Commercial Determinants Of Health Research Articles

Ghosts in the labour market: perceived health implications of informal labour in Australia.

Employment conditions are important social and commercial determinants of health. Informal employment-also known as 'cash-in-hand' and 'undeclared' work-is a discrete employment condition that has salience around the world. Fuelled by neoliberal ideology, informal employment has become increasingly common in high-income countries. Public health research concerning the health of informal workers comes largely from low- and middle-income countries, where the phenomenon is more visible. There has been little research on the health effects of informal employment in high-income countries including Australia. Twenty-nine workers aged 18 years and older, who were undertaking informal work activities, were recruited using social media and an online marketplace in Tarndanya (Adelaide-Kaurna Country), Australia. Qualitative narrative data, demographic profiles, and physical and mental health scores were collected. Most informal workers reported unfair and indecent employment conditions including job insecurity, low income, coercion, and lack of respect and dignity at work, and were often exposed to unsafe and unhealthy work environments. Workplace injuries and exposure to occupational hazards were common; and Physical and Mental Component Scores were poorer among informal workers when compared to the population of South Australia as a whole. With informal employment in Australia described as part of a 'significant, pervasive, damaging and growing' problem, there is a need for a health promotion lens over industrial relations policies in the interest of creating equitable access to fair and decent work.

Health and equity impacts of global consultancy firms

BackgroundConcern is growing over the power, influence, and threats to health and equity from the operations of large global consultancy firms. Collectively, these firms support a neoliberal policy environment promoting business interests ahead of public health. Global consultancy firms act as commercial determinants of health, an evolving area of research over recent years. However, this research mainly focuses on specific corporations or industry sectors, especially those which produce harmful products, including ultra-processed food, alcohol, and fossil fuels. It is therefore important to expand the focus to include large global consultancy firms and place a public health and equity lens over their operations.Main bodyGlobal consultancy firms have wide-ranging conflicts of interest. These arise from the ‘revolving door’ employment strategies between their own staff and those from government and regulatory bodies. These firms also advise governments on taxation and other matters while concurrently advising corporate clients on ways to minimise taxation. They advise fossil fuel corporations while also advising governments on climate and health policies. These firms undermine the capabilities of the public sector through the outsourcing of traditional public sector roles to these private interests. Consultancy firms foster private interests through their engagement with the higher education sector, and thereby weaken the tradition of transparent management of university affairs by accountable university councils. While private consultancies cannot be blamed for all the negative consequences for health and equity caused by the problems associated with globalisation and advanced capitalism, they have played a role in amplifying them.ConclusionAddressing the negative impacts of global consultancy firms will require strengthening the public sector, enforcing greater transparency, accountability, and minimising conflicts of interest. It will also demand critical thought, counter discourses, and activism to reframe the narratives supporting neo-liberal ideas of governance that are promoted in both government and business arenas.

The commercial determinants of health in Ireland: fueling an industrial epidemic at home and abroad.

The commercial determinants of health in Ireland: fueling an industrial epidemic at home and abroad.

Capitalism and the ‘commercial determinants of health’: A more-than-human micropolitics

This paper argues that studies of the ‘commercial determinants of health’ (CDoH) need to acknowledge fully the part the capitalist mode of commodity production and exchange plays in producing negative health outcomes. This proposition is supported by recourse to a recent development in political economy that has established a more-than-human, relational and monist (or ‘flat’) ontology of capitalism, in place of the more conventional neo-Marxist perspective. This ontology reveals a dynamic to capitalism that operates beyond human intentionality, driven by the supply of, and demand for the capacities of commodities. This dynamic determines the production and consumption of all commodities, some among which (such as tobacco, alcohol and processed foods) contribute to ill-health. A case study of food consumption reveals how these supply and demand affects drive ‘unhealthy’ food choices by consumers. Ways to undermine this more-than-human dynamic are offered as an innovative approach to addressing the effects of commerce and capitalism upon health.

Characteristics of commercial determinants of health research on corporate activities: A scoping review.

