BACKGROUND: Noncommunicable diseases (NCDs), including hypertension and diabetes, account for approximately 27% of all deaths in Kenya, with 26% of adults having elevated blood pressure. Despite devolution of health services to county governments in 2013, financing for NCD management at the primary health care (PHC) level remains weak. This study examines financial determinants shaping hypertension and diabetes care in PHC facilities within a devolved county health system in rural Kisumu County, Kenya. METHODS: We conducted a convergent parallel mixed-methods cross-sectional study in seven public PHC facilities in Seme Sub-County, providing new facility-level evidence on how the interaction between devolution’s financing architecture, facility-level financial autonomy constraints, and resource allocation mechanisms shapes chronic disease care effectiveness in rural Kenya. Quantitative data were collected via structured questionnaires and retrospective document review of financial records (January–August 2024). Qualitative data were gathered through key informant interviews (n = 7) with facility in-charges exploring planning, budgeting, and resource allocation. Descriptive statistics were produced in STATA v16; qualitative data were analyzed thematically in R. RESULTS: All seven facilities prepared annual workplans and budgets, but none achieved comprehensive NCD-specific planning (workplan + budget + dedicated NCD budget line). Funding sources were narrow: 71.4% (n = 5) of the facilities depended on NHIF reimbursements and donor support, while only 28.6% (n = 2) received direct county funding; 57.1% (n = 4) of the facilities relied on only two funding streams. Although all facilities held bank accounts, none had formal financial autonomy and expenditures required county-level approval, typically taking 3–4 weeks (57.1%, n = 4) to over two months (28.6%, n = 2). Combined with unreliable central supplies, this lack of autonomy meant facilities could not procure locally when stockouts occurred; consequently 85.7% (n = 6) of the facilities reported frequent medication stockouts. Facility in-charges attributed these failures to inadequate, unpredictable funding and centralized approval processes that prevented timely local procurement. CONCLUSIONS: Rural PHC facilities operate under structural governance failures in Kenya’s devolved health financing system that systematically undermine effective NCD care. The centralization of financial authority at county level, absence of ring-fenced NCD budgets, and misalignment between planning processes and resource allocation represent system-level policy contradictions rather than facility-level operational deficiencies. Addressing these governance failures requires not only increased funding but constitutional fiscal decision-space for facilities, mandatory NCD budget protection, and reformed disbursement mechanisms essential for equitable chronic care under Kenya’s UHC agenda. The sustainability of chronic care depends fundamentally on facility decision space, not only on funding volume. These findings are transferable to other Kenyan counties under the same devolved framework and to decentralized health systems in sub-Saharan Africa facing similar tensions between fiscal accountability and operational autonomy for chronic disease management.
Healthcare organizations exchange sensitive health records, including behavioral health data, across peer-to-peer networks, and it is challenging to find and fix compliance issues proactively. The Healthcare industry anticipates a growing need to audit substance use disorder patient data, commonly referred to as Part 2 data, having been shared without a release of information signed by the patient. To address this need, we developed and evaluated a novel methodology to detect Part 2 data exchanged between organizations that integrates Blockchain technologies with knowledge graphs. We detect substance use disorder data in patient encounters exchanged using clinical terminology based upon the value sets provided by the National Institutes of Health for the Substance Abuse and Mental Health Services Administration. Generally, we consider sharing Part 2 data without consent as Byzantine medical faults, as they represent data shared between known and trusted network participants, that is valid, but is not relevant, and sharing it causes a breach. In this paper, we present our methodology in detail along with the experiment results. We model a medical network of hospitals based upon the most recent healthcare legislation, TEFCA, and generate synthetic patient encounter data dynamically in HL7 format. We convert exchanged encounter data into a knowledge graph data model so that we can use SNOMED-CT for identifying Part 2 data. For cohorts of 1,000 patients, we detect Part 2 data in a subset of their encounter data shared between organizations and log that securely on an Ethereum-based blockchain.
We study the determinants of transaction fees in the Bitcoin and Ethereum blockchains, particularly focusing on the recent Merge – Ethereum's transition from a Proof-of-Work to a Proof-of-Stake consensus mechanism. Using multivariate regression analysis, we find that blockchain fees in USD increase with network congestion, measured by the mempool count, in a non-linear manner as hypothesized by Huberman, Leshno, and Moallemi (2021). Additionally, the fees are positively influenced by the respective native currency's returns over the past six months. The Merge resulted in a fee reduction for both Bitcoin and Ethereum blockchains.
