How does this work then?

Every 1g reduction in people’s average salt intake has been estimated to prevent 7,000 deaths a year from strokes and heart attacks – and save the NHS £1.5bn.

Dying young/early/quick saves the NHS money. So how does salt cost it cash?

41 comments on “How does this work then?

  1. Because obviously these people will never die of anything else so they will never cost the NHS anything…

  2. All this increasing emphasis on risk prevention and increasing longevity comes at costs that people are only just beginning to wake up to. Not just the financial ones but things like caring for people who are too old or senile to look after themselves. There needs to be a reset in attitudes. Just how can the NHS possibly cope with the growing issues without the budget getting even more out of control?

  3. I guess it saves the NHS £1.5bn *now* in return for an (unmentioned) bigger bill later on. Standard lobbying ploy.

  4. It’s not the dying (at any age) that causes big healthcare costs, it’s the costs of treating chronic illness and disability. Especially now that cardiovascular events (strokes and heart attacks) are pretty survivable compared to a few years ago, the number of people needing long-term care for the resulting disability is increasing.

    Salt is honestly a bit of a red (salted?) herring, provided you have normal kidney function, but there is good evidence that treating and preventing even very marginal blood pressure increases has a big impact on CV morbidity.

  5. Now that most people believe they will dehydrate unless they constantly swig a mouthful from the bottle they carry around, I wonder how many of them actually have a sodium deficiency?

  6. Does this dying early account for the lost tax revenue during what should of been the highest earning period of life?

    I had a discussion about this with the SO who insisted dying early cost the state money due to lost tax income.

    P.S. I was going to comment on the CT article, but then saw Discus’s T&C. No way I’m agreeing to that!

  7. PF, Kendrick is right in that experts seem to be afraid of uncertainty and will always go with a conclusion and where necessary make the data fit. It’s just a human characteristic, we all do it. Must be a survival trait.

  8. BiG

    Purely focusing on Tim’s point above:

    it was explained to me once that on average it’s the last two years of life that racks up the big costs wrt to the NHS?

    If we assume that the priniciple is right even if the number isn’t, then:

    Yes, a shift away from shorter cardio type to longer care type will increase that 2 year number.

    But also, if the 2 year number is constant, dying at 70 rather than 80 will on average save the NHS money.

    Hence, logically, dying earlier of a cardio type (or similar) rather than later of a care type will self evidently save the NHS money?

    PHE are clearly making the point that excess salt will cause cardio issues rather than cause (for example) dementia.

  9. I really do wonder if, when people thought about the NHS, the idea of spending half of it on old people was the idea. I imagine a lot of people thought of it more in terms of kids being able to have a life, that fathers could get back to work and women could keep house.

    That’s where all the spending growth is. OK, there’s a few things like my niece’s rare eye disease where she’s being prevented from going blind and treating childhood leukaemia which cost a lot of money, but actually the incidence is rare. Leukaemia occurs in around 1 in 1000 children.

  10. It occurs to me that three current issues are in fact all about the reversal of the customer/supplier agreement.

    Brexit, I told the government what to do but they are more aware of what’s good for me so they are not doing it.

    The NHS is supposed to provide health care but it wants to lecture me about my lifestyle on flimsy grounds, as if the lecture was their raison d’etre.

    Electricity: I buy it from a supplier. It’s up to them to make sure there’s enough not lecture me on what I do with it or how it’s made nor implement dodgy green policies without my opt-in.

  11. PF – I had heard it was the final 6 months.
    Saying that, I’ve cost the NHS considerably in the last 46 years and will continue to cost them the rest of my life.

    My missus will cost them in drugs.

    Yep, we will cost them a pretty penny by staying alive. Dead, we won’t cost them a penny.
    And I’m sure the government won’t miss the couple of grand total taxes we pay between us a year.

  12. “Head of Public Health England demands” tells one a great deal about the UK in 2018.
    Can’t help notice that Les Gilets Jaunes are bringing France to a standstill, protesting about fuel prices that are considerably lower than those in the UK.
    And that May’s leave plan seems to be a done deal with the EU apparatchiks & you are now waiting on your political class to give the coup de grace to your Referendum desires.
    I’d say you’re in serious trouble, back there.

  13. Tim is correct: end of life costs are about the same, whether age 55 or 80. By dying at 55, 25 years of medical costs are saved. While not as high as end of life costs, the costs are still significant.

  14. People now survive cardiovascular events rather than dying from them, as was the case 20 years ago. They leave behind considerable disability however. My own FIL was paraplegic and survived 8 years following a stroke. Only his wife’s self-sacrifice prevented him from becoming a major burden on the health services.

    Of course dying later results in higher health care costs, but we’re happy with that, right? It’s the combination of dying later with a longer duration of chronic disability (because we still get strokes and heart attacks but are much less likely to die of them) that really drives costs up.

