Cost-effectiveness of sodium reduction and other public health interventions

Policies which address the food environment at the population level may help prevent chronic disease, but societal benefits and costs are still uncertain. Dietary sodium has long been linked to increased prevalence of hypertension, a primary risk factor for cardiovascular and renal diseases. We discuss how interventions reducing sodium intake compare to other medical and public health interventions. Among the key features that make a reduction in sodium intake a very realistic public health goal are two institutional factors: 1) The vast majority of sodium is added during commercial food production with only 1/5th naturally occurring or added by the consumer; 2) the FDA can regulate the use of such food additives.

Americans consume daily about 3400mg of sodium (about 8.5 grams of salt), almost 1.5 times the recommended maximum intake for adults of 2300 mg. Several different models resulting in fairly similar conclusions have been published in the last 2 years, one result being that lowering average population sodium intake to 2300 mg per day would reduce cases of hypertension by 11 million, save $18 billion health care dollars, and gain 312,000 quality-adjusted life years (QALYs) worth $32 billion annually. Compared to many medical prevention strategies (i.e. screening for breast cancer, renopathy screening for diabetes 2, influenza vaccination), a sodium reduction intervention has a much larger potential to increase QALYs because of its broad reach, yet would be much less costly to implement. Compared to other desirable dietary changes (e.g. increase in fruit/vegetable consumption, reduction in excess discretionary calories), sodium reduction is a very realistic target in the short term.