Resource systems and health: A water–energy–food–health nexus framework for hypertension prediction

The global hypertension pandemic remains a leading preventable risk factor for cardiovascular disease, yet public health interventions focused on individual behavior modification have proven insufficient. Hypertension prevalence continues to rise, driven by dietary shifts toward ultra-processed foods, increasingly sedentary urban lifestyles, disrupted access to safe water, unequal availability of nutritious, affordable food, and energy systems that shape the cost and reliability of cooling and cooking as well as air quality. The Water-Energy-Food (WEF) nexus offers a systems level framework for resource management but has historically marginalized health outcomes, creating a critical implementation gap. This paper operationalizes the Water-Energy-Food-Health (WEFH) nexus framework to reframe hypertension not as a purely clinical condition, but as an emergent property of the coupled resource systems that shape human environments and choices. The methodology leverages epidemiological metrics to attribute a portion of the total hypertension disease burden to specific exposures in the water, energy, and food sectors, followed by systematic interventions to address this burden. The results revealed that WEFH-related major sodium pathways collectively contribute to 15.1% of the total global hypertension burden. Scenario analysis of large-scale interventions revealed significant advantages and cross-sectoral trade-offs. The findings provide quantitative evidence that hypertension is highly impacted by WEF systems, while system related interventions reduced the global hypertension burden by 52.6%. An integrated approach is essential for designing effective and sustainable interventions that create synergies between public health improvement and resource security, thereby unlocking new opportunities for system level interventions to strengthen community resilience and well-being.