Food Policies and Disease Prevention – the IMPACT model
Heart disease, stroke, diabetes, dementia and cancers cause over 90% of premature UK deaths; however, most are preventable. Researchers at the University of Liverpool have developed computational models to quantify and compare different prevention policies, successfully advancing food policies such as the UK dietary salt reduction targets, sugary drinks tax, along with EU and WHO policies to eliminate industrial transfats from the world's food supplies.
The challenge
Non-communicable diseases (NCDs) include heart disease, stroke, diabetes, dementia and cancers. NCDs prematurely kill over 175,000 Britons every year. However, most premature NCDs are preventable. Crucially, some 40% are attributable to poor diet and obesity.
When developing health policies for the prevention of diseases, choices need to be made between different strategies. For instance, should we prioritise population-based interventions rather than those aimed at high-risk individuals? Should priority be given to cost-effective policy interventions for primary prevention (eg lowering blood pressure by reducing salt intake) rather than secondary prevention (eg treatment of people with high blood pressure)? Research and modelling are required to assess the most appropriate and effective mix of these strategies, and to inform key decision making bodies.
Our research
Professor Simon Capewell, Professor Martin O’Flaherty and Dr Chris Kypridemos jointly lead a comprehensive research programme using innovative computational models. They can thus define epidemiological trends, then quantify and compare the potential health, economic and equity benefits of healthier food policies to prevent NCDs. Compared with medical treatments, population-wide NCD prevention policies consistently save more lives, reduce inequalities and achieve impressive cost-savings.
Their IMPACT computational epidemiological models provide clear explanations for the dramatic cardiovascular and NCD trends in the UK, USA and diverse high, middle and low income countries. Furthermore, their research has shown that the number of older people with care needs in the UK will expand by 25% within a decade, due to population ageing. At age 65, a quarter of life expectancy will likely involve disability (a key issue for NHS service planners).
Their work informing evidence-based healthy food policies covers three areas:
- Sugary Drinks Tax and Obesity Prevention
- Dietary Salt Reduction Policies
- Eliminating Industrial Transfats.
Their ongoing research involves further modelling innovation and seeks to better understand the evolving burden of premature NCDs, and how best to prevent them by harnessing policy actions across all sectors of society.
Working in partnership
To effect real change to health and food policy, Professors Capewell and O’Flaherty consistently engage a wide range of key stakeholders, including advocacy groups, policy makers, and local councils, while also advocating their research on influential committees, groups and councils. Professor Capewell was Chair of the NICE Programme Development Group for cardiovascular disease prevention, as well as being a founder member of the campaign group Action on Sugar. Professor O'Flaherty advises the WHO Eastern Mediterranean Regional Office on industrial transfats reduction. The WHO subsequently launched the 'Replace Initiative' to eliminate industrial transfats from the world's food supplies. To date six countries have applied these recommendations. The team also engage the media (TV, radio, broadsheet newspapers, as well as social media) to promote key messages, build public awareness and support of proposed policy changes.
Disease prevention through policy change
The results have successfully advanced diverse food policies, by empowering advocacy groups and informing parliament and government, including:
- A UK sugary drinks tax (adopted into law 2016), raising £250 million annual revenue for schools and slashing drink sugar content by 29%; hence 400,000 fewer people becoming obese or overweight by 2030
- Their dietary salt reduction analyses empowered the 2019 Prevention Green Paper salt target, potentially preventing over 25,000 heart attacks and strokes, and saving over £1 billion by 2025
- Food transfats elimination: the new EC regulation is predicted to annually prevent approximately 1,500 heart disease and stroke deaths, with £260 million in healthcare savings.
All three policies are already reducing inequalities, admissions and NHS costs.
We need to speak about smart ways to improve public health: understanding the societal, economic and political structures driving the NCD epidemic, focussing more on populations, not just individuals. The aim is to move prevention 'upstream' (i.e. less healthcare system, more population-wide policies).
Dr Chris Kypridemos
There are no magic bullets - we need to find the best combination of prevention and care to maximise longer, disease-free lives for everyone.
Professor Martin O'Flaherty
