| Summary: | Introduction: Cardiovascular disease and cancers are the main causes of premature death and disability in England. This thesis uses a microsimulation modelling methodology to examine and quantify the effectiveness and equity of existing primary prevention policies and feasible alternatives. Methods: I created and validated IMPACT_NCD, a dynamic stochastic microsimulation model from first epidemiological principles, to simulate the life course of synthetic individuals under counterfactual scenarios. First, I used the model to quantify the contribution of statins to the observed decline in total cholesterol in England. Then, I examined a national screening programme known as 'NHS Health Checks'. Afterwards, I estimated the effectiveness and equity of the national salt reduction strategy. Finally, I studied two proposed policies for the tobacco 'endgame'; a total sales ban, and a sales ban restricted to those born in or after 2000. Results: The model suggested that statins contributed only about a third of the observed total cholesterol decline in England since 1991-92. Their impact on reducing socioeconomic inequalities in total cholesterol was generally positive, contrary to what was anticipated. NHS Health Checks may prevent or postpone about 19,000 cases of cardiovascular disease by 2030; however, population wide structural policies could be three times more effective and generally more equitable. IMPACT_NCD estimated that the national salt reduction strategy may have prevented or postponed about 52,000 cases of cardiovascular disease and 5000 cases of gastric cancer since 2003. Additional legislative policies from 2016 onwards could further prevent or postpone approximately 20,000 more cases by 2030, while reducing inequalities. Finally, a total ban on sales of tobacco products could prevent or postpone about 90,000 cases of cardiovascular disease, 79,000 cases of lung cancer, and tremendously reduce health inequalities by 2045. The age restricted ban could have small benefits overall within the simulation horizon. Conclusions: Increasing the structural elements of existing policies or complementing them with new structural policies might maximise their effectiveness and equity. Simulation modelling is valuable for the evaluation of existing policies and the design of new fit for purpose policies that will take into account the complex nature and dynamics of the populations.
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