Challenges to reorienting public health policy at a local level

Abstract Local government is a key public service provider in England, working collaboratively to provide health and social care alongside the National Health Service (NHS), and with responsibilities for housing and planning, leisure and recreation, waste and sanitation, and licensing and community safety. As such, it is an important site for public health prevention efforts, including those to address the commercial determinants of health (CDoH). Local government can therefore be a key focal point for efforts to move prevention further ‘upstream’ to the structural and systemic determinants of health. In this presentation, we will discuss the findings of an interview study conducted as part of LHGP, where we interviewed local government practitioners to both examine how they understand, operationalise, and act on public health issues related to CDoH and identify facilitators and barriers they face when adopting a structural, upstream approach. Our aim in this research is to understand how local government decisionmakers conceptualise public health prevention, the policymaking process, and commercial influence, and how these conceptualisations influence their practice. Through qualitative analysis of 37 interviews with practitioners from local and regional government across England, we produced several key themes. These include how the CDoH are framed; how officers navigate complexity in both evidence and governance structures; and the nuances of interacting with businesses both local and global. We also identify key challenges and facilitators to addressing ‘upstream’ CDoH and build thriving local communities. We conclude with a brief discussion of how these findings can serve as the basis for actions to support robust public health policymaking and outcomes in partnership with our local government and civil sector partners on the LHGP project.