Estimated impacts of mandatory sodium reformulation targets on sodium consumption, health outcomes, health sector costs and health equity in Aotearoa New Zealand

Aims Cardiovascular disease (CVD) is the leading cause of death in Aotearoa New Zealand (NZ), including for Māori, the Indigenous population. Sodium intake is a modifiable CVD risk factor. In 2021, the World Health Organization (WHO) released sodium reduction benchmarks for 58 packaged food categories. We aimed to estimate the health, health-sector cost, and equity impacts of mandating these benchmarks in NZ. Methods Nationally representative data on household food purchases, packaged food sodium content, and dietary intake were used to estimate baseline sodium consumption (2011) and changes following implementation of the WHO benchmarks. A dietary multi-state life-table model estimated impacts on health-adjusted life years (HALYs) and health system costs (2011 NZ$, 3% discount rate) over the remaining lifetime of the 2011 NZ population (n = 4.4 million). Analyses examined impacts by sex and for Māori. Results Mandatory reformulation was estimated to reduce sodium intake by 470 mg/day per person (1.18 g salt), a 22% reduction from baseline. Across population groups, age-standardised reductions ranged from 380 to 660 mg/day (22-23%), generating an estimated 55,600 HALYs (95% uncertainty interval 19,100-90,000) and NZ$535.2 million in health-system cost savings (95% UI: 183.0-914.6 million) over the population lifetime. Māori gained 11,600 HALYs (95% UI: 4,900-17,700), equivalent to 17.2 HALYs per 1,000 population, compared with 11.8 per 1,000 among non-Māori. Conclusion Mandating WHO sodium benchmarks in NZ could substantially reduce sodium intake, improve population health, reduce health sector costs, and advance health equity. Findings support adoption of this strategy in Aotearoa NZ.