Arterial hypertension affects a third of the world's population and is a significant risk factor for cardiovascular disease. Blood pressure (BP) is one of the most relevant parameters used for monitoring of possible hypertension states in patients at risk of cardiovascular disease. Hence, there exists a need for new monitoring solutions, which allow to increase the frequency between BP assessments, but also allow to reduce the level of occlusion in the attempts. Moens-Korteweg equation is among the main principles to estimate BP by dispensing of any inflatable cuff. This principle might lead to an indirect estimation of BP by measuring the time it takes the pressure pulse to propagate between two pre-established vascular points, accordingly the pulse transit time (PTT) method. This thesis proposes a wearable PTT-based method to estimate central aortic BP (CABP) and, the main milestones of this work included: proof of concept of the proposed method (pilot work), the development of a wearable device (including two stages of validation), the proposition of a miniaturized version (integrated circuit) of the analog front-end of the wearable hardware, and, the development of a novel PTT-based model (PTTBM, i.e., the mathematical relationship between measured variables and estimated BP) suitable for the proposed wearable methodology to estimate BP. The main contributions found at each milestone are presented. One of the contributions of this thesis is the use of the PTT-principle for estimating CABP instead of the peripheral BP (PBP) (as typically used in the literature). The pilot work showed the feasibility of CABP estimation from the PTT principle by using electrocardiogram (ECG) and ballistocardiogram (BCG) recordings from off-the-shelf equipment. Results showed that CABP was more correlated with the proposed methodology in comparison to all PBP variables assessed; confirming our hypothesis that the CABP is the most suitable parameter to collate through the time elapsed from ECG R-wave to the BCG J-wave. That is, considered featured time (RJ-interval) includes the time of a pulse pressure propagating at an aortic district. Bland-Altman plots showed an almost zero mean error (\u\ < 0.02mmHg) and bounded standard deviation o < 5mmHg for all systolic and mean central BP readings. Pilot work provided a landmark in order to develop a compact device that allows the integration of wireless blood pressure monitoring into a wearable system. Another contribution of this thesis is the proposition of a wearable device for PTT-computing by also including design considerations for the signal conditioning chains for ECG and BCG signals. The proposed design procedure takes care of minimizing the impact of spurious delays between physiological signals, which eventually degrade the PTT computation. Further, such a procedure could be suitable for any PTT-acquisition. Filtering with low and controlled delay is required for this biomedical application, and proposed conditioning chains provide less than 2ms group-delay, showing the effectiveness of the proposed approach. In order to provide the methodology with higher autonomy and integration, a highly miniaturized implementation of the filtering approach was also proposed. It includes the design of proposed architectures in CMOS technology to implement the particular low-delay filtering at reduced bandwidth featuring ultra-low-power characteristics. Results show that less than 2ms delay for the ECG QRS-complex can be achieved with a total current consumption of IDD = 2:1nA at VDD = 1:2V of power supply. Such development meant another significant contribution of this work in the conception of highly autonomous wearable devices for PTT acquisition. The first stage of validations on the wearable CABP estimation showed that, when considering data from one volunteer, results achieved with off-the-shelf equipment could be replicated by using a proposed wearable device, and the method could be further validated by using the wearable version. Additionally, CABP estimation from the proposed wearable device could be feasible by using three feature times (FTs) as CABP surrogates; that is, RI, RJ, and IJ intervals (from ECG and BCG wearable recordings). The first validation of the method also showed that CABP could be accurately predicted by the proposed methodology when in the order of daily calibrations are performed. The second stage of validations involved a study with a group of volunteers, and new alternatives were explored (twentyseven: nine PTTBMs along the three FTs) for the CABP estimation. We found that CABP could be accurately estimated (inside AAMI requirements) through the presented methodology by using four of the explored alternatives, whereas the RI interval, an FT lacking any PTT assessment, emerged as the best surrogate for the CABP estimation. Hence, a principle different from the traditional PTT-based method arises as a more advantageous method for the CABP estimation in the light of evidence reported in this validation, and, to our knowledge, this is the first time that CABP has been successfully estimated from a wearable device. The final significant contribution of this thesis meant the last chain-link in the process to achieve an utterly original method to estimate CABP. A novel PTTBM to estimate CABP is proposed, which uses a ow-driven two-element Windkesel network constructed from FTs extracted from the wearable recordings. When classic PTTBMs are applied, the fitting of parameters often leads to values without a physiological basis. Opposite to that in the proposed PTTBM, the parameters have a clear physiological meaning, and the parameter fitting led to values that are consistent with this meaning and more stable throughout calibrations. In conclusion, this thesis introduces a novel device that exploits an alternative and indirect method for CABP estimation. Variants of the principle used, accordingly, PTT method, have been previously explored to estimate PBP but not for central aortic BP. Additionally, the device was designed to be wearable; that is, it is attached to the clothes, causing low discomfort for the user during the measurement, thus, allowing continuous and ambulatory monitoring of aortic pressure. The developed wearable system, validated in a series of volunteers, showed promising results towards the continuous CABP monitoring.
