Easing of salt rules ‘responsible’ for more than 10,000 cases of stomach cancer and heart disease
In 2011, England introduced the Public Health Responsibility Deal, a public-private partnership, which gave greater freedom to the food industry to set and monitor targets for salt intakes
A relaxation of rules for salt intake has been linked to 9,900 cases of cardiovascular disease (CVD), including heart attacks and stroke, and 1,500 stomach cancer cases in the UK, according to a new estimate.
In 2011, England introduced the Public Health Responsibility Deal, a public-private partnership (PPP), which gave greater freedom to the food industry to set and monitor targets for salt intakes.
“We estimated that the responsibility deal has been responsible for approximately 9,900 additional cases of CVD and 1,500 additional cases of gastric cancers between 2011 and 2018,” says the research team from Imperial College London and the University of Liverpool.
The study, published in the Journal of Epidemiology and Community Health, also found that the additional burden of these diseases, which could otherwise have been prevented, not only hit the UK economy but also the nation’s health.
Researchers estimate that relaxing the food industry regulations cost the economy around £160 million ($199.5 million) from 2011-2017. “This includes healthcare costs of extra heart attacks, strokes and cancer cases, and the loss of productivity due to workplace absences,” says the team.
Salt in the diet can come from ready meals, processed meats like bacon and ham, cheese, salty snack foods, instant noodles, bread, and processed cereal products.
Reducing salt intake has been identified as one of the most cost-effective measures countries can take to improve population health outcomes.
According to the World Health Organization (WHO), high sodium consumption (greater than two grams/day, equivalent to five grams salt/day) and insufficient potassium intake (less than 3.5 grams/day) contribute to high blood pressure and increase the risk of heart disease and stroke.
The WHO recommends salt intake of fewer than 5 grams per day for adults to help reduce blood pressure and risk of cardiovascular disease, stroke, and coronary heart attack. “An estimated 2.5 million deaths could be prevented each year if global salt consumption were reduced to the recommended level,” says the WHO.
According to the researchers, adults in England are thought to eat an average of eight grams daily, and two in three people consume too much salt - with most of this coming from processed foods such as bread, processed meats, and ready meals.
Change in regulations are to be blamed
Between 2003 and 2010, as part of the salt reduction strategy, the Food Standards Agency (FSA) specified targets for 85 categories of food.
In 2006, the FSA published industry salt targets -- approximately 10–20% reductions -- to be achieved by 2010, including a reformulation of foods known to contain high levels of salt, and the introduction of food labeling. Public health campaigns on how to reduce salt consumption accompanied this, as well as pressure from the government, which threatened further regulation in the event of poor industry compliance.
In 2011, however, this policy was replaced by the responsibility deal, in which the food industry could set their own targets. There was a range of food pledges they could sign up for, including chef training in using less salt, providing salt content on menus, and reformulation, all within two years of signing the pledges. They also had to report their progress to the Department of Health.
For their study, the researchers used data from the National Diet and Nutrition Survey and national salt surveys (2000-2013). These surveys included urine analysis of over 3,000 people (aged 19-64 years), which showed in detail how much salt they were eating in their diet every day, and acted as a representative sample of the population. The team estimated the impact of the deal on trends in salt intake and associated changes in cardiovascular disease and gastric cancer incidence. In 2000-2001, mean salt intake was 10.5 grams/day in men and 8.0 grams/day in women.
The researchers found that previous reductions in population-level salt intake in England slowed significantly after the implementation of the responsibility deal in 2011.
The analysis shows before 2011, salt intake was falling annually by 0.2g a day for men, and 0.12g a day for women. However, after 2011, when the regulations were relaxed, annual declines slowed to 0.11g per day for men and 0.07g per day for women. This "slowing," according to the team, was associated with the additional cases of cardiovascular disease and gastric cancer.
Without urgent action and a robust strategy, the researchers are predicting even more avoidable heart attacks, strokes, and cancer cases. Using a computer model, the team estimated that a failure to toughen regulations could lead to an extra 26,000 cases of cardiovascular disease, and 3,800 cases of stomach cancer between 2019 and 2025. This, according to the analysis, could cost an additional £960 million ($1,197 million) to the economy over the next six years.
The researchers say that a public-private partnership such as the responsibility deal lack robust and independent target setting as well as monitoring and enforcement, and is, therefore, unlikely to produce optimal health gains.
“Proponents of the responsibility deal argued that the increased role of the industry would deliver more effective action to reduce salt intakes at a lower cost than the FSA strategy, but our findings suggest this not to be the case. The design and implementation of the deal have been criticized for being underpinned by pledges made by the food industry, not following the evidence of effectiveness to improve diets. While 46% of food industry salt reduction pledges did include a reformulation of their products by 2013, the independent evaluation concluded that none of these measures were prompted by the deal. Our findings suggest that the deal may have had a particularly negative impact among more deprived populations. Without independent targets and monitoring, PPPs are unlikely to deliver the improvements in population health claimed by their proponents,” says the paper.