His learning about how researchers can engage with and support goverments and wider stakeholders to make investment decisions in public health is underpinned by his and colleagues' earlier work around the suite of NICE Public Health ROI Tools. These ROI tools provided the basis for many public health investment decisions in England and were informed by the work on tobacco control led by Subhash. The ROI tools are practical, customisable models to help make real-world decisions in context of local, regional and national government decision-making. Economic arguments are needed to make the business case for public health investments. Subhash led the roll out of ROI work to several European nations through a €2 million multi-centre European Commission funded study, EQUIPT. He has been the coordinator of a large scale inter-disciplinary collaboration of national and international expertise. Subhash is the lead author of a book, ROI in Public Health Policy: Supporting Decision Making (Palgrave Macmillan). Subhash’s work in public health research has been as diverse as the discipline itself – from developing a household decision making pathway for child health care in low- and middle income countries (LMICs) to quantifying the economic impact of breastfeeding promotion in industrialised countries; from evaluating health insurance for its population health impact in LMICs to finding out what interventions could improve physical activity globally. His doctoral researchers have investigated whether integrated care models, particularly in a local area in England, are effective; what determines obesity in West Africa and particularly the role of physical activity and dietary habits to reduce obesity among adults in Ghana; and what the correlates of COVID-19 hospitalisations and long-COVID in Ghana were. His visiting student from Sri Lanka has investigated the economics of physical activity in LMICs. Such research evidence, particularly in LMICs, is key to developing and evaluating public health measures for their value for money.   Subhash is intrigued not only by "health systems" questions (e.g. In LMICs and industrialised countries, what works to improve population health outcomes and at what cost?) but also by "health research systems" questions. Subhash worked with the WHO Euro to review the evidence on policies, interventions and tools for establishing and/or strengthening national health research systems and their effectiveness. In particular, Subhash and colleagues have investigated the extent of integration of research (particularly economic evaluations) into policymaking in Spain and what implications the Spanish experience could have globally for strenthening both systems. As a member of various external committees (NICE Technology Appraisal, NIHR PGfAHR and SPI-B), Subhash has contributed to decision making processes around funding of medical technologies, research in applied health, and behavioural measures to tackle public health emergencies.        Google Profile Orcid Profile ResearchGate BURA Profile

Related Research Group(s)


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