Steffen Baumann, Richard Stone, Esraa Abdelall, Varun A. Srikrishnan · 7 authors
The adoption of blockchain shows a variety of benefits owing to an incorruptible digital ledger and a decentralized database. This has eliminated the need for a gatekeeper to oversee all associated transactions. Blockchain, the underlying technology behind Bitcoin and other crypto-currencies, has found use in many industries besides finance, such as healthcare, where it is used for verifying medical licensing and credentialing, for tracking medical equipment (or consumables) from production to usage, and in cases associated with high levels of privacy and security. Patient data is collected using a plethora of patient-generated data devices, such as Internet of Things (IoT)-enabled wearables, health trackers, and home use medical devices. As a result, the data is siloed amongst several applications and/or vendors’ proprietary solutions. Of all this data, only some of it is transmitted to Electronic Medical Records. This produces the risk that not all data collected will be reviewed at the point of care due to the abundance of data collected. This article explains the areas within healthcare where blockchain could address data usability challenges and analyzes new ways in which patient health data can be collected to address the increasing number of challenges associated with the amount of data being generated over time. It also describes the drivers behind this data collection trend, the associated challenges and the subsequent ramifications. It concludes with a review of previous studies on data usability challenges and the means by which blockchain can be used to overcome these challenges.
Tim K. Mackey, Hirofumi Bekki, Tokio Matsuzaki, Hiroshi Mizushima
Japan is undergoing a major population health transition as its society ages, and it continues to experience low birth rates. An aging Japan will bring new challenges to its public health system, highlighted as a model for universal health coverage (UHC) around the world. Specific challenges Japan's health care system will face include an increase in national public health expenditures, higher demand for health care services, acute need for elder and long-term care, shortage of health care workers, and disparities between health care access in rural versus urban areas. Blockchain technology has the potential to address some of these challenges, but only if a health blockchain is conceptualized, designed, localized, and deployed in a way that is compatible with Japan's centralized UHC-centric public health system. Blockchain solutions must also be adaptive to opportunities and barriers unique to Japan's national health and innovation policy, including its regulatory sandbox system, while also seeking to learn from blockchain adoption in the private sector and in other countries. This viewpoint outlines the major opportunities and potential challenges to blockchain adoption for the future of Japan's health care.
A problem facing healthcare record systems throughout the world is how to share the medical data with more stakeholders for various purposes without sacrificing data privacy and integrity. Blockchain, operating in a state of consensus, is the underpinning technology that maintains the Bitcoin transaction ledger. Blockchain as a promising technology to manage the transactions has been gaining popularity in the domain of healthcare. Blockchain technology has the potential of securely, privately, and comprehensively manage patient health records. In this work, we discuss the latest status of blockchain technology and how it could solve the current issues in healthcare systems. We evaluate the blockchain technology from the multiple perspectives around healthcare data, including privacy, security, control, and storage. We review the current projects and researches of blockchain in the domain of healthcare records and provide the insight into the design and construction of next generations of blockchain-based healthcare systems.
