Impact on policy & practice

Shifting the gravity of spending?

Exploring methods for supporting public health commissioners in priority setting to improve population health and address health inequalities.

Fuse researchers based at Durham University are researching, with colleagues at the School of Health and Related Research (ScHARR) at Sheffield University and the University of Kent,  priority-setting tools local authority commissioners might find useful for public health investment and, conversely, disinvestment.

In a climate of austerity and ongoing spending cuts, there is increased urgency to demonstrate return on investment in relation to public health interventions and explore methods of decision-support for public health priority-setting. The return of the responsibility for public health commissioning to local authorities also means that priority-setting take place within new organisational and cultural settings, which presents new challenges.

An initial two year study supported public health priority-setting in three local authority case study sites across England. The study brought together academic expertise from health economics and public health in a series of seminars and targeted decision-making support sessions for public health commissioners.

The relevance of prioritisation methods and their impact on spending patterns within and across programmes was evaluated through a series of initial and follow up interviews with decision-makers in each site.

The first stage of the study concluded that the relocation of public health to local authorities has raised questions about where and how investment should be prioritised.

The study found that there were four main influences on priorities for public health investment in the case study sites:

  • an organisational context where health was less likely to be associated with health care and where accountability was to a local electorate;
  • a commissioning and priority-setting context located within broader local authority priority-setting and decision making processes;
  • different views of what counts as evidence and, in particular, the importance of local knowledge; and
  • debates over what constitutes a public health intervention, triggered by the transfer of the public health budget from the NHS to local authorities in England.

This research project is funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) and ran from April 2012 to July 2015.

A one-year follow on study is selecting a number of additional local authorities which have adopted priority-setting tools and approaches to identify what helps and hinders their uptake and impact.

Contact information: Prof David Hunter, Director and Professor of Health Policy & Management in Centre for Public Policy & Health, email:, tel: +44 (0) 191 33 40362.



SPHR summary



  • Shifting the Gravity of Spending? Workshop to explore methods in public health priority-setting, 17 January 2017. Event report
  • Faculty of Public Health Annual Conference 2015, Fuse parallel session on “Public Health in Practice”, with presentation on “Prioritising public health investment in three local authorities in England: views on targeted health economics support” by Silvia Scalabrini and Jo Grey, 24 June 2015.
  • SPHR@L Seminar Series, London School of Hygiene & Tropical Medicine, Tuesday 7 October 2014, presented by Dr. Silvia Scalabrini (Durham University).
  • Fuse Quarterly Research Meeting, July 2013.

News items:

  • Fuse news item, “Relocation of public health raises questions about where and how to invest”, 8 December 2015


  • SPHR@L blog, “Are Local Authorities using their new responsibilities to shift the gravity of their spending towards preventive health?”, 29 September 2014, by Dr. Silvia Scalabrini

Project page:


Take a look at some other examples of Fuse research activity in the NIHR School for Public Health Research.

Last modified: Wed, 08 Feb 2017 12:35:55 GMT