Business practices have influenced human health for centuries, yet an overarching concept to study these activities across nations, time periods, and industries (called 'the commercial determinants of health' (CDH)) has emerged only recently. The purpose of this review was to assess the descriptive characteristics of CDH research and to identify remaining research gaps. We systematically searched four databases (Scopus, OVID Medline, Ovid Embase, and Ovid Global Health) on Sept 13, 2022 for literature using CDH terms that described corporate activities that have the potential to influence population health and/or health equity (n = 116). We evaluated the following characteristics of the literature: methods employed, industries studied, regions investigated, funders, reported conflicts of interest, and publication in open-access formats. The characteristics of the articles included that many were conceptual (50/116 articles; 43%) or used qualitative methods (37; 32%). Only eight articles (7%) used quantitative or mixed methods. The articles most often discussed corporate activities in relation to the food and beverage (51/116; 44%), tobacco (20; 17%), and alcohol industries (19; 16%), with limited research on activities occurring in other industries. Most articles (42/58 articles reporting a regional focus; 72%) focused on corporate activities occurring in high-income regions of the world. Our findings indicate that literature that has used CDH terms and described corporate practices that influence human health has primarily focused on three major industries in higher-income regions of the world. Qualitative methods were the most common empirical method for investigating these activities. CDH-focused investigations of corporate practices conducted by less-studied industries (e.g., social media) and in lower-income regions are recommended. Longitudinal quantitative studies assessing the associations between corporate practices and a range of health outcomes is also a necessary next step for this field.

Privatisation of government services in Australia: what is known about health and equity impacts

BackgroundHistorically in Australia, all levels of government created collective wealth by owning and operating infrastructure, and managing natural assets, key public goods and essential services while being answerable to the public. This strong state tradition was challenged in the 1980s when privatisation became a widespread government approach globally. Privatisation involves displacing the public sector through modes of financing, ownership, management and product or service delivery. The Australian literature shows that negative effects from privatisation are not spread equitably, and the health and equity impacts appear to be under-researched. This narrative overview aims to address a gap in the literature by answering research questions on what evidence exists for positive and negative outcomes of privatisation; how well societal impacts are evaluated, and the implications for health and equity.MethodsDatabase and grey literature were searched by keywords, with inclusion criteria of items limited to Australia, published between 1990 and 2022, relating to any industry or government sector, including an evaluative aspect, or identifying positive or negative aspects from privatisation, contracting out, or outsourcing. Thematic analysis was aided by NVivo qualitative data software and guided by an a-priori coding frame.ResultsNo items explicitly reflected on the relationship between privatisation and health. Main themes identified were the public cost of privatisation, loss of government control and expertise, lack of accountability and transparency, constraints to accessing social determinants of health, and benefits accruing to the private sector.DiscussionOur results supported the view that privatisation is more than asset-stripping the public sector. It is a comprehensive strategy for restructuring public services in the interests of capital, with privatisation therefore both a political and commercial determinant of health. There is growing discussion on the need for re-nationalisation of certain public assets, including by the Victorian government.ConclusionPrivatisation of public services is likely to have had an adverse impact on population health and contributed to the increase in inequities. This review suggests that there is little evidence for the benefits of privatisation, with a need for greater attention to political and commercial determinants of health in policy formation and in research.

Commercial Determinants of Health and its influence on trauma care

As the World Health Organization (WHO) states, Commercial determinants of health (CDoH) are the private sector activities that affect people’s health, directly or indirectly, positively or negatively. The private sector influences the social, physical, and cultural environments through business actions and societal engagements. CDoH includes all products and services provided by private entities to gain a financial profit, market strategies, research funding, working conditions, production externalities, and political activities, such as misinformation, lobbying, and donations. Some parts of the private sector also use instrumental, structural, and discursive power to undermine public health policies that threaten profits. Therefore CDoH impacts a wide range of health outcomes, such as non-communicable diseases, communicable diseases and epidemics, injuries on roads and from weapons, violence, and mental health conditions

Children, young people and the Commercial Determinants of Health.

The commercial determinants of health (CDoH) have a significant impact on the health and well-being of children and young people (subsequently referred to as young people). While most research has focused on the influence of harmful industry marketing on young people, more recent CDoH frameworks have emphasized that a range of commercial systems and practices may influence health and well-being. Focusing on the impact of traditional and digital media, contemporary marketing strategies and corporate production and consumption processes, the following article outlines the impact of the CDoH on the health and wellbeing of young people. The article also provides evidence about how young people conceptualize the impact of corporate actors on health, and their involvement in advocacy strategies to respond. The article recommends that when collaborating with young people to understand the impacts of and responses to the CDoH, we should seek to diversify investigations towards the impact of a range of corporate tactics, systems and structures, rather than simply focusing on the impacts of advertising. This should include considering areas and priorities that young people identify as areas for action and understanding why some young people are more vulnerable to commercial tactics than others. Youth are powerful allies in responding to the CDoH. Public health and health promotion stakeholders could do more to champion the voices of young people and allow them to be active participants in the decisions that are made about harmful commercial practices and health.

