Date Published: June 6, 2017
Publisher: Public Library of Science
Author(s): Jonathan Pearson-Stuttard, Piotr Bandosz, Colin D. Rehm, Jose Penalvo, Laurie Whitsel, Tom Gaziano, Zach Conrad, Parke Wilde, Renata Micha, Ffion Lloyd-Williams, Simon Capewell, Dariush Mozaffarian, Martin O’Flaherty, Sanjay Basu
Abstract: BackgroundLarge socio-economic disparities exist in US dietary habits and cardiovascular disease (CVD) mortality. While economic incentives have demonstrated success in improving dietary choices, the quantitative impact of different dietary policies on CVD disparities is not well established. We aimed to quantify and compare the potential effects on total CVD mortality and disparities of specific dietary policies to increase fruit and vegetable (F&V) consumption and reduce sugar-sweetened beverage (SSB) consumption in the US.Methods and findingsUsing the US IMPACT Food Policy Model and probabilistic sensitivity analyses, we estimated and compared the reductions in CVD mortality and socio-economic disparities in the US population potentially achievable from 2015 to 2030 with specific dietary policy scenarios: (a) a national mass media campaign (MMC) aimed to increase consumption of F&Vs and reduce consumption of SSBs, (b) a national fiscal policy to tax SSBs to increase prices by 10%, (c) a national fiscal policy to subsidise F&Vs to reduce prices by 10%, and (d) a targeted policy to subsidise F&Vs to reduce prices by 30% among Supplemental Nutrition Assistance Program (SNAP) participants only. We also evaluated a combined policy approach, combining all of the above policies. Data sources included the Surveillance, Epidemiology, and End Results Program, National Vital Statistics System, National Health and Nutrition Examination Survey, and published meta-analyses.Among the individual policy scenarios, a national 10% F&V subsidy was projected to be most beneficial, potentially resulting in approximately 150,500 (95% uncertainty interval [UI] 141,400–158,500) CVD deaths prevented or postponed (DPPs) by 2030 in the US. This far exceeds the approximately 35,100 (95% UI 31,700–37,500) DPPs potentially attributable to a 30% F&V subsidy targeting SNAP participants, the approximately 25,800 (95% UI 24,300–28,500) DPPs for a 1-y MMC, or the approximately 31,000 (95% UI 26,800–35,300) DPPs for a 10% SSB tax.Neither the MMC nor the individual national economic policies would significantly reduce CVD socio-economic disparities. However, the SNAP-targeted intervention might potentially reduce CVD disparities between SNAP participants and SNAP-ineligible individuals, by approximately 8% (10 DPPs per 100,000 population). The combined policy approach might save more lives than any single policy studied (approximately 230,000 DPPs by 2030) while also significantly reducing disparities, by approximately 6% (7 DPPs per 100,000 population).Limitations include our effect estimates in the model; these estimates use interventional and prospective observational studies (not exclusively randomised controlled trials). They are thus imperfect and should be interpreted as the best available evidence. Another key limitation is that we considered only CVD outcomes; the policies we explored would undoubtedly have additional beneficial effects upon other diseases. Further, we did not model or compare the cost-effectiveness of each proposed policy.ConclusionsFiscal strategies targeting diet might substantially reduce CVD burdens. A national 10% F&V subsidy would save by far the most lives, while a 30% F&V subsidy targeting SNAP participants would most reduce socio-economic disparities. A combined policy would have the greatest overall impact on both mortality and socio-economic disparities.
Partial Text: Cardiovascular disease (CVD) is declining in the US [1–3]. However, CVD remains the leading cause of mortality, generating approximately 800,000 deaths and 6 million hospital admissions annually . Crucially, these burdens are highly unequal across the population, in particular according to socio-economic status (SES) .
We modelled the potential effects of specific US dietary policies targeting F&Vs and SSBs from 2015 to 2030 using the previously validated US IMPACT Food Policy Model. We quantified and compared the associated change in dietary intake for a national MMC, national fiscal policies targeting F&Vs or SSBs, and a F&V targeted policy in SNAP participants, all by age, sex, and SNAP participation status. We also evaluated the joint associated change in dietary intake of combining these policies. We modelled the comparative effects upon coronary heart disease (CHD), stroke, and total CVD mortality, as well as the effect on CVD socio-economic disparities, comparing SNAP participants and SNAP-ineligible individuals.
Our study suggests that reducing the price of healthy foods for SNAP participants whilst additionally reducing SSB consumption nationally through taxes and a media campaign could potentially reduce socio-economic disparities in CVD mortality and powerfully improve dietary quality, the leading risk factor for CVD.