Christine Cleghorn

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. Lay summary: Requiring food manufacturers in Aotearoa New Zealand to meet World Health Organization sodium (salt) targets could reduce salt intake, prevent disease, save health sector costs, and improve health equity for Māori. Mandatory sodium reformulation of packaged foods was estimated to reduce average sodium intake by 470 mg per person per day (equivalent to 1.18 g of salt), a 22% reduction from current levels, resulting in health benefits across the population. The policy was estimated to generate 55,600 health-adjusted life years and save NZ$535 million in healthcare costs over the population’s lifetime, with greater health gains per person for Māori than non-Māori, helping reduce health inequities.

Engaging with stakeholders/contributors is vital to achieve a comprehensive approach to policymaking about the food (kai) system. The food system in Aotearoa New Zealand (Aotearoa NZ) is associated with high environmental impacts and inequitably distributed health consequences by ethnicity and socio-economic status. We engaged with contributors from government agencies, industry, academics, community, rural and urban Māori communities to develop policy actions to support New Zealanders to eat healthy sustainable food. This paper outlines methods used to score contributor identified policies with follow-up focus groups and interviews where the highest scored policies were discussed, to understand contributor perspectives on the scope, implementation, barriers, and possible unintended consequences of these policies. Semi-structured interviews (12) and focus groups (6) were conducted. The top five scored policies among all contributors were: healthy food and drink policies in schools and kura (Māori-language immersion schools); supporting māra kai (food garden) and community gardens; garden to table programmes in schools and kura; education about sustainable and healthy food; and increasing incomes. The top five policies for Māori were: healthy food and drink policies in schools and kura; garden to table programmes in schools and kura; remove GST from core foods; increase incomes and make local food cheaper by supporting local growers. Considerations for policy implementation involved implementing multiple policies at once, the importance of evaluation, finding existing examples of policies, strong collaboration for long-term outcomes, and centring policies through a Māori framework.

Background . Estimating environmental impacts has become an integral part of dietary assessments. These estimations rely on available life cycle assessment (LCA) data and databases of LCA information, which should be as recent and context specific as possible. Objectives . We aimed to update the existing New Zealand (NZ) dietary LCA database with recently available NZ data and provide documentation to streamline regular future updates. Following the update, we also aimed to investigate the impact of the updated database on emission estimates for dietary intakes in the population. Methods . A search was developed and conducted on November 18th, 2024. Recently published or identified LCA data for food items produced in NZ were integrated into the database. A comparison of the estimates of total greenhouse gas emissions due to dietary intake between the original database and updated database was conducted on existing NZ dietary intake data. Results and discussion . Updates in nine food items resulted in small net emissions decreases in fourteen food categories of the New Zealand Adult Nutrition Survey 2008/09. The estimate of average daily emissions due to dietary intake per adult in NZ decreased by approximately 1%, from 4.99 kgCO ₂ eq to 4.91 kgCO ₂ eq. This resulted in a decreased estimate of 350 tCO ₂ eq per day for the entire population. Small changes in LCA data can accumulate to substantial effects over the entire population; however, a 1% decrease in production emissions over 15 years shows that efficiencies in status quo patterns of food production alone are vastly inadequate to meet Paris obligations. More transformative changes will rapidly be needed.

Food production and consumption impacts both planetary and population health. This research aimed to estimate the impacts of three stakeholder-selected food policies for the New Zealand (NZ) population. These were modelled using a proportional multistate lifetable model through to health gains, health equity impacts, and health system costs/cost savings. Exempting core, sustainable foods from Goods and Services Tax resulted in 87,340 health adjusted life years (HALYs) (95% Uncertainty Interval (UI): 72,590 to 104,140) and health system cost savings of $925.0 Million (M), UI: $661.5 to $1220.3M. Education about healthy sustainable foods generated small health impacts (1,170 HALYs, UI: 930 to 1,430) and health system cost savings ($9.6M, UI: $6.8 to $12.9M). Māra kai (gardening for food) and community gardens generated 8,040 HALYs (UI: 4,720 to 11,800) and would cost the government $364.3M (UI: $267.6 to $464.6M). All scenarios produced more age-standardised per capita health gain for Māori (Indigenous population) than non-Māori. The first two policies were cost saving while the māra kai and community gardens policy was borderline cost-effective. These results show that these policies have the potential to improve population health and reduce NZ ethnic health inequities. Due to the up-front investment needed for these policies and the lag in generating health system costs savings, research into the policies wider benefits need to be considered alongside these results. Results could be used to inform diet policy in high-income countries. For NZ, careful policy design involving relevant stakeholders, including Māori communities, is needed to ensure health benefits are realised.

We aimed to model the impact of product reformulation following adoption of the Health Star Rating (HSR) nutrition labelling system in Aotearoa New Zealand (NZ). Household panel data (2014–19) was used to estimate the effect of HSR labels on product nutrient content. Observed changes were applied to population dietary intakes. Impacts were modelled through to Health Adjusted Life Years (HALYs) and health sector costs (NZ$2011 consumer price index (CPI) adjusted to NZ$2023) using a proportional multi‐state life‐table (pMSLT) model over the remaining life of the 2011 NZ population ( n  = 4.4 million, 3% discounted). Modelling the current HSR uptake (23% products on average), NZ adults’ mean daily energy, sodium and fibre intakes changed by 0.7 KJ (0.0%), –18.2 mg (−0.5%) and 0.04 g (0.2%). This resulted in 700 (95% uncertainty interval (UI): –600–1,800) HALYs gained, and estimated net costs (combining intervention costs and health system cost savings) of $8.4 million (M, 95% UI: –$17.4 to $35.4M). An estimated 24,300 HALYs (95% UI: 19,400–29,900) and $568.1M (95% UI: $430.1 to $733.7M) cost savings were seen if the HSR was made mandatory in 2025. The results of the current HSR uptake find minimal reformulation causing very small changes in population nutrient intake and therefore resulting in small health gains. Mandatory HSR nutrition labels could deliver population health gains and health sector cost savings through reformulation. There is, however, real uncertainty around the scheme's effect on energy intake which will affect these impacts.