Current Approaches of Artificial Intelligence (AI) in Leading Behavioural Change: The Latest Review

Digital health is plagued by low interest and adherence, but research suggests improvements are possible. Non-health care, for-profit digital enterprises like LinkedIn, Twitter, and Facebook undertake behavioural experiments to enhance user engagement. Today, everyone is impacted by commercial determinants of health, and the selection of unhealthy options compounds economic, social, and racial disparities that already exist. However, healthcare providers tend to prioritize pharmacological approaches at the expense of influencing patients’ actions. Thus, it is crucial to ensure that artificial intelligence (AI) is integrated as well as applied within the systems to improve related fields. Both Scopus and Web of Science (WoS) have indexed the previously examined body of work in their respective databases. This review is going to be divided into three different themes: (1) health, (2) education, and (3) other fields. This paper aims to analyse the existing data or outcomes via analysis, categorization, comparison, and summary. It also may uncover research gaps and explore field possibilities. This review included English-language research and literature from 2022. This study summarises current approaches of Artificial Intelligence (AI) in leading behavioural change from different fields of literature.

Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design.

Alcohol consumption is causally associated with long-term health-related consequences, such as cancer and cardiovascular disease, and short-term harms, such as accidents and injuries. Alcohol consumption has increased among midlife women (aged 40-65) over the last two decades in high-income countries. This study aimed to centre women's voices by using co-design methodologies to investigate what women identify as strategies that could assist them and other women their age to reduce their alcohol consumption. Human-centred design workshops were undertaken with 39 women, and conventional qualitative content analysis was used to analyse information from written workshop materials to develop categories in the data and count their occurrence. Six categories, or strategies, emerged, listed here from most to least represented: 'Participate in alternative activities to drinking alcohol', 'Track alcohol consumption and set goals', 'Seek support from family and friends', 'Drink alcohol-free beverages', 'Reduce supply of alcohol in the home' and 'Seek professional support'. Our findings identify strategies that are realistic and feasible to midlife women; our sample, however, likely reflects a more affluent subsection of this group, and as such, any focus on individual-level strategies must be complemented by policies that increase equitable access to healthcare and act on the social and commercial determinants of health. An intersectional approach to alcohol and other drug research is required to examine how the interplay of gender and other markers of social identities shape alcohol consumption.

The Awareness of the Role of Commercial Determinants of Health and the Readiness to Accept Restrictions on Unhealthy Food Advertising in Polish Society.

The negative consequences of commercial determinants of health (CDoH) have become a major challenge for public health systems, especially in terms of non-communicable diseases (NCDs). CDoH are defined as profit-driven factors that influence health. In this study, we assessed the awareness of CDoH and the attitudes toward potential restrictions on advertising, as well as fiscal interventions targeting food products with harmful effects on health in Polish society. Our analysis is based on data from a computer-based web interviewing (CAWI) survey performed in May 2022 among 2008 adult internet users from Poland. Multivariable logistic regression models were developed for variables derived from three items exploring the respondents' understanding of the relationship between CDoH and NCDs, as well as three items asking about their acceptance of a prohibition of advertising unhealthy products during sports events, a general ban on unhealthy food advertising, and their attitudes toward sugar-sweetened beverages (SSBs). Food (FL) and e-health literacy (eHL) levels were consistently positive predictors of both awareness of CDoH and acceptance of the proposed actions. Both higher FL and eHL were significantly associated with the opinion that advertising unhealthy food is associated with the prevalence of NCDs (OR, 95% CI: 1.03, 1.02-1.05, and 1.04, 1.02-1.06, respectively). Health literacy was less frequently a significant predictor of the dependent variables. Among sociodemographic factors, a respondent's level of education and age showed a significant relationship with their awareness and acceptance of countermeasures against CDoH. Respondents with a university master's level of education were more likely to agree with the statement on the relationship between big industry profits and harm to society's health (OR, 95% CI: 1.96, 1.42-2.69) and to support a ban on advertising unhealthy food similar to that for tobacco products (OR, 95% CI: 1.66, 1.21-2.27). Respondents suffering from chronic diseases were also consistently more likely to show a greater understanding of the harmful impact of CDoH and support proposed restrictions. For example, they were more likely to agree with restrictions on advertising harmful products during sports events (OR, 95% CI: 1.23, 1.02-1.50) and the introduction of a sugar tax (OR, 95% CI: 1.26, 1.03-1.54). Our study revealed that more than 50% of the Polish population is conscious of the problem of the harmful effects of big industries producing and selling processed food, sugar-sweetened beverages, and alcoholic beverages. Interestingly, slightly more than half of the respondents supported the introduction of restrictions on advertising such products. Still, only approximately 30% of them accepted a sugar tax to counter the obesity epidemic. The results of our study indicate that Polish society is open to the introduction of regulations aimed at limiting the impact of commercial determinants of health. To our knowledge, this is one of the first studies to assess the awareness of CDoH and the acceptance of restrictions to limit their impact.

