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

Link to original articleWelcome 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: Shallow Report on Hypertension, published by Joel Tan (CEARCH) on November 21, 2022 on The Effective Altruism Forum.SummaryTaking into account the expected benefits of eliminating hypertension (i.e. improved health and greater economic output), as well as the tractability of sodium taxation policy advocacy, I find that the marginal expected value of sodium taxation policy advocacy to control hypertension to be 190,927 DALYs per USD 100,000, which is around 300x as cost-effective as giving to a GiveWell top charity.Key PointsImportance: This is a strongly important cause, with 1.28 1010 DALYs at stake from now to the indefinite future. Around 84% of the burden is health related, while 16% is economic in nature.Neglectedness: Whatever governments/charities/businesses are doing to solve this problem (e.g. labelling laws/providing low sodium food in food banks/developing new hypertension drugs) may be making a difference, since age-standardized DALYs lost are falling, but (a) attribution is hard, and structural factors (e.g. more educated populations eating and exercising better, or economic development expanding access to healthcare) will also be behind the decline; and (b) all this is insufficient all the same, with population growth and ageing driving an increase in DALYs lost over time for the coming decades.Tractability: A moderately tractable solution in the form of sodium taxes is available. This is highly effective if and when implemented, but there is of course considerably uncertainty as to whether advocacy for taxes on food – which are highly unpopular – can succeed.Further DiscussionThis is a highly promising cause area that CEARCH will be conducting deeper research into, but it is important to note that early stage CEAs tend to be overoptimistic, and it is likely that this initial x300 GiveWell estimate will be revised downwards after more research and greater scrutiny, possibly extremely substantially (e.g. a one or two magnitude downgrade in cost-effectiveness).DALYs lost to hypertension have grown tremendously (43.5%) from 1990 to 2015, and it is certainly not just a rich world problem – over that same period, DALYs lost to hypertension in LMICs exploded (45% increase in high-middle income countries, 72% increase in middle income countries, 94% in low-middle income countries, and 86% in low income countries); and of the large countries, Bangladesh notably saw a fairly staggering near-tripling of DALYs lost.Growth in DALYs lost is driven not just by population growth and ageing, but also by urbanization and corresponding lifestyle changes (e.g. excessive dietary sodium, stress, sedentary lifestyle etc).Note that the analysis here does not model income effects from the tax (i.e. reduced purchasing power causing less consumption of healthy food) or substitution effects, whether positive (e.g. reducing sugar and fat consumption from food – such as junk food – that is high in not just salt but also sugar and fat) or negative (i.e. causing people to switch to low-salt high-sugar food or drinks); the analysis here also does not model the impact of industry reformulating food products in response to a sodium tax. My sense is that these balance out to some extent, but it is very hard to say.There is extremely high uncertainty over the calculations over how the problem will grow or shrink in the coming decades. This is certainly an area where expert advice and expert epidemiological modelling would be extremely valuable, and is something that CEARCH will pursue at deeper research stages.We underestimate the economic burden insofar as it focuses on the burden from hypertension (i.e. SBP of > 140 mm Hg) even though high systolic blood pressure (i.e. SBP of > 110-115 mm Hg) has adverse health consequences and presumably negative economic effects as well....