Food production plays a central role in the health of humanity and our environment. New Zealand produces a large amount of food, but it is unknown if it can produce enough of the right crops in the places to better the health of New Zealanders, profitably, while maintaining New Zealand's primary production exports and meeting ambitions to lower greenhouse gas (GHGs) emissions and nutrient losses to water. We tested two scenarios that aimed at delivering a healthy diet while maximising profit and minimising GHGs (climate‐focused scenario) or losses of nitrogen (N) and phosphorus (P) to water (freshwater‐focused scenario). Land use change was targeted to areas not currently meeting bottom lines for N or P loss but needed to spill over to other areas to meet dietary targets in both scenarios. The maximum cost of the required land use change was about 1% of the primary sector's export revenues, and orders of magnitude less than the estimated savings for the health system from an optimised diet. We conclude that shifting productive land uses can help meet environmental targets for GHGs, N and P while saving money and improving the health of its people.

Population diets have impacts on both human and planetary health. This research aims to optimise a New Zealand (NZ) version of the EAT-Lancet diet and to model the impact of this diet on population health if it was adopted in NZ. The optimisation methods used mathematical equations in Excel to ensure: population diets met the nutritional recommendations; diet-related greenhouse gas (GHG) emissions did not exceed the NZ GHG boundary; and diet costs did not exceed baseline costs of the average diet. The EAT-Lancet diet was also directly mapped onto the NZ adult nutrition survey food groups, as another estimate of a NZ EAT-Lancet diet. Both diets were modelled using a DIET multi-state life-table model to estimate lifetime impacts on quality adjusted life years (QALYs), ethnic health inequities and health system costs. The optimised diet differed greatly from baseline intake with large amounts of fruits and vegetables, some fish but no beef, lamb, pork or poultry. Modelling nationwide adoption of the NZ EAT-Lancet diets generated large health savings (approximately 1.4 million QALYs), and health system cost savings (around NZD 20 billion). A healthy, climate-friendly, cost-neutral diet is possible for NZ and, if adopted, could provide large health gain, cost savings and reductions in ethnic health inequities.

Climate change is one of the top threats to human health and strategies to mitigate climate change are essential. International research has shown that policies to shift dietary consumption away from foods with high green-house gas (GHG) emissions associated with their production may produce health and climate co-benefits. A multi-state life-table model was used to estimate the health (in quality adjusted life years, QALY), health system costs and equity impacts of several scenarios in the New Zealand population. GHG emissions that have been assigned to the foods consumed by New Zealanders in the 2008/09 Adult Nutrition Survey have been added to this model to estimate the climate co-benefits of these scenarios. This presentation will outline an optimised healthy, sustainable diet for New Zealanders and describe the potential health and climate impacts of this and other population-wide theoretical shifts in dietary intake. Modelling results of price policies that could be implemented in New Zealand to shift dietary intake towards more healthy and sustainable foods will also be presented. Having information on the health and climate co-benefits of dietary shifts, policies and interventions can provide justification for policy makers to implement policies that both improve the health of the population and help to mitigate climate change.

Background: Evidence suggests that smartphone apps can be effective in the self-management of weight. Given the low cost, broad reach, and apparent effectiveness of weight loss apps, governments may seek to encourage their uptake as a tool to reduce excess weight in the population. Mass media campaigns are 1 mechanism for promoting app use. However, the cost and potential cost-effectiveness are important considerations.Objective: The aim of our study was to use modeling to assess the health impacts, health system costs, cost-effectiveness, and health equity of a mass media campaign to promote high-quality smartphone apps for weight loss in New Zealand.Methods: We used an established proportional multistate life table model that simulates the 2011 New Zealand adult population over the lifetime, subgrouped by age, sex, and ethnicity (Māori [Indigenous] or non-Māori). The risk factor was BMI. The model compared business as usual to a one-off mass media campaign intervention, which included the pooled effect size from a recent meta-analysis of smartphone weight loss apps. The resulting impact on BMI and BMI-related diseases was captured through changes in health gain (quality-adjusted life years) and in health system costs. The difference in total health system costs was the net sum of intervention costs and downstream cost offsets because of altered disease rates. An annual discount rate of 3% was applied to health gains and health system costs. Multiple scenarios and sensitivity analyses were conducted, including an equity adjustment.Results: Across the remaining lifetime of the modeled 2011 New Zealand population, the mass media campaign to promote weight loss app use had an estimated overall health gain of 181 (95% uncertainty interval 113-270) quality-adjusted life years and health care costs of –NZ $606,000 (–US $408,000; 95% uncertainty interval –NZ $2,540,000 [–US $1,709,000] to NZ $907,000 [US $610,000]). The mean health care costs were negative, representing overall savings to the health system. Across the outcomes examined in this study, the modeled mass media campaign to promote weight loss apps among the general population would be expected to provide higher per capita health gain for Māori and hence reduce health inequities arising from high BMI, assuming that the intervention would be as effective for Māori as it is for non-Māori.Conclusions: A modeled mass media campaign to encourage the adoption of smartphone apps to promote weight loss among the New Zealand adult population is expected to yield an overall gain in health and to be cost-saving to the health system. Although other interventions in the nutrition and physical activity space are even more beneficial to health and produce larger cost savings (eg, fiscal policies and food reformulation), governments may choose to include strategies to promote health app use as complementary measures.