Cardiovascular disease (CVD) is the leading cause of death in the US and globally, with direct and indirect costs exceeding half a trillion dollars/year in the US only. We and others have shown that suboptimal diet is a leading cause of CVD. Thus, improving diet must be a major priority for reducing CVD burden. While we now understand several key dietary priorities for reducing CVD, we know far less about how to effectively promote healthy diets in the population. In ongoing NIH-funded work, we have systematically assessed the quantitative effects of specific evidence-based policy (population-based) interventions to improve diet and reduce CVD. Specific policy actions within four policy domains appear highly promising: (1) food prices (taxation, subsidies); (2) food composition (reformulation); (3) food promotion (marketing); and (4) food labeling (nutrition facts panels, front-of-package labels). Yet evidence on efficacy alone is often insufficient to move policy, without knowledge on cost, cost-effectiveness, feasibility, and equity assurance of any given intervention. Each of these are potential barriers to policy adoption, and each could vary substantially depending on the policy and target population group. The present proposal builds upon substantial prior work and rigorous methodology developed to begin to address each of these barriers. We propose to evaluate the costs (Aim 1), cost-effectiveness and effects on disparities (Aim 2), and political and legal feasibility (Aim 3) of 14 specific evidence-based policies to improve diet and reduce CVD in the US.
For Aim 1, we will adopt a micro-costing approach and established methods to estimate the cost of implementing each policy at the national level. Then, we will use an IMPACT Food Policy Model and a discrete event CVD microsimulation policy model to project short (5-10 years), medium (10-20 years) and long (lifetime) term costs and CVD benefits of each intervention in the US population. Cost- effectiveness will be evaluated as incremental costs per incremental quality-adjusted life years gained. Effects on disparities will be evaluated by comparing adults eligible vs. not eligible for the Supplemental Nutrition Assistance Program (SNAP). We will subsequently conduct an in-depth political analysis for each policy to generate a stakeholder map, assess the political feasibility/impact, and derive specific strategies to overcome identified political barriers. Legal feasibility will be analyzed for each policy in parallel, to determine constitutional authorizationas well as barriers to implementation at the federal, state, and local levels. This innovative investigation will provide high impact findings on the cost, cost-effectiveness, influence on disparities, and political and legal feasibility of promising dietary policies to reduce CVD in the US. The findings will be critical to inform the planning, implementation and evaluation of evidence-based dietary strategies to achieve optimal cardiovascular health and reduce inequities for all Americans.

Public Health Relevance

Given rising CVD prevalence, long-term complications, medical challenges, and escalating health care costs, preventing the onset of CVD is of paramount importance. The assessment of the cost, cost- effectiveness, influence on disparities, and political and legal feasibility of evidence-based policy (population- based) strategies to alter diet and reduce CVD will provide essential insights for evidence-based preventive efforts, identify important gaps for future studies, and advance the methodology of such assessments. Such evaluation is novel, and directly fulfills the NIH's mission to pursue fundamental knowledge about human health and illness and the application of that knowledge to extend healthy life and reduce the economic and health burdens of disease for all Americans.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Dissemination and Implementation Research in Health Study Section (DIRH)
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Kaufmann, Peter G
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Tufts University
Other Domestic Higher Education
United States
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