EA - Deep Report on Hypertension by Joel Tan (CEARCH)

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Deep Report on Hypertension, published by Joel Tan (CEARCH) on August 2, 2023 on The Effective Altruism Forum.Taking into account (a) the expected benefits of eliminating hypertension, in terms of improved health and increased economic output, while also factoring in (b) the expected costs on the economic front and (c) the tractability of advocacy for top sodium reduction policies (i.e. a sodium tax; mandatory food reformulation; a strategic location intervention; a public education campaign; and front-of-pack labelling) to prevent and ameliorate hypertension, CEARCH finds the marginal expected value of advocacy for these top sodium reduction policies to control hypertension to be 88,052 DALYs per USD 100,000, which is at least 10x as cost-effective as giving to a GiveWell top charity.Our detailed cost-effectiveness analysis can be found here, as can the full report can be read here.Introduction: This report on hypertension is the culmination of three iterative rounds of research: (i) an initial shallow research round involving 1 week of desktop research; (ii) a subsequent intermediate research round involving 2 weeks of desktop research and expert interviews; and (iii) a final deep research round involving 3 weeks of desktop research, expert interviews, and the commissioning of surveys and quantitative modelling.Importance: Globally, hypertension is certainly a problem, and causes a significant health burden of 248 million disability-adjusted life years (DALYs) in 2024, as well as an accompanying net economic burden equivalent to 748 million foregone doublings of GDP per capita, each of which people typically value at around 1/5th of a year of healthy life. And the problem is only expected to grow between 2024 and 2100, as a result of factors like high sodium consumption, ageing, and population growth.Neglectedness: Government policy is far from adequate, with only 4% of countries currently implementing the top WHO-recommended ideas on sodium reduction, and this not expected to change much going forward - based on the historical track record, any individual country has only a 1% chance per annum of introducing such policies. At the same time, while there are NGOs working on hypertension and sodium reduction (e.g. in China, India and Latin America) - and while some are impact-oriented in focusing on poorer countries where the disease is growing far more rapidly than in wealthier countries - fundamentally, not enough is being done.Tractability: There are many potential solutions to the problem of hypertension (e.g. reducing dietary sodium, increasing potassium consumption, and pharmacological agents); however, we find that the most cost-effective solution is likely to be advocacy for top sodium reduction policies - specifically: a sodium tax; mandatory food reformulation; a strategic location intervention to change food availability in public institutions like hospitals, schools, workplaces and nursing homes; a public education campaign; and front-of-pack labelling. The theory of change behind this intervention package is as such:Step 1: Lobby a government to implement top sodium reduction policies.Step 2a: Sodium tax reduces sodium consumption.Step 2b: Mandatory food reformulation reduces sodium consumption.Step 2c: Strategic location intervention reduces sodium consumption.Step 2d: Public education reduces sodium consumption.Step 2e: Mandatory front-of-pack labelling reduces sodium consumption.Step 3: Lower sodium consumption in a single country reduces blood pressure and hence the global disease burden of hypertensionUsing the track record of past sodium control and sugar tax advocacy efforts and of general lobbying attempts (i.e. an "outside view"), and combining this with reasoning through the particulars of the case (i.e. an "inside view"), our bes...