Patrick Li, Scott D. Nelson, Bradley Malin, You Chen
Background: Access to accurate and complete medication histories across healthcare institutions enables effective patient care. Histories across healthcare institutions currently rely on centralized systems for sharing medication data. However, there is a lack of efficient mechanisms to ensure that medication histories transferred from one institution to another are accurate, secure, and trustworthy. Methods: In this article, we introduce a decentralized medication management system (DMMS) that leverages the advantages of blockchain to manage medication histories. DMMS is realized as a decentralized network under the hyperledger fabric framework. Based on the network, we designed an architecture, within which each prescriber can create prescriptions for each patient and perform queries about historical prescriptions accordingly. Finally, we analyzed the advantages of DMMS over centralized systems in terms of accuracy, security, trustworthiness, and privacy. Results: We developed a proof of concept to showcase DMMS. In this system, a prescriber prescribes medications for a patient and then encrypts the prescriptions via the patient’s public keys. Patients can query their own prescriptions from different histories across healthcare institutions and then decrypt the prescriptions via their private keys. At the same time, a prescriber can query a patient’s prescription records across healthcare institutions after approval from the patient. Analytic results show that DMMS can improve security, trustworthiness, and privacy in medication history sharing and exchanging across healthcare institutions. In addition, we discuss the potential for DMMS in e-prescribing markets. Conclusions: This study shows that a distributed secure ledger can enable reliable, interoperable, and accurate medication history sharing. Keywords: Blockchain Ledger, Decentralized, Hyperledger Fabric Framework, Medication Histories Please see a related Letter to the Editor (https://doi.org/10.30953/bhty.v2.98), and its response (https://doi.org/10.30953/bhty.v2.108)
Norm R.C. Campbell, Daniel T. Lackland, Graham A. MacGregor
The World Health Organization (WHO) aided by investigators from the Cochrane Collaboration published an updated review of randomized trials and prospective cohort studies on dietary sodium conducted in healthy populations.1, 2 Their quantitative analyses indicated that sodium intake <2000 mg/d was associated with reductions in blood pressure. In cohort studies, higher sodium intake was associated with a 24% higher risk of stroke, a 63% higher risk of stroke death, and a 32% higher risk of coronary heart disease death. There was inadequate statistical power to address other endpoints in the analysis. There was no adverse effect on lipids, catecholamines, or renal function in adults with less sodium intake. High dietary sodium intake caused higher blood pressure in children.1 These findings resulted in a renewed WHO recommendation for dietary sodium to be <2000 mg/d in adults and to even less in children based on their relatively lower caloric requirements. The American Heart Association also recently updated its comprehensive review of the literature reiterating its recommendation for dietary sodium to be less than 1500 mg/d.3 Biomedical, evolutionary, and aspects of epidemiologic and clinical research were not included in the WHO review but also strongly support harmful effects of “higher than physiological levels” of dietary sodium.2-12 A wide variety of animal species exposed to higher than physiological levels of dietary sodium develop hypertension, vascular, cardiac, and renal adverse outcomes.4, 13 To our knowledge, barring settings of acute sodium depletion, there is no animal species in which higher than physiological sodium intake improves health, and, in all settings, sodium-induced hypertension is harmful. Increased dietary sodium is a procarcinogen in animal studies (gastric cancer) and is associated with gastric cancer in human studies,14, 15 particularly in association with Helicobacter pylori infection. Adult human physiological sodium needs are <1000 mg based on analyses in “hunter gather” populations or analyses of “primitive” diets.16, 17 Societies where sodium intakes remain <1000 mg have no increase in blood pressure with age and hypertension is uncommon.4 If people from the hunter-gather societies who consume physiological levels of dietary sodium migrate to communities where there is high sodium intake or if sodium is introduced into their society's food supply, blood pressure increases and vascular diseases develop.4, 18 Reducing dietary sodium in communities or populations has been associated with reduced blood pressure and vascular events.4 In clinical trials, lowering dietary sodium reduces blood pressure,4 and there is no evidence for less of an impact of reduced dietary sodium on blood pressure at the lowest levels of sodium intake tested (1200 mg sodium). It is estimated that there are up to 3.1 million sodium-related deaths per year and that reducing dietary sodium is one of the most effective (and cost-effective) interventions to improve health.19 Two reviews have recently generated controversy. A review by Yusuf and colleagues proclaims that “there is no convincing evidence that moderate intake of sodium (3–5 g/d2) is associated with increased risk of cardiovascular disease compared with lower levels of sodium consumption.”20 However, there are several issues regarding the conclusions reported. The methodology employed in the Yusuf review is similar to many of the previous critiques of attempts to reduce dietary sodium towards physiological levels in (1) not being a systematic review (there is not even a