Reducing salt intake by 15% and implementing key elements of WHO's tobacco control framework would avert millions of chronic disease related deaths for as little as an average US$0.36 per person per year. These are the conclusions of Dr Perviz Asaria, Kings Fund London, UK and colleagues, authors of this third paper in The Lancet Chronic Diseases Series.
In their analysis, the authors studies 23 countries* worldwide that carry 80% of the burden of chronic disease for low-income and middle-income countries. Two meta-analyses have shown that reducing salt intake in people with or without high blood pressure can reduce blood pressure by small but important amounts. In these countries, salt is used to preserve meat and fish, in seasoning and sauces, and at the table. Simple changes in diet, such as avoiding salty foods and not adding it at the table, can reduce sodium intake by 3-4.5g per day, around 30% of the average intake. Lowering salt content of, eg, soy sauce is also feasible, as is salt substitution.
The authors modelled the effect of a 15% reduction in salt consumption in the 23 countries, which would be achieved by voluntary reductions in salt content of processed foods and condiments by manufacturers, plus a sustained mass-media campaign aimed to encourage dietary change within households and communities. This strategy could avert 8.5 million deaths between 2006-2015.
For tobacco control, the authors looked at implementing four parts of the WHO Framework Convention on Tobacco Control (FCTC) increased taxes on tobacco to reduce smoking prevalence, enforcement of smoke-free workplaces, tobacco packaging and labelling restrictions combined with public awareness campaigns on health-risks of smoking, and finally a comprehensive ban on tobacco advertising, promotion, and sponsorship. Such interventions would reduce smoking prevalence by an estimated 20.8% in the 23 countries studied, thereby averting 5.5 million deaths from chronic diseases related to smoking -- ie, cardiovascular diseases, respiratory diseases, and cancers.
Combining both salt reduction and tobacco control figures would give an adjusted total of 13.8 million chronic disease related deaths averted. Most of the deaths averted (75.8%) would be from cardiovascular diseases, followed by deaths from respiratory disease (15.4%), and cancers (8.7%). More than half (58.7%) of deaths averted would be in men, due to their higher/longer exposures to tobacco in these countries. Deaths averted in men older and younger than 70 years would be about equal, whereas 71% of deaths averted in women would be in those aged over 70 years, reflecting lower tobacco exposures and later onset of cardiovascular mortality in women and the greater benefit of salt reduction in older age-groups who have higher baseline blood pressures.
Whilst actual numbers of deaths averted were highest in China and India due to sheer population size, the highest reductions in mortality rates per 100000 population over 30 years were in Russia (166), Poland (160), and Ukraine (153), reflecting the very high rates of cardiovascular disease in this populations, their high baseline blood pressures and exposure to tobacco. Salt interventions alone also had the greatest effect in these countries, while tobacco control alone had the highest effect in Poland, Vietnam, China, and Indonesia. The total averted deaths in the 23 countries would represent 60% of the global goal** for reduction of chronic disease for these countries, and 38% of the worldwide global goal.
The cost of implementing the strategy would range from US$0.14 to $0.38 per person per year in low-income and lower-middle income countries, and from $0.52 to $1.04 per person per year in upper-middle income countries. The average across the 23 countries was $0.36 per person per year, which on average was equivalent to 0.5% of government health spending in the 23 countries. However this proportion was 4.7% in the nine low-income countries studied. Most of the total cost, between 67-80%, would be to implement tobacco control, with the rest coming from salt restriction implementation.
The authors conclude: "Analysis of the global goal presented in the first paper of this Series suggests that [people in whom deaths are averted] might survive for 18 years on average. A small number of population-based interventions, which could be implemented without great cost or the need for structural change to the health system, especially in the 20 out of 23 countries that are signatories to the FCTC, could make a major contribution to the goal of reducing rates of death from chronic diseases by an additional 2% per year."
This paper associated with this release can be found at http://www.eurekalert.org/jrnls/lance/CD3.pdf
Journal
The Lancet