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This chapter examines the feasibility of achieving health equity, arguing that it requires addressing both access to health care and the broader social determinants of health. Health equity ensures fair opportunities for all individuals to attain their highest health potential, transcending insurance access to include resources like housing, education, and food security. Barriers such as systemic inequities, lack of insurance, and geographic and transportation constraints disproportionately impact marginalized communities, contributing to health disparities. By analyzing policies like the Affordable Care Act in the United States and universal health care systems in Sweden and Denmark, the chapter highlights the potential of integrative approaches to close equity gaps. It underscores the principle of “meeting people where they are” to tailor interventions to diverse social, cultural, and economic contexts. Strategies for bipartisan solutions and public–private partnerships are presented as pathways to sustainable, inclusive health policies that prioritize equity beyond the point of care.
This study assessed the cost-effectiveness of the Centers for Disease Control and Prevention’s (CDC’s) Sodium Reduction in Communities Program (SRCP).
Design:
We collected implementation costs and performance measure indicators from SRCP recipients and their partner food service organisations. We estimated the cost per person and per food service organisation reached and the cost per menu item impacted. We estimated the short-term effectiveness of SRCP in reducing sodium consumption and used it as an input in the Prevention Impact Simulation Model to project the long-term impact on medical cost savings and quality-adjusted life-years gained due to a reduction in CVD and estimate the cost-effectiveness of SRCP if sustained through 2025 and 2040.
Setting:
CDC funded eight recipients as part of the 2016–2021 round of the SRCP to work with food service organisations in eight settings to increase the availability and purchase of lower-sodium food options.
Participants:
Eight SRCP recipients and twenty of their partners.
Results:
At the recipient level, average cost per person reached was $10, and average cost per food service organisation reached was $42 917. At the food service organisation level, median monthly cost per food item impacted by recipe modification or product substitution was $684. Cost-effectiveness analyses showed that, if sustained, the programme is cost saving (i.e. the reduction in medical costs is greater than the implementation costs) in the target population by $1·82 through 2025 and $2·09 through 2040.
Conclusions:
By providing evidence of the cost-effectiveness of a real-world sodium reduction initiative, this study can help inform decisions by public health organisations about related CVD prevention interventions.
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