pretense of being comprehensive), (2) selectively highlighting inconsistent studies rather than totality of evidence, (3) dismissing or ignoring substantive science that indicates harm from increased dietary sodium, (4) citing research findings that find sodium reduction harmful as facts while not disclosing the study's major design and methodological flaws as likely explanations, and (5) not clearly indicating how divergent their opinion is but rather implying they are clarifying scientific understanding.21 Thus, this review may be affected by bias in selection and only focuses on selected studies rather than the full body of evidence. The 2013 report from the Institute of Medicine (IOM) also claimed that the evidence supporting dietary sodium intake <2300 mg was “inconclusive,”22 but the IOM did not dispute the evidence for reducing sodium to this level. The IOM review was conducted largely by epidemiologists and several aspects of their review are flawed. The perspective that adding sodium to food has the potential to harm the public does not seem to have been the prime consideration. The main consideration was to assess whether interventions to reduce dietary sodium directly reduce cardiovascular disease. The review focused on recent controlled trials and cohort studies on sodium intake <2300 mg/d and on sodium reduction in the settings of disease. Although (1) hypertension is the most expensive cardiovascular disease category in the United States, (2) impacts 30% of the adult population, (3) there is a causal relationship between blood pressure and cardiovascular disease to the extent hypertension is the leading global risk for death and disability, and (4) 30% of hypertension is caused by increased dietary sodium, the IOM committee did not consider sodium-induced hypertension to be an outcome on which to base recommendations.23, 24 Furthermore many of the invited experts presenting at the public program of the IOM had in the past made public statements against lowering dietary sodium and or disclosed financial interests.22 The IOM committee examined cohort studies qualitatively and noted many had substantive methodological flaws. For example, nearly all the studies that did not find a benefit of sodium intake <2300 mg/d controlled for blood pressure and hence were not designed to assess sodium outcomes related to blood pressure. The controversial publication by Stolarz-Skrzypek and colleagues represents an example of where it was concluded that high salt intake did not cause cardiovascular disease, even though blood pressure was controlled.25 Some of the studies that did not find benefits of lower sodium intake used estimates of sodium intake that were frail and one even retrospectively assessed random spot urine sodium in trials where about 30% of participants were prescribed diuretic therapy. A series of 4 studies, representing a significant proportion of the research, were conducted by a single research group, all finding that high dietary sodium was associated with reduced disease. In addition, the senior investigator on that research team was a consultant with the Salt Institute. Two of the same databases were examined by other investigators and the repeat analyses found harm from increased sodium intake (albeit only in obese patients in one analysis).26-30 The refuted studies were still considered by the IOM (as were the refuting studies) without comment. The meta-analysis of cohort studies in healthy populations conducted by WHO does not seem to have been considered, or the updated Cochrane analysis.31, 32 Many of the cohort studies considered by the IOM were conducted in patients with substantive disease where people ingesting lower sodium were likely to be much sicker and sick people do not eat leading to a reduced sodium intake, ie, reverse causality. Perhaps most notable were a series of unusual but large randomized controlled trials conducted in patients with heart failure. Those with heart failure were treated with large, fixed doses of furosemide 500 to 1000 mg/d as well as spironolactone and drugs designed to block the renin-angiotensin system. Even though they had features of salt and water depletion, they were then randomized to lower dietary sodium and water intake and found to have worse outcomes. That it is possible to harm patients with heart failure who are sodium and volume depleted by very high doses of furosemide (or any other mechanism) and then restricting sodium and water is not surprising. It is surprising that such trial evidence is considered when clinical recommendations are to individualize use of diuretics and to use diuretics only to reduce clinical evidence of excess fluid.33 However, a meta-analysis of these studies has now been withdrawn due to obvious discrepancies in some of the results and therefore these heart failure trial results can no longer be considered until reanalysis of original data by an independent committee is published. Low-quality and poorly designed research on dietary sodium has become common and is a major source of controversy. Such studies are those (1) in patients with diseases with a high probability of reverse causality (in cohort studies, patients with more severe disease are likely to have worse outcomes but also likely to eat less sodium), (2) with flimsy assessment of sodium intake in settings where multiple days of carefully performed 24-hour urine sodium assessments (or in some specific circumstances dietary assessment) are needed to reliably define an individual's sodium intake, (3) that control for blood pressure (the major mechanism for sodium causing harm), (4) that do not adequately control for other substantive confounding factors, and (5) that disregard confounding pharmacologic agents (diuretics