Prof Graham MacGregor CBE, Professor of Cardiovascular Medicine at Queen Mary University of London and Chair of Action on Salt / World Action on Salt, Sugar and Health
Earlier this year, evidence emerged from South Africa that mandatory salt targets resulted in a huge fall in salt intake, even amongst the most deprived groups.
Impressively, this was possible without government monitoring to check food companies were complying. In South Africa, salt reduction is enshrined in law and the industry knows better than to cross that line.
In the UK, we have no such law. Despite evidence proving the negative effects of salt on health, it’s outrageous that food companies and chefs are still adding unnecessary levels of salt to food; putting their consumers’ health at risk.
Since 2011, more than 95,000 people have died needlessly in the UK from excess salt, with costs to the UK economy topping £43bn. Isn’t it time we did something?
And therein lies the issue - the impact of eating too much salt is not a new and we already know what needs to be done to prevent it. Decades of evidence tells us unequivocally that salt increases blood pressure.
High blood pressure leads to thousands of unnecessary deaths worldwide from heart attacks, heart failure and stroke – the cause of one in four deaths in England and equivalent to one death every four minutes. Indeed, high blood pressure is responsible for almost two thirds (62%) of stroke and half of heart disease (49%). High salt intake also contributes to kidney disease, stomach cancer and osteoporosis – and potentially to obesity too.
Everyone is at risk from the health effects of eating too much salt. Most of our salt intake comes from the food we buy, with processed foods contributing to 75% of our daily salt intake.
In 2004, the Food Standards Agency (FSA) developed a programme of salt reduction. It was a triumph and by 2011, population salt intake had fallen by 15%, accompanied by falls in average blood pressure and deaths from stroke and heart disease. The UK’s model inspired many more countries to take action. To date, more than 50 countries have salt targets similar to the UK.
Then in a disastrous move, in 2011 salt reduction was removed from the FSA and placed under the public health responsibility deal, which, unbelievably, gave the food industry the reins to improve public health. Predictably, the majority of companies did not stick to targets, the industry was not properly monitored, and salt reduction progress stalled.
Responsibility now lies with the Department of Health and their Office for Health Improvement and Disparities, where salt reduction has been merged with obesity prevention. Unfortunately, it has not been prioritised as the most cost-effective public health intervention to prevent stroke and heart disease. A tragedy for public health.
In recent years, obesity prevention has been prioritised and rightly so. Obesity places a huge burden on individuals. But delays in implementing promised policies, alongside the numerous loopholes in those policies, have meant a distinct lack of progress on preventing obesity, rates of which have increased during the pandemic. Add to this that obesity is a hugely complex health condition, without a clear and simple method of prevention. Salt reduction, on the other hand, is much easier to achieve and has an immediate and large health impact.
For the 7.6 million of us living with stroke or heart disease, or the 16 million of us who have high blood pressure, and all of us who eat processed and prepared foods from shops, restaurants, fast food outlets and takeaways – salt reduction is as vital as ever. The policy works, it just needs to be enforced.
I’m sure many will agree that after the past few years, it’s time for a big public health win.
Mandatory, comprehensive salt reduction targets are a proportionate intervention that would require all companies to work towards the same standards, in the same way that many companies have reduced sugar in drinks as a result of the Soft Drinks Industry Levy.
What’s more, many companies operating in the UK are already adhering to mandatory salt targets in South Africa, Argentina, Oman and another 16 countries.
Government must now resurrect their salt reduction ambitions. It’s not too late to turn this tragedy back into a triumph.