(Mis)understanding alcohol use disorder: Making the case for a public health first approach

‘Alcohol use disorder’ (AUD) is used by several contemporary conceptualizations to identify, treat and prevent problems associated with alcohol use. Such conceptualizations encompass diagnostic classifications and broader frameworks for policy and practice. However, current AUD concepts are subject to multiple tensions and limitations in capturing and responding to the complex and heterogeneous nature of alcohol problems. Further, public understandings of alcohol problems are heavily divergent from professional AUD concepts and remain embedded within an ‘alcoholism’ master narrative in which disease model stereotypes come with multiple costs for prevention and ‘recovery’. The persistence of a problematic ‘alcoholism’ paradigm reflects the coalescing of multiple forces including the cognitive appeal of reductionism, motives to stigmatize and ‘other’, and an over-emphasis on AUD as an individually located biomedical problem. Public misperceptions of AUD as a matter of the individual, the individual’s essence, and misconceived notions of responsibility and control have been bolstered by industry interests and the ascension of neuroscience and genetics, in turn diverting attention from the importance of the environmental and commercial determinants of health and the effectiveness of under-utilized public health policies. We call for multiple stakeholders to support efforts to prioritize a public health first approach to advancing AUD research, policy and treatment in order to make significant advances in AUD prevention and treatment. We offer several recommendations to assist in shifting public understanding and scientific limitations in AUD concepts and responses.

Commentary on Fazzino et al.: Proof for why we need cross-industry approaches to research on the commercial determinants of health.

Commentary on Fazzino et al.: Proof for why we need cross-industry approaches to research on the commercial determinants of health.

The Pitfalls of Ascribing Moral Agency to Corporations: Public Obligation and Political and Social Contexts in the Commercial Determinants of Health.

Policy Points Government and civil society should be held more accountable for creating food and beverage regulatory policies rather than assigning moral agency to the food and beverage industry. Nutrition policymaking institutions should ensure civil society's ability to design regulatory policy. Government policymaking institutions should be isolated from industry interference.

11.H. Round table: Moving the agenda forward on the Commercial Determinants of Health

Abstract Commercial actors play a vital role in society, yet there is growing evidence that they are responsible for escalating levels of avoidable ill health, planetary damage and social and health inequity. These problems are increasingly referred to as the ‘commercial determinants of health’ (CDOH). A recent Lancet Series on CDOH brought together a global intergenerational and multidisciplinary team of researchers and thought leaders to help consolidate thinking around the CDOH. It defined the CDOH as “the systems, practices and pathways through which commercial actors drive health and equity”. This workshop brings together one of the three lead authors from the CDOH Lancet series, with leading members of the civil society and intergovernmental organisations (including the WHO CDOH Lead and WHO European lead for NCDs) to discuss and engage with the audience on this complex and urgent issue. By bringing together these experts, this workshop explores the role that different agencies can play in tackling the CDOH. The workshop will consist of a presentation based on the lessons from the Lancet Series on Commercial Determinants of Health followed by a panel discussion among participants enabled by the workshop chair who will encourage audience discussion and participation. Discussants will be asked to comment on challenges and considerations for addressing CDOH in the WHO European Region, the role of civil society in the EU policy making context and the way forward in a global agenda. By convening these experts, the workshop aims to engage the audience in a discussion that builds their understanding of the CDOH and what they can do to respond to this problem. While much of the Lancet series is quite conceptual in its approach to CDOH, this workshop supports the public health community to move beyond simply understanding the systematic nature of the CDOH. In particular, the workshop aims to support researchers, practitioners, and policy makers to collaboratively develop possible solutions to CDOH and practical next steps to drive the CDOH agenda forward in the European Region. We recognise that this is a large amount of content to discuss in this workshop; however, we see this workshop (and the lancet CDOH series) as initiating a larger and ongoing conversation within the public health community. Key messages • CDOH is a complex and systematic issue that is hurting the health of people in Europe with low awareness of how they manifest and impact public health issues. • Despite the complexity of CDOH, there are practical measures that the public health community can implement at local, national, regional, and global level to tackle them. Speakers/Panelists Anna Gilmore University of Bath, Bath, UK Gauden Galea WHO, Beijing, China Monika Kosinska WHO, Guildford, UK Florence Berteletti EuroCare, Brussels, Belgium

