The impact of price promotions on sales of unhealthy food and drink products in British retail stores.

We study the health impact of food and beverage price promotion strategies-multi-buy offers and price discounts, typically biased toward unhealthy product categories-in British consumer retail. We are the first to employ econometric models from the marketing literature to analyze the impact of price promotions with a focus on population health. Our dynamic, reduced form demand model incorporates endogenous inventory (stock piling), consumption rates imputed from repeat purchases and allows for unobserved household heterogeneity. We find that removing price discounts is more effective for reducing purchase volume compared to removing multi-buy offers for 10 out of 12 food and drink groups, particularly those products for which price reduction is more common than multibuy. We find that price promotions induce consumption-and waste -through behavioral effects, associated with increased household inventory (stockpiling).

Primary care and cancer: an analysis of the impact and inequalities of the COVID-19 pandemic on patient pathways.

OBJECTIVES: We explore the routes to cancer diagnosis to further undertanding of the inequality in the reduction in detection of new cancers since the start of the pandemic. We use different data sets to assess stages in the cancer pathway: primary care data for primary care consultations, routine and urgent referrals and published analysis of cancer registry data for appointments and first treatments. SETTING: Primary and cancer care. PARTICIPANTS: In this study we combine multiple data sets to perform a population-based cohort study on different areas of the cancer pathway. For primary care analysis, we use a random sample of 5 00 000 patients from the Clinical Practice Research Datalink. Postreferral we perform a secondary data analysis on the Cancer Wait Times data and the National Cancer Registry Analysis Service COVID-19 data equity pack. OUTCOME MEASURES: Primary care: consultation, urgent cancer referral and routine referral rates, then appointments following an urgent cancer referral, and first treatments for new cancer, for all and by quintile of patient's local area index of multiple deprivation. RESULTS: Primary care contacts and urgent cancer referrals in England fell by 11.6% (95% CI 11.4% to 11.7%) and 20.2% (95% CI 18.1% to 22.3%) respectively between the start of the first non-pharmaceutical intervention in March 2020 and the end of January 2021, while routine referrals had not recovered to prepandemic levels. Reductions in first treatments for newly diagnosed cancers are down 16.3% (95% CI 15.9% to 16.6%). The reduction in the number of 2-week wait referrals and first treatments for all cancer has been largest for those living in poorer areas, despite having a smaller reduction in primary care contact. CONCLUSIONS: Our results further evidence the strain on primary care and the presence of the inverse care law, and the dire need to address the inequalities so sharply brought into focus by the pandemic. We need to address the disconnect between the importance we place on the role of primary care and the resources we devote to it.

Reducing consumption of unhealthy foods and beverages through banning price promotions: what is the evidence and will it work?

OBJECTIVE: Increasing prevalence of overweight and obese people in England has led policymakers to consider regulating the use of price promotions on foods high in fat, sugar and salt content. In January 2019, the government opened a consultation programme for a policy proposal that significantly restricts the use of price promotions that can induce consumers to buy higher volumes of unhealthy foods and beverages. These proposed policies are the first of their kind in public health and are believed to reduce excess purchasing and, therefore, overconsumption of unhealthy products. This study summarises evidence relating price promotions to the purchasing of food and drink for home consumption and places it in the context of the proposed policy. DESIGN: Non-systematic review of quantitative analyses of price promotions in food and drink published in peer-reviewed journals and sighted by PubMed, ScienceDirect & EBSCOhost between 1980 and January 2018. RESULTS: While the impact of price promotions on sales has been of interest to marketing academics for a long time with modelling studies showing that its use has increased food and drink sales by 12-43 %, it is only now being picked up in the public health sphere. However, existing evidence does not consider the effects of removing or restricting the use of price promotions across the food sector. In this commentary, we discuss existing evidence, how it deals with the complexity of shoppers' behaviour in reacting to price promotions on foods and, importantly, what can be learned from it in this policy context. CONCLUSIONS: The current evidence base supports the notion that price promotions increase purchasing of unhealthy food, and while the proposed restriction policy is yet to be evaluated for consumption and health effects, there is arguably sufficient evidence to proceed. This evidence is not restricted to volume-based promotions. Close monitoring and proper evaluation should follow to provide empirical evidence of its intended and unintended effects.

Health and care spending and its value, past, present and future.

In times of relatively low public spending in the UK since 2009-2010, health spending has been protected above all else. At the same time budgets for education, housing and public safety have fallen. This is in part due to the presence of growing demand for healthcare: while the population has increased by around one-third since 1950, healthcare spending as a share on national income has more than doubled. Continuing increases in quantity and complexity of the use of the health service as well as the unit costs indicate that these pressures will not be alleviated any time soon. However, there are clear benefits to investing in health; research finds that a 10% increase in health spending was associated with a gain of 3.5 months of life expectancy across the Organisation for Economic Co-operation and Development from 1995 to 2015. In this paper, we discuss the potential value of additional -spending.