Deep Report on Hypertension

Note: This post was updated in August 2025, after we edited and improved the main report’s executive summary for readability. Our detailed cost-effectiveness analysis can be found here, as can the full report can be read here.

Key Takeaway: CEARCH recommends preventing hypertension via salt reduction policy as a high impact philanthropic cause.

Introduction: CEARCH is a research and grantmaking organization – we try to find and fund highly cost-effective philanthropic ideas. The primary author for this report is Joel Tan, the Managing Director of CEARCH, and the lead researcher and grantmaker for its global health & development portfolio.

Importance: Hypertension (i.e. high blood pressure) causes cardiovascular disease and is a leading cause of premature death worldwide. In 2024, hypertension caused the loss of 231 million disability-adjusted life years (DALYs), while having an economic cost equivalent to foregoing the doubling of income for 748 million people.

Cost-Effectiveness: The cause area is highly cost-effective. Projects that advocate for (and assist governments in implementing) WHO-recommended salt reduction policies (i.e. a sodium tax; mandatory food reformulation; strategic location interventions to change menus in places like hospitals, schools and workplaces; a public education campaign; and front-of-pack labelling) avert 23,168 DALYs per USD 100,000, which is around 30x as cost-effective as GiveWell top charities – which are themselves some of the very best in the world. (CEA). This high cost-effectiveness is driven by the following factors:

  • The disease burden of hypertension is large, and only growing as countries get richer and diets/​exercise habits get worse.

  • Policy is uniqely cost-effective amongst philanthropic interventions, due to its large scale of impact (since policy has national reach) and low cost per capita (given that government resources are being leveraged, and government spending is typically less counterfactually valuable than high-impact philanthropic dollars).

Scientific Evidence: There is strong scientific evidence suggesting that the intervention of advocating for and implementing salt reduction will successfully improve health. The theory of change behind this intervention is as such:

  • Step 1: Lobby a government to implement top sodium reduction policies.

  • Step 2a: A sodium tax reduces sodium consumption.

  • Step 2b: Mandatory food reformulation reduces sodium consumption.

  • Step 2c: Strategic location intervention reduces sodium consumption.

  • Step 2d: Public education reduces sodium consumption.

  • Step 2e: Mandatory front-of-pack labelling reduces sodium consumption.

  • Step 3: Lower sodium consumption reduces high blood pressure and its associated disease burden.

Using the track record of past sodium reduction and sugar tax advocacy efforts and of general lobbying attempts (i.e. an “outside view”), and combining this with reasoning through the particulars of the case (i.e. an “inside view”), our best guess is that funding advocacy campaigns will have a 9% chance of successfully enacting top sodium reduction policies.

Meanwhile, based on various systematic reviews and meta-analyses, and after robust discounting (e.g. to adjust for issues like endogeneity, external validity and publication bias), we expect that top sodium reductions policies to significantly reduce sodium consumption: (a) sodium tax by −77 mg/​person/​day; (b) mandatory food reformulation by −226 mg/​person/​day; (c) strategic location interventions by −23 mg/​day; (d) a public education campaign by −35 mg/​day; and mandatory front-of-pack labelling by −53 mg/​day.

Finally, based on a quantitative model we commissioned from an external expert epidemiologist – itself using parameters from meta-analyses and other empirical data, and after robust discounting – we expect lower sodium consumption to meaningfully reduce the disease burden of hypertension (n.b. a 100mg reduction in global sodium consumption yields a 0.1% reduction in the hypertension disease burden globally).

Expert Consensus: The consensus amongst the experts we interviewed was unanimous:

  • The global disease burden of hypertension, already large, will rise in the coming decades.

  • To solve this problem, we should take a preventive approach using policy, as opposed to a treatment approach using already under-resourced healthcare systems in low and middle income countries.

Beneficiary Survey: One legitimate concern that people may have – especially if they are of a more libertarian bent – is that a tax on sodium reduces freedom of choice. To address this issue, CEARCH ran a moral weights survey to estimate the disvalue of being unable to eat salty food, and found that this cost was marginal relative to the health benefit (-8%).

Neglectedness: Government policy is far from adequate, with only 4% of countries currently implementing the top WHO-recommended ideas on sodium reduction, and this is not expected to change much going forward – based on the historical track record, any individual country has only a 1% chance per annum of introducing such policies. At the same time, while there are NGOs working on hypertension and sodium reduction (e.g. in China, India and Latin America), and while some are impact-oriented in focusing on poorer countries (where the disease is growing far more rapidly than in wealthier countries), it remains the case that not enough is being done globally.

Implementation: From our interviews with NGOs working in the space, we find that there is a lack of funding; and this is backed up by observations from the academic literature. However, on the talent side of things, the NGOs we interviewed were more optimistic; they tended to believe that there is not a talent gap

Conclusion: Overall, our view is that advocacy for & implementation of salt reduction policy to prevent hypertension is (a) extremely cost-effective. Moreover, this cause looks promising outside of raw cost-effectiveness, given (b) the strong scientific evidence underlying the theory of change; (c) the consensus recommendation of experts; and (d) beneficiary surveys indicating that potential intangible downsides (e.g. reduced freedom of choice) are marginal relative to the health benefits.

Hence, we recommend that individuals and organizations seeking to maximize their impact support this cause area. In particular, we recommend that:

  • Charity incubators like Charity Entrepreneurship found a new organization to implement this idea.

  • Grantmakers and individual donors fund organizations working in this space.