    I definitely agree with the following:
    Almost all hypertension is primary and has no identifiable cause. Caveat – this doesn’t mean it’s not bad for you.
    Salt consumption has only a modest effect on BP in most people. Caveat – on the population level this can still translate into a lot of damage spared.

    Its where “CV disease causes elevated BP” that it runs into trouble for me. I don’t believe atherosclerosis is a prominent driver of elevated BP. It affects predominantly the large arteries and the vascular tone* part of hypertension comes from much smaller vessels. Further, LVH is not a cause of essential hypertension, it is a consequence of it.

    I don’t think renal artery stenosis is a good model here as any kind of kidney dysfunction results in (sometimes quite extreme) hypertension. Renal artery stenosis is rare, the resulting hypertension is easily reversible, because you can stent the arteries. In boring old primary nephrosclerosis the BP elevation is only reversible by drugs, because the cardiac contribution is “locked in” by the extent of irreversible kidney damage, and the high vascular tone that probably caused the HT in the first place is in much smaller vessels downstream of the arteries.

    CTPH is simply too obscure and rare to worry about – kidney failure is vastly more common.

    The kidney/RAAS thing is interesting to get into but how much time do you have? Filtration rate is directly proportional (roughly) to blood pressure and RAAS is the kidney’s primary way of saying “I need to work faster, please increase blood throughput”. It works short term but hypertension is either the biggest or second biggest (diabetes competes) cause of kidney failure. The kidney sets up a vicious cycle in which it demands higher pressure, but damages itself further in so doing. If he has problems controlling electrolytes in elderly patients these will be likely people with tubulointerstitial disease and relatively advanced kidney failure (common in the elderly), and of course underlying disease affects your choice of drugs, d’uh.

    Exercise, always good. Magnesium? I guess he thinks it competes with calcium transport. More potassium? Not usually if you have kidney failure (common in hypertensives) and/or are using potassium-sparing diuretics.

    *: BP is subject to the laws of physics, and there are only 3 variables that affect pressure – cardiac output, blood volume, and vascular tone (pipe width). All antihypertensives work on one of these, with cardiac output there is more than one way of controlling this.

  15. Martin

    Which is why, if it comes to any concept of redistribution or believing in a fair society, health – more than other issue, including housing, food, etc – is where some sort of fair mutual insurance process is most needed. It can happen to any of us, whilst others of us can be as lucky as hell. Whereas no one “needs” more than one hamburger a day (or one roof) etc (hence less critical need for redistribution).

  16. Humans need salt. Most have no problems with it. Selbie is full of sh+t. But then he works for the full-o’-sh+t PHE.

    ‘I’m concerned about food companies’ slow progress in meeting targets for salt reduction.’

    Vee told you vhat to do; vhy aren’t you doing
    it ?!?!

    No state funding should go to PHE. They are evil.

  17. BiG

    Interesting. The link I provided included a whole series of articles. The first one or two (coincidentally) looked at the same issues (!), and which you’ve clearly given gone into quite a bit of detail on – thanks..:)

    I think what I get from Kendrick, as Rhoda says and as you allude to, is that we don’t always reliably know and people don’t always necessarily like to admit that.

  18. Oh god, yeah, I can’t read let alone hope to know enough to comment the lot.

    Doctors are very happy to admit they don’t know what causes your or my hypertension. We do know (because the research really is extremely solid on this) that as much BP reduction as you can stand has an impact on overall survival and on cardiovacular survival in particular.

  19. Bloke on the M4

    The NHS was going to pay for itself by reducing days lost to illness. In the same way, state education was going to pay for itself by an educated workforce earning more and paying more tax. So you see, we are much richer under socialism.

  20. “Doctors are very happy to admit they don’t know what causes your or my hypertension.”

    My dermatologist commented to me years ago that the Great Mystery is why a spot gets skin cancer, and not the spot next to it. Which, presumably, has the same genetics and has existed in the identical environment for just as long. Hence, they don’t know what causes skin cancer, either. They know it has high correlation sun exposure, but that alone doesn’t explain it.

  21. This salt phobia is standard post modern medicine. Selbie conflates treatment with cause. Managing salt is important for some patients. But that doesn’t make salt the cause of the condition.

    We see this SOS with diabetes and carbohydrates. Diabetics need to manage their carbohydrate intake. That doesn’t make the carbs the cause of the problem. The cause of diabetes is unknown. After billions of dollars and decades of research, the cause is still unknown.

    There are many who really, really want sugar to be the cause, but it’s not.

  22. BP: and yet, and yet. The last couple of things I read on this had US doctors pressing for ever lower BP targets, and a Canadian paper crying “no”. To me that suggests that things are not remotely cut and dried.

    McKendrick has a book out: “Doctoring Data” – a tour de force, I’d say.

