Cardiovascular disease is one of the biggest public health challenges facing America today by any measure. It is the leading cause of mortality and morbidity in the U.S., resulting in 800,000 deaths and 6 million hospital admissions per year. Cardiovascular disease costs the economy $318 billion annually in healthcare costs and an additional $237 billion in lost productivity.
Sodium consumption is the leading modifiable risk factor for both cardiovascular disease and high blood pressure, so it’s no surprise that in 2016 the U.S. Food and Drug Administration (FDA) proposed adopting voluntary 2-year and 10-year sodium targets for commercially processed and prepared foods. These targets are in line with policies that have been proven to reduce sodium intake in the U.K. and other European countries. However, the U.S. Congress has moved to block the FDA from issuing such standards, in part due to questions about their effectiveness.
A recent study led by Imperial College of London’s Dr. Jonathan Pearson-Stuttard in collaboration with U.S. and other international researcher institutions sheds some light on these important questions. Aspiring public health professionals anywhere in the world can work on impactful projects like these with the 100% online Global Masters in Public Health from Imperial College London.
Evaluating the Effectiveness and Costs of Sodium Targets
Researchers used the previously-validated US IMPACT Food Policy Model to project the standards’ impact on cardiovascular disease (CVD) cases and deaths, quality-adjusted life years (QALYs), and cost-effectiveness over a 20-year time period. Because the standards are voluntary, the researchers also modeled several different compliance scenarios to estimate of the range of potential outcomes.
- 100% compliance with 10-year targets: The optimal scenario would prevent 450,000 CVD cases, gain 2.1 million QALYs, and produce cost savings of $41 billion.
- 50% compliance with 10-year targets: The moderate scenario would prevent 220,000 CVD cases, gain 1.1 million QALYs, and save $19 billion in costs.
- 100% compliance with 2-year targets, 0% compliance with 10-year targets: The pessimistic scenario would prevent 120,000 CVD cases, gain 700,000 QALYs, and save $12 billion in costs.
A Monte Carlo sensitivity analysis indicated that all three scenarios yielded a greater than 80% probability that the standards would be cost-effective by 2021 and cost-saving by 2031, making a clear case that these policies make sense from a health as well as an economic perspective. These cost-saving estimates included both industry costs from reformulating products to meet the targets, as well as government costs for administering the policy itself.
It’s also worth noting that the absolute health benefits of the policy would be roughly 50% higher for men than women, owing to their higher sodium intake. The policy would also benefit older Americans and black Americans. The impacts on black Americans is important considering the disproportionate CVD burdens faced by this population. This factor makes the policy effective from an equity perspective (as well as in absolute terms).
International Collaboration Key for Nutritional Health
As noted above, the FDA’s proposed standards for the U.S. were based on those implemented in the U.K. and other European countries. Similarly, the research team for this project spanned both continents. Co-authors of the report include Dr. Pearson-Stuttard of Imperial College London as well as researchers from the University of Liverpool, Tufts University, the Medical University of Gdansk, Poland, and the American Heart Association.
The collaboration with U.S. researchers at Tufts and the American Heart Association are part of an extensive track record of collaboration between Imperial College and American institutions. In fact, U.S. researchers were the co-authors for nearly 8,000 papers published by Imperial researchers from 2015 to 2017, more than any other country.
The study was conducted as part of the Food-PRICE (Food Policy Review and Intervention Cost-Effectiveness) project at Tufts, a collaboration of US and European researchers seeking to identify population-level nutrition strategies to improve public health outcomes for Americans. Areas of focus for the project include heart disease, stroke, diabetes, obesity, and cancer in the US.
If you’re interested in making an impact on public health and public policy in the US — or anywhere else in the world — the Global Master of Public Health degree from Imperial College gives you the chance to collaborate with peers and study on your schedule from wherever you are.