UK researchers identify the shortcomings of the Public Health Responsibility Deal, a voluntary self-regulating pact between the government and food industry in 2011 to curb the salt content of food.
However, the team’s findings suggest that the deal may have slowed the rate of reduction of salt in food resulting in excess cardiovascular (CVD) and cancer cases.
“Evidence from around the world is now showing that mandatory approaches are much more effective than self-regulation by industry in reducing the amount of salt and sugar in our diet,” said Dr Anthony Laverty, lead author of the research from Imperial’s School of Public Health.
He highlights the Public Health Responsibility Deal's lack of robust and independent target setting, monitoring, and enforcement, which contributed to an extra 9900 cases of cardiovascular disease, and 1,500 cases of stomach cancer.
However, a number of experts highlighted the limitations of the research. Francesco Cappuccio, Cephalon professor of cardiovascular medicine & epidemiology at the University of Warwick, said, “The data cannot imply causality as they are not prospective recordings in the same individuals and not all potential confounders could be considered.
“Response rates are low in each survey, thus affecting the overall generalisability and some limitation in data quality is present when assessing associations with socio-economic status. However, plausibility and consistency with other evidence makes the results not surprising.”
Alun Hughes, professor of cardiovascular physiology and pharmacology at University College London (UCL), said,”The study has limitations (as discussed by the authors).”
“These are the lack of repeated measures of salt intake in the same individuals, the comparatively small sample sizes, and the assumption that salt intake was set to decline along the same trajectory as it had over the period 2003-10.”
Professor Hughes added that this assumption was not implausible but, as a counterfactual, was impossible to verify.
“Likewise the estimates of mortality, costs, and impact on health inequalities that might result from any slowdown in reductions in salt intake, while based on reasonable (and probably conservative) assumptions, are projections and should be regarded with due caution.”
‘A tragedy for public health’
However, Professor Hughes along with a number of experts agreed the study cast doubt on the effectiveness of the deal in terms of reducing dietary salt intake.
“We’ve long known that the Public Health Responsibility Deal was a tragedy for public health,” said Graham MacGregor, professor of cardiovascular medicine at Queen Mary University of London.
“Independent evaluations highlighted its lack of effectiveness and this research markedly brings home the effect the deal had on the UK’s once world-leading salt reduction programme.
“The slowing in the reduction of salt intake led to many thousands of entirely preventable occurrences of cardiovascular disease and stomach cancer, particularly in those from more deprived backgrounds.
“The Secretary of State for Health promised new salt reduction plans in his delayed prevention green paper and this paper reiterates the overwhelming need for a revived salt reduction strategy in the UK.
The UK currently has no active salt reduction strategy, with the last set of salt reduction targets having expired at the end of 2017.
Countries that have mandatory salt targets for certain foods include Belgium (bread), Bulgaria (bread, milk products, meat products), Greece (bread, tomato products), Hungary (bread), Netherlands (bread) and Portugal (bread).
Portugal along with Hungary also tax high salt foods, with Finland and Portugal implementing regulation on front of pack labelling.
Source: Journal of Epidemiology & Community Health
Published online: DOI: 10.1136.jech-2018-211749
“Quantifying the impact of the Public Health Responsibility Deal on salt intake, cardiovascular disease and gastric cancer burdens: interrupted time series and microsimulation study.”
Authors: Anthony Laverty et al.