Will Cardiovascular Disease Prevention Widen Health Inequalities?

Simon Capewell and Hilary Graham review different population strategies for preventing cardiovascular disease and conclude that screening and treating high-risk individuals may be ineffective and widen social inequalities

Editorial: Selling a sugar tax: the sweet smell of success?

This editorial briefly considers the increasing epidemic of obesity and Type 2 diabetes, the underlying drivers of junk food and sugary drinks, and the recent scientific and campaigning movements culminating in the UK Chancellor's surprise announcement of a Sugary Drinks Levy

United Nations’ dietary policies to prevent cardiovascular disease

Modest diet changes could halve the global burde

An economic evaluation of salt reduction policies to reduce coronary heart disease in England: a policy modeling study

AbstractObjectivesDietary salt intake has been causally linked to high blood pressure and increased risk of cardiovascular events. Cardiovascular disease causes approximately 35% of total UK deaths, at an estimated annual cost of £30 billion. The World Health Organization and the National Institute for Health and Care Excellence have recommended a reduction in the intake of salt in people's diets. This study evaluated the cost-effectiveness of four population health policies to reduce dietary salt intake on an English population to prevent coronary heart disease (CHD).MethodsThe validated IMPACT CHD model was used to quantify and compare four policies: 1) Change4Life health promotion campaign, 2) front-of-pack traffic light labeling to display salt content, 3) Food Standards Agency working with the food industry to reduce salt (voluntary), and 4) mandatory reformulation to reduce salt in processed foods. The effectiveness of these policies in reducing salt intake, and hence blood pressure, was determined by systematic literature review. The model calculated the reduction in mortality associated with each policy, quantified as life-years gained over 10 years. Policy costs were calculated using evidence from published sources. Health care costs for specific CHD patient groups were estimated. Costs were compared against a “do nothing” baseline.ResultsAll policies resulted in a life-year gain over the baseline. Change4life and labeling each gained approximately 1960 life-years, voluntary reformulation 14,560 life-years, and mandatory reformulation 19,320 life-years. Each policy appeared cost saving, with mandatory reformulation offering the largest cost saving, more than £660 million.ConclusionsAll policies to reduce dietary salt intake could gain life-years and reduce health care expenditure on coronary heart disease

Bringing prevention to the population: an important role for cardiologists in policy-making.

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Food for thought? Potential conflicts of interest in academic experts advising government and charities on dietary policies

Abstract Background A conflict of interest (CoI) can occur between public duty and private interest, in which a public official’s private-capacity interest could improperly influence the performance of their official duties and responsibilities. The most tangible and commonly considered CoI are financial. However, CoI can also arise due to other types of influence including interpersonal relationships, career progression, or ideology. CoI thus exist in academia, business, government and non-governmental organisations. However, public knowledge of CoI is currently limited due to a lack of information. The mechanisms of managing potential conflicts of interest also remain unclear due to a lack of guidelines. We therefore examined the independence of academic experts and how well potential CoI are identified and addressed in four government and non-governmental organisations in the UK responsible for the development of food policy. Methods Policy analysis. We developed an analytical framework to explore CoI in high-level UK food policy advice, using four case studies. Two government policy-making bodies: Department of Health ‘Obesity Review Group’ (ORG), ‘Scientific Advisory Committee on Nutrition’ (SACN) and two charities: ‘Action on Sugar’ (AoS), & ‘Heart of Mersey’ (HoM). Information was obtained from publicly available sources and declarations. We developed a five point ordinal scale based upon the ideology of the Nolan Principles of Public Life. Group members were individually categorised on the ordinal ConScale from “0”, (complete independence from the food and drink industry) to “4”, (employed by the food and drink industry or a representative organisation). Results CoI involving various industries have long been evident in policy making, academia and clinical practice. Suggested approaches for managing CoI could be categorised as “deny”, “describe”, or “diminish”. Declared CoI were common in the ORG and SACN. 4 out of 28 ORG members were direct industry employees. In SACN 11 out of 17 members declared industry advisory roles or industry research funding. The two charities appeared to have equally strong academic expertise but fewer conflicts. No HoM members declared CoI. 5 out of 21 AoS members declared links with industry, mainly pharmaceutical companies. We were unable to obtain information on conflicts for some individuals. Conclusions Conflicts of interest are unavoidable but potentially manageable. Government organisations responsible for policy development and implementation must institutionalize an approach to identify (disclose) and manage (mitigate or eliminate) perceived and actual CoI to improve public confidence in government decision-making relevant to food policy