UK population salt reduction: an experiment in public health

Abstract

BackgroundThe UK has implemented a programme of voluntary salt reduction in collaboration with the food industry, which has resulted in a fall in salt intake in the population. We undertook a comprehensive analysis of the programme with the aim of providing a simple step-by-step guide for development and implementation of a national salt reduction programme that other countries could follow. MethodsWe identified several key components of the UK salt reduction programme by reviewing (1) the documents archived by Consensus Action on Salt and Health (CASH) on the UK salt reduction policy, (2) journal and press articles, and (3) relevant websites. The main elements of the UK programme include (1) setting up of an action group with strong leadership and scientific credibility; (2) establishing salt intake by measuring 24-h urinary sodium in a random sample of the population and identifying the major sources of salt by dietary record; (3) setting a salt intake target for the population and developing a salt-reduction strategy; (4) setting progressively lower voluntary salt targets for over 80 categories of food, with a clear timeframe for the industry to achieve these targets; (5) working and engaging with the food industry to encourage reformulation of food to contain less salt to meet these targets; (6) introducing clear labelling of salt content in food; (7) undertaking consumer awareness campaigns; (8) monitoring progress by (a) frequent surveys and media publicity of salt content in food, including naming and shaming, and (b) repeated 24-h urinary sodium measurement at 3–5-year intervals; and (9) applying pressure through media exposure with a potential threat of regulation by the Department of Health. FindingsThe outcome of the successful implementation of the UK salt reduction programme is shown in four areas. First, product surveys over the years showed substantial reductions in the salt content in food; for example, a 20% reduction in the salt content of bread from 2001 to 2011. Second, there was an increase in consumers' awareness of the dangers of salt and an increase in the number of individuals trying to cut down on salt, with a decrease in salt use at the table and a reduction in table and cooking salt sales. Third, the mean salt intake in the population as measured by 24-h urinary sodium fell from 9·5 g per day to 8·1 g per day (15% reduction; p<0·05) during the 7 years since the salt reduction programme began in 2003–04. Fourth, the reduction in salt intake achieved in the UK was estimated to prevent about 9000 cardiovascular deaths a year, saving the UK economy more than £1·5 billion per annum. A limitation of our study was the absence of a control group. InterpretationThe UK salt reduction programme reduced the salt intake of the whole population by gradual reformulation on a voluntary basis, reinforced by strong political pressure. Several countries are already following the UK's lead. The challenge now is to spread this policy out to all other countries around the world with appropriate local modifications. A reduction in salt intake worldwide would result in major public health improvements and cost savings. FundingNone.