Here is our report from evaluating an innovative programme to take a whole-systems approach to healthy weight in Wales. We carried out this evaluation on behalf of Public Health Wales. We explored learning about systems working and its impact as the programme progressed from mapping systems and laying the groundwork into developing systems actions across local, regional, and national levels in Wales.

About the Programme

The Whole Systems Approach to Healthy Weight Programme is ambitious, delivered by Public Health Wales, the Directors of Public Health Leadership Group, and Welsh Government. It is part of a larger movement in Wales to tackle complex issues using systems change approaches, supported by the forward-thinking Future Generations Act. Its strength lies in moving from describing the theory of systems change, towards facilitating practical implementation in seven different local contexts as well as at the national and national-local levels.

Our evaluation

Building on our previous evaluation and systems change work in Wales, this research explored delivery in line with the Programme’s 9-step approach, and progress towards systems change impacts. We spoke with public health professionals across Wales at the regional and national level, and co-developed six unique case studies to show the systems learning in practice.

Delivery so far

There has been cross-cutting progress in laying the groundwork, building relationships, making in-roads into key system structures such as Public Service Boards, identifying target ‘sub-systems’ in which to make changes, and implementing new ideas. The extent, fidelity, and pace of delivery vary across regions, shaped by local contexts, histories, capacities, challenges and opportunities. Furthermore, the drivers of healthy weight vary geographically, particularly along the lines of urban/rural divides and levels of deprivation.

Key lessons and next steps

As the delivery continues, further learning will continue to emerge and shape the programme in line with systems change principles. Some of our key lessons to guide this thinking going forward were:

• A programme at this scale must navigate some of the inherent tensions within systems change, for example: short-term wins versus sustainable change; ‘zooming out’ and ‘zooming in’; allow national consistency but local flexibility; and measuring and demonstrating success within programme timeframes.
• Some of the determinants of healthy weight, particularly commercial determinants, may require national as well as regional action to make most impact. The potential for ‘sliding’ learning and action up and down these geographical scales, is one of the strengths of the programme design.
• Adhering to a systems change approach – long-term, hard-to-predict change that is non-linear and cross-boundary – within systems whose organising principles do not always match this, can be challenging and is an area of ongoing learning.
• That said, the departure from typical ways of working that the programme represents, is valued by stakeholders. There is a strong shared commitment to systems change as the right way to tackle healthy weight amongst the stakeholders we spoke to, which helps to keep driving the work forward.
• Systems change remains at the forefront of the Welsh Government’s strategy for Healthy Weight: Healthy Wales, incorporating learning from the evaluation in it’s 2025-2027 delivery plan.

You can read the report below:

Evaluation of Whole Systems Approach to Healthy Weight

Gwerthuso Dull System Gyfan ar gyfer Pwysau Iach