Burden of T1DM and T2DM among adolescents in Western Europe, 1990-2019: results from the GBD 2019

Abstract Background Type 1 (T1DM) and type 2 diabetes mellitus (T2DM) are major causes of global morbidity and mortality. As little is known about the burden of DM in adolescents in Western Europe (WE), we aimed to explore the epidemiology of T1DM and T2DM among 10-24-year-olds, including temporal trends. Methods Estimates were retrieved from the Global Burden of Diseases study 2019 (GBD 2019). We reported counts, rates per 100,000 population, and percentage changes from 1990 to 2019 for incidence, prevalence and years lived with disability (YLDs) of T1DM and T2DM, and the burden of T2DM in YLDs attributable to high body mass index (HBMI), for 24 WE countries. Results In 2019, prevalence and YLDs estimates were higher for T1DM than T2DM among 10-24 years old adolescents in WE. However, T2DM incidence rates per 100,000 population were 3.5 times higher than T1DM. T2DM showed a greater increase in prevalence and YLDs than T1DM in the 30-year observation period in all WE countries. The highest prevalence rate of T1DM was in Finland (542.7 [402.9-681.0]), while the United Kingdom had the highest prevalence for T2DM (751.0 [501.2-1063.3]). Prevalence increased with age, while only minor differences were observed between sexes. In 2019, HBMI accounted for 28.8 (12.6-54.9) of the attributable YLD rates for T2DM in age group 20-24 years in WE. Conclusions The findings show the substantial burden posed by DM among adolescents in WE. The study can help inform the development and implementation of appropriate infrastructure and healthcare frameworks for adolescent-centred diabetes care. It highlights the need for transition services, and adolescent-oriented education programs, as well as investments in data systems to improve the availability and quality of data for T1DM and T2DM in 10-24-year-olds. Finally, it can be used to guide policymakers towards prevention of obesity and broader policy actions on the social and commercial determinants of health across the life course. Key messages • Adolescent-oriented health system responses on transition services, data collection systems, education, and complications’ prevention are needed to achieve targets for NCDs within the 2030 UN SDGs. • T2DM should not only be considered as an adult-onset disease, implying a paradigm shift for paediatric DM services and a strengthening of interventions on social and commercial determinants of health.

5.L. Workshop: School health literacy as a means to achieve European public health goals

Abstract Background In recent years, health literacy has been acknowledged as crucial in context of school health promotion, prevention, and education. In 2020, the Schools for Health in Europe Network, linking the 53 WHO European Region Member States to collaborate on school health, released a milestone fact sheet on health literacy in schools, including an evidence synthesis on how health literacy impacts not only health goals but educational outcomes. In 2021, the World Health Organization Regional Office for Europe produced an evidence informed report, recommending the way forward regarding school health literacy in the realm of European public health. Organizational health literacy of schools is named a key responsibility for educational establishments alongside activities to address digitalization in education, climate and planetary health, the commercial determinants of health, the role of social media, and the aftermath of the Covid-19 pandemic. Achieving health literacy development throughout childhood and adolescence requires an early and systematic approach, ideally implemented in schools. Classroom learning and instruction by teachers qualified in health education are key to strengthen skills, behaviours, knowledge, and attitudes that schoolchildren will need to appropriately manage health information from various sources and form health decisions to promote their health in everyday life. Schools are widely accepted as the ideal setting for children to learn about and take responsibility for their own health and self-directed learning, bringing together all elements of health literacy including digital, mental, and organizational health literacy. Teaching materials and targeted sessions on health literacy, either embedded into a subject or as a cross-cutting topic, have several benefits: they reach all children regardless of their social, cultural or development background, they can be delivered over the course of a decade and longer, they can be repeated to enhance learning effects, with increasing grades the complexity and content can be expanded, and in schools it is possible to swiftly respond to contemporary health concerns of children. Objectives This workshop will present empirical findings and intervention research results from various school health literacy studies. (i) The first presentation will discuss findings of school principal's health literacy. (ii) The second presentation will provide key findings from the first ever study on organizational health literacy in schools. (iii) The third presentation will present the evaluation of a mental health literacy programme for students and teachers. (iv) The fourth presentation will introduce a digital health literacy intervention for schoolchildren. The format of this workshop will be 4x7-minute presentations followed by a 20-minute panel discussion, reflecting the relevance of the results to public health research, practice and policy. Key messages • School health literacy is an important topic within the context of school health promotion, prevention, and education. • Addressing health literacy as early as in schools will enable children and adolescent to become health literate, enabling them to face health challenges over the life-course.

