Modelling the potential long-term costs and health benefits of dietary salt and alcohol reduction policies

Hypertension is the most significant modifiable risk factor for cardiovascular disease, and its prevalence is rising rapidly in low- and middle-income countries (LMICs). Excess dietary salt and alcohol misuse are major behavioural determinants, yet evidence on the long-term impact of prevention strategies in LMICs remains limited. This thesis develops and applies a public health economic model to estimate the potential health and economic benefits of salt- and alcohol-reduction strategies in Ghana, a country undergoing rapid urbanisation with increasing harmful alcohol use and high dietary salt intake.
A systematic scoping review mapped the global use of health economic models for alcohol and salt interventions, identifying methodological gaps and a scarcity of evidence from sub-Saharan Africa. To contextualise the modelling, a review of Ghana’s national policies highlighted weak implementation and enforcement of strategies targeting salt and alcohol consumption. Complementary qualitative research applied the socio-ecological model, identifying multi-level drivers of unhealthy consumption and highlighting political, cultural, and structural barriers to effective policy delivery. These insights, together with a rapid review of interventions, guided selection of two feasible strategies for Ghana: brief interventions for harmful drinking and a salt-reduction mass media campaign.
The adapted microsimulation model, parameterised with Ghana-specific epidemiological data, projected the long-term health and economic outcomes of these strategies. The combined intervention scenario yielded the greatest benefits, averting up to 2.8 million disability-adjusted life years over the population’s lifetime. This approach demonstrated synergistic effects, amplifying both health and economic gains. While cost outcomes were subject to uncertainty, all evaluated strategies showed plausible maximum justifiable intervention costs under conservative willingness-to-pay thresholds.
This thesis demonstrates how adapting a health economic model with contextual policy analysis and stakeholder engagement can generate locally relevant evidence for NCD prevention, offering a transferable framework to guide cost-effective strategies reducing hypertension and cardiovascular disease in Ghana and similar LMICs.