The current fish trade increases fish availability and provides essential nutrients to most countries globally. However, many countries still consume less fish than they produce. A health-sensitive trade policy could help address this imbalance. In this study, we examined how prioritizing domestic fish consumption in some net-exporting countries with low fish consumption could improve fish availability and impact global and regional health burdens. Using bilateral fish trade data from 2010 to 2019 and diet-disease relationships, we compared the impact of current trade versus trade patterns (focused on domestic consumption) on reducing deaths from ischemic heart disease (IHD), the world’s leading cause of death. Our results showed that the current trade system delivered health benefits and could have prevented approximately 130,000 IHD deaths worldwide; one-third of these benefits went to high-income countries, where health gains were mainly transferred from net-exporting low- and middle-income countries (LMICs) with relatively high IHD death rates. Shifting a portion of exports to prioritize domestic consumption in net-exporting countries may reduce IHD deaths by 26% in LMICs and prevent an additional 15,400 IHD deaths globally compared with the current trade. Moreover, it would only cause a 0.7% reduction in health benefits in net-importing countries and no reduction in low- and lower-middle-income net-importing countries. Thus, increasing fish consumption in countries with low fish intake could be more effective in reducing the global burden of disease. Our findings could assist policymakers in developing health-sensitive policies to improve health outcomes.