Noncommunicable diseases, risk factors, commercial determinants

Unhealthy diet is an important risk factor for chronic diseases. Often this is seen as an individual level problem, but what we eat to a large extent is determined by complex, external factors, that lie outside the direct scope of control of individuals. In this plenary, the link between the commercial determinants of health, diet, and chronic diseases will be explored with a focus on positive action and what can be done concretely to improve our food systems and diets and thereby our health. The topic will be addressed from several angles, looking e.g., at what policy and legislation can achieve, how civil society can contribute, and how we can empower individuals through improved health literacy. Moderators: Josep Figueras, Director European Observatory on Health Systems and Policies Nicole Mauer, European Observatory on Health Systems and Policies Introductory keynote speaker: Iveta Nagyova, President EUPHA and Head of the Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia Speakers/Panellists: Mark Petticrew, London School of Hygiene and Tropical Medicine, London, UK Amandine Garde, Public Health and School of Law and Social Justice, University of Liverpool, Liverpool, UK Simon Bacon, Concordia University, Montreal, Canada

Making multisectoral committees work: Lessons from tobacco control in two Pacific small island developing states

AbstractThe consumption of harmful commodities drives the noncommunicable disease (NCD) epidemic globally and in Pacific small island developing states. Multisectoral committees are commonly chosen avenues to facilitate policy coherence across government sectors in regulating the commercial determinants of health (CDoH), but these committees often fail to function as intended. This paper aims to explore the institutional conditions that enable or constrain multisectoral committees in facilitating policy coherence for tobacco control in Fiji and Vanuatu. An exploratory, qualitative research design was applied, incorporating a two‐case study design with within‐case analysis and cross‐case synthesis. Data collection consisted of 70 in‐depth interviews in 2018 and 2019. Data collection and analysis were informed by an analytical framework drawn from the institutional collective action framework. The results show that the current amount of authority behind the investigated multisectoral committees in Fiji and Vanuatu is inadequate to meaningfully bring stakeholders together for an issue with high complexity. Moreover, multisectoral discussions on tobacco control have a high risk to break down, as the collaboration may generate unwanted impacts to one or more actors and the net benefits are perceived to be low. The authority behind multisectoral committees might be strengthened by the chairmanship of a cross‐sectoral, high‐level government official and the allocation of more resources for managing intersectoral engagement. Divergent preferences might be brought closer together by showcasing the socioeconomic costs of NCDs and policies affecting the availability, affordability, accessibility, and desirability of tobacco and raising awareness about CDoH in nonhealth sectors.

Exploring English policymakers' attitudes towards dementia risk reduction: A qualitative study.

A growing evidence-base indicates that dementia occurrence can be changed. This has been linked to potentially modifiable risk factors. Risk reduction and primary prevention strategies are increasingly recognized as needing to include population-level policies to tackle the social and commercial determinants of health. How this knowledge can influence policymaking on dementia prevention is unknown. Understanding attitudes of policymakers is an important step in translating evidence into practice, helping to gauge system readiness for implementation, and potential barriers and enablers for influencing policy. The aim of this qualitative study is to explore the understanding of, and attitudes to, dementia risk reduction and population-level prevention strategies amongst English policymakers at national, regional, and local level. Semi-structured interviews were undertaken with a range of dementia and prevention policymakers, with purposive sampling of national and local policymakers, including politicians, government officials, health system leaders, academics, and dementia charity directors. Analysis of interview transcripts was undertaken by thematic analysis. 14 policymakers were interviewed between November 2021 and February 2022. Three main themes were identified (1) Preventability of dementia, (2) Prevention approach, (3) Barriers and facilitators to improving the approach. Policymakers generally held dementia to be partially preventable. Policymakers recognised that both individual- and population-level approaches to primary prevention of dementia are required - with some policymakers perceiving that population-level approaches are under-utilised. Key barriers to implementing more population-level approaches were identified as the complexity and co-ordination required to effectively tackle upstream determinants of health.