More than 30 experts and health organizations call out UK government’s declining salt reduction program

19 Sep 2023 --- Action on Salt (AoS), the British Heart Foundation, the British Medical Association and 30 other health organizations and professionals signed an open letter to UK government party leaders urging a revitalization of its salt reduction program in light of recent study findings. 

According to researchers at Queen Mary University, at the salt reduction program’s peak – between 2003 and 2014 – there was a 19% reduction in salt intake. The study further states that this may have saved an estimated more than 9,000 lives annually.

However, the researchers state that since the government transferred control of the program from the Food Standards Agency to the Department of Health in 2010 and what the study states was a resultant loosening of restrictions – by 2014 salt intake began to increase again, coincided with an increase of deaths due to ischaemic heart disease (IHD) and stroke.

Moreover, AoS and the study stress that in 2014, the responsibility for salt policy was transferred to the food industry, further loosening the program’s reins.

“This new research confirms the relationship between reduced salt consumption and improved health outcomes,” Mhairi Brown, policy and public affairs lead at AoS, tells Nutrition Insight. “The UK salt reduction program was a great success in reducing population salt intake by 19% between 2003 and 2014.” 

“As salt intakes went down, so did population blood pressure and deaths from heart disease and stroke. In recent years, however, the program was abandoned, largely due to pressure from the food industry. Salt intake reduction has since stalled, along with reductions in blood pressure and cardiovascular disease.”

Rising pressures
AoS stresses that the consequences of this policy shift are evident in rising blood pressure levels, increased mortality rates from strokes and heart disease and a general decline in public health.

Therefore, the open letter to UK party leaders advocates for the implementation of a mandatory and comprehensive salt reduction program to safeguard public health and the economy.

Additionally, the organization underscores that this call for action coincides with a consumer poll it recently conducted, which showed that nearly 90% of the UK citizens expressed a willingness to see the government take measures to protect against avoidable health conditions like heart disease and strokes.The study highlights that the UK Government’s salt reduction program saved lives and billion of dollars in health care and related costs.

Furthermore, nearly 80% say they believe that government ministers should be doing more to reduce the nation’s salt consumption and 85% support government mandates for food companies to reduce unnecessary salt in their products.

“Reducing salt is simple and cost-effective – most of our food comes ‘ready salted’ which means we can’t take it out ourselves,” Brown explains. “Responsibility falls on the food industry to reduce unnecessary salt in food but there are no incentives for industry to adhere to a voluntary program.” 

“Taking learnings from this research, we need stronger incentives for the food industry to comply, and that involves a comprehensive and mandatory program as the logical step forward.”

Reduce salt to save lives?
Published in the Journal of Hypertension, researchers from Queen Mary University in London, utilized publicly available data from the UK Data Service, the National Diet and Nutrition Survey (NDNS) 2001 and the NDNS Assessment of Dietary Sodium from 2006 to 2018.

According to the researchers, the findings underscore the critical importance of salt reduction initiatives in improving public health, particularly in reducing premature deaths from strokes and heart disease. 

It further spotlights that if the previous successful program had continued, an estimated 38,000 deaths from strokes and heart disease, including 24,000 premature fatalities, could have been prevented between 2014 and 2018.

“Cardiovascular disease (CVD) accounts for around one in five premature deaths in England (i.e. deaths before the age of 70 years),” Brown reveals. “Worryingly, people living in the most deprived areas of the country are four times more likely to die prematurely from CVD than those in the most affluent areas.’

She further adds that the cost of treating CVDs increases the societal and individual burden of declining salt regulations.

“During 2019 and 2020, there were around one million hospital admissions for cardiovascular disease in England, leading to 5.5 million bed days. England alone spends an estimated £7.4 billion (US$9.2 billion) on CVD healthcare costs annually, and the wider economic impact of these diseases is estimated at £15.8 billion (US$19.6 billion), which includes productivity losses.”

The case for increased regulation
Both Brown and the study point to the more than decade-long decline in IHD-related deaths that took place from 2001 to 2011. IHD-related deaths decreased from 43.44 per 100,000 people in 2003 to 27.23 per 100,000 by 2014. Similarly, deaths due to stroke also decreased from 12.24 per 100,000 people in 2003 to 8.9 per 100,000 people in 2014.

Over 30 other health professionals and organizations sent an open letter to the UK government calling for increased salt regulations.However, both of the rates plateaued starting in 2011 and began to increase again starting in 2014. Brown states that the slowdown is estimated to cost the UK government approximately UK £54 billion (US$66.9 billion) by 2029.

“Reducing salt intake would reduce the number of deaths from cardiovascular disease at a population level,” she reveals. “Reducing average daily intake of salt by just 1g per day would prevent more than 4,000 premature deaths each year and save £1.5 billion (US$1.85 billion) in healthcare costs.”

Proven effects
Brown further emphasizes that numerous other countries have enforced obligatory objectives to decrease salt levels in their national diets and highlights South Africa as a prominent case. 

In 2013, South Africa’s Ministry of Health introduced legislation aimed at reducing salt content in various food items, including bread, butter, margarine, snack foods, processed meat, instant noodles, soups and stocks. The country’s mandated salt goals were set to be achieved by 2019. 

However, a study published in 2022 revealed that the average daily salt consumption in the population had decreased by slightly more than 1g per day. Notably, individuals with lower incomes experienced more significant reductions.

“It’s clear that some form of legislation is needed to overcome the failures of the current voluntary program, and the only thing holding this back is political will,” says Brown. “The government must step up and commit to reducing salt intake and protecting the nation’s health.” 

“With a General Election due next year, we might see the next government take the reins and push forward with a mandatory program,” she concludes.

By William Bradford Nichols