and antihypertensive drugs). Another potential marker of a low-quality study is when the author's discussion cites only evidence that supports the manuscript's findings without the context of the overall literature and its interpretation. There is a need for developing and setting standards for clinical research on dietary sodium. Such standards could be used by researchers in designing studies, funding bodies in assessing proposals, journal reviewers, and editorial bodies in selecting articles to publish. Setting standards have been successfully utilized in the past to improve designs for conducting clinical trials and systematic reviews but have not been disease-specific. WHO or major international scientific organizations could develop such standards. Notably, the Pan American Health Organization (of WHO) Technical Advisory Group on dietary salt reduction has proposed to develop such standards. Humans evolved on <1000 mg of sodium per day. There is an estimated 3.1 million deaths per year attributed to the widespread addition of sodium to food (making sodium additives to food one of the most lethal and disabling interventions of industrialization) and little evidence to select a safe threshold of adding sodium to food. Requiring incontrovertible proof of benefit to reduce dietary sodium to a given level is a food industry commercial perspective on a major public health issue. Establishing a safe level (if there is one) for the addition of sodium to food is the public health question at issue. Indeed, if incontrovertible proof for other aspects of nutrition is required, no public health policy on nutrition would be advocated, eg, no action on obesity, fruit and vegetable consumption, trans fats, saturated fat, and sugar consumption. The IOM, even with their limited scope, should have estimated the numbers of Americans with hypertension related to sodium intake >2300 mg/d vs <2300 mg/d and the direct costs. Given the public health context and causing hypertension in a large number of people, the IOM would likely have concluded (as have all other scientific review bodies, including the 2013 WHO report) that reducing dietary salt to <2300 mg/d is one of the more important health interventions to improve health. Another factor likely generating controversy is the examination of select research without the context that is known about dietary sodium or the context of public health research on food (where sodium has been more extensively and thoroughly studied than other nutrients). Performing limited reviews of the evidence, by those with great expertise in narrow areas of research with select perspectives on what constitutes acceptable evidence, does not seem to be a reasonable mechanism to address a major societal public health issue. The IOM review focused on limited evidence (cohort studies and randomized controlled trials published after 2003 with limited outcomes [mostly cardiovascular]). Given the importance, with the millions of lives and billions of dollars at stake, only comprehensive reviews of all the evidence by committees with broad expertise, conducted under the auspices of highly regarded institutions, should be considered relevant. Another major factor that has likely generated controversy is financial conflicts of interest. The food and salt industry has been active in promoting commercial interpretations of the evidence. Salt Institute consultants and staff regularly provide commentary and assist with media releases that support a commercially beneficial perspective sometimes without disclosure. Quite worrying are instances where academics have received funding or been consultants with the food industry but not disclosed, or even in some settings denied, these associations. The food/salt sector has (1) sponsored reviews of the sodium evidence, which counter those of the health and scientific community, and were published in an academic journal without disclosure of commercial interests and continue to be disseminated free of charge34 (International Life Sciences Institute Web site accessed June 19, 2013), (2) continued to invite dissident scientists to present at sponsored symposia, (3) developed educational material on the health benefits of sodium for schools, and (4) even promoted that sodium intake is associated with greater intelligence and longevity (http://www.bmj.com/content/344/bmj.e2769/rr/582338). Newspapers and even scientific journals require readerships to be commercially viable and seem to promote controversy around dietary sodium. The commercial sector and those with commercial interest should have a very limited and defined role in conducting and interpreting pivotal health research and an even lesser role in the policy development stage. Further, governments could and should hold and allow the public to hold industry and their consultants accountable for health costs, death, and disability. The more comprehensive and systematic the review, the more credible the review institution and reviewers, the less commercial influence in the review, and the better the science the less controversial the efforts to normalize sodium ingestion are. Much controversy is generated by limited or low-quality reviews, science, are commercial interests. Efforts to address these issues are needed to guide efforts to improve the health and well-being of our populations. Reducing dietary sodium by 30% is one of the agreed targets approved by the United Nations and the World Health Assembly, and reducing dietary salt to <2000 mg/d is one of a few recommended best buys to reduce noncommunicable diseases by WHO. There is an urgent need for coordinated actions by governments, industry, academia, and civil society to reduce dietary salt to maintain health and well-being.