    Having worked in two universities each of which had the best medical school in the UK, I can say that medics’ grasp of statistics tends to be distinctly weak. And, boy, do they “know” things that they can’t cite sources for.

  23. Weight loss has by far the greatest effect on blood pressure followed by moderate exercise, medication is in a feeble third place and accompanied by side effects. Unless you have severe kidney disease, salt reduction is meh and accompanied by an increase in heart rate so probably zero effect on end result of progression to congestive heart failure. Guess where the money is?

  24. Medics definitely have a poor grasp of statistics*.

    Gamecock: high BP causes stroke, heart attacks, kidney failure, retinopathy, and a bunch of other interesting, often preventable stuff. This is far beyond reasonable doubt, not the usual “picking your nose causes/cures toenail cancer” pop epidemiology. On the population level, reducing BP (in which reduced salt intake plays a small role) reduces that healthcare burden. We cannot, of course, tell in advance which individual patients benefit, and which will get sick of/die of something else, but that is risk for you.

    *: Source: I teach statistics to medics.

  25. “medication is in a feeble third place and accompanied by side effects. Unless you have severe kidney disease, salt reduction is meh ”

    Agreed. And (1) how many people ever manage to get those pounds off (2) how many people have CKD?

  26. Medics definitely have a poor grasp of statistics*.

    *: Source: I teach statistics to medics.

    Best not write your own ad copy.

  27. “Do Nordics have a higher than UK incidence of strokes, heart attacks etc?”

    The incidence of death from stroke is higher in Denmark (44 per 100,000 per year) than the UK (38 per 100,000 per year).

    So, you’ve considered one foodstuff as the single covariate of stroke incidence. You know what? If someone else had indulged in a univariate analysis of, say, the influence of sex on pay, you would doubtless be all over them for not considering all those confounding factors.

  28. Pcar, with less salt they would live at least into their 50s. 🙂 How do you isolate the salt effects from the vodka effects, and the vit D stuff and the most important SAD effects?

  29. Dammit, BiG, you are doing the same thing I complain of. Salt control is a treatment, not a preventative.

    The quango wants to restrict salt in food products to the general population. People diagnosed with some medical conditions need to restrict their salt intake. The general public DOES NOT.

    “Gamecock: high BP causes stroke, heart attacks, kidney failure, retinopathy, and a bunch of other interesting, often preventable stuff.”

    Non sequitur.

  30. Salt control as a treatment reduces BP. Incrementally, modestly, but still does. And in turn, reduction in BP reduces the number of, morbidity attributable to, and mortality from, CV events (competing causes of death will of course win in the end but that’s obvious*). At the population level, in the general public, including people who don’t have a medical reason to stick to a severely salt-restricted diet**.

    This simply isn’t negotiable, it is true, the evidence is as watertight as it gets in epidemiology because the vast number of people with high BP, vast control group without, and availability of numerous medications for reducing BP makes this one of the easiest questions to research. It’s the explanation for why various prodnoses want more power over your ready meals.

    Obviously, as a classical liberal, I think said prodnoses should go to hell.

    *: Anyone using this argument should also argue we should not use antibiotics because you will only die (later) of cancer or heart disase instead.

    **: In most cases this is itself aimed at lowering BP to prevent CV events.

  31. The dangers of BP are not relevant.

    Strong, autocratic central control of a private economy is the subject. PHE is not only trying to write a prescription for the non-sick, they are trying to force third-parties to comply with their demands. They are fascist pigs.

    Don’t defend them by talking about how dangerous BP is.

  32. @Bloke in Germany, November 25, 2018 at 10:07 pm

    Note last line: “More Scaremongering BS”

    I was confident answer would be “yes/no, but genes” or “no significant difference”. Denmark higher may be bacon?

    Some sense from Dr Max:
    Kellogg’s has had its appeal upheld against a ban on its cartoon characters. Coco the Monkey and Tony the Tiger were accused of promoting ‘unhealthy’ cereal.

    Well, amen to that. The idea that foods are ‘good’ or ‘bad’ goes against everything we should be teaching youngsters about diet.

    We want them to learn that there is no such thing as good or bad food, just healthy and unhealthy quantities of certain foods.

  33. Those are population numbers, not samples. So provided similar methodology (who knows how the stats are compiled in each country, what is counted as a stroke or not, etc.) By definition “significant”

    There are too many factors to pick one out and say “that’s the cause”. If you forced me, first thing I would look at is whether Denmark has an older population than the UK. Age is a very reliable correlate of many diseases. Especially stroke incidence.

  34. Some deaths are more expensive than others.

    And you stop contributing to the NHS when you die.

    I don’t know the details behind this specific calculation though. It would be nice if newspapers would link back too the data behind such stories. Very few do.

  35. In most of the civilized world, salt is fortified with Iodine. The lack of Iodine causes goiters amongst other things.

    So if this prat wants to do something useful, he would lobby that we follow the rest of the world and fortify our salt.

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