Success of UK Salt Reduction Program Halted by Government Interference

30 Apr 2015 --- A group of leading scientists has called for more urgent action to protect and improve the health of the UK population as they say that the food we eat is now the biggest cause of death and ill health in the UK, owing to the large amounts of salt, saturated fat, and sugars added by the food industry.

The UK Food Standards Agency (FSA) was set up in 2000 to deal with bovine spongiform encephalopathy and was also made responsible for nutrition. It was made independent from ministerial control but could report to parliament through the public health minister. The independent Scientific Advisory Committee on Nutrition (SACN) was set up at the same time to advise both the FSA and the government on the evidence for nutrition and health. The FSA had an independently elected board, which decided on policy in open meetings. Policy was then actioned by the FSA in conjunction with the food industry and non-governmental organisations. The FSA became a world leader in improving nutrition, in particular pioneering the reduction in the amount of salt added to food by industry. 

MacGregor and his colleagues have described the UK’s successful salt reduction programme under the FSA and how Andrew Lansley and the coalition government have taken a major step backwards with the “responsibility deal.”

In 1994 the Committee on Medical Aspects of Food and Nutrition Policy (COMA) recommended a reduction in salt intake to <6 g/day, which was initially rejected, but after some campaigning, it was agreed with John Krebs, chair of the FSA, that salt reduction would be the first of several pioneering nutritional policies that the FSA would take on. SACN was then asked to review all the evidence on salt and health.

After considerable debate it was decided that industry should be given voluntary salt targets but that the FSA and non-governmental organisations should be responsible for close monitoring and enforcement of the targets to ensure that all the major food companies would be involved and that they would all aim for the same targets.

The reductions have been made slowly, with no reported loss of sales by the food industry. The average salt intake, measured by 24 h urinary sodium in a random sample of the adult population, fell by 15%, from 9.5 g/day in 2003 to 8.1 g/day in 2011. This was accompanied by a fall in population blood pressure and mortality from stroke and ischaemic heart disease.

The FSA and the National Institute for Health and Care Excellence estimated that salt reduction campaigns have prevented around 9000 deaths due to stroke and ischaemic heart disease a year and resulted in annual healthcare savings of around £1.5bn (€2.1bn; $2.2bn) in the UK. 

When the coalition government was formed in 2010 Andrew Lansley was appointed secretary of state for health, and he moved the responsibility for nutrition from the FSA to the Department of Health. This disrupted the salt reduction programme, making it unclear who would be responsible for the policy. In 2011 Lansley launched the responsibility deal, whereby he made the alcohol and food industries responsible for reducing alcohol consumption and improving nutrition, respectively. As a result, salt reduction lost momentum. The majority of non-governmental organisations that initially signed up to the deal subsequently withdrew over concerns that the interests of industry had been prioritised over public health and that no commitment was made on alternative actions if the pledges did not work.

CASH had several meetings with Lansley and the Department of Health between 2010 and 2012, during which Lansley said that he wanted to scrap the salt targets for 2012. After strong lobbying from CASH he agreed to accept them but refused to set new targets for 2014. He also relaxed the reporting mechanisms, enabling the food industry to present their own feedback, which made the information harder to analyse. This lack of clarity resulted in many companies stopping or slowing down their planned reductions in salt added to foods.

The responsibility deal seemed to be a way of getting the food industry involved in improving nutrition without the Department of Health having to take much responsibility. This gave the food industry the potential to make exaggerated claims on what they were achieving. Throughout the salt target meetings in 2013 it became clear that some companies had failed to meet the 2012 targets, and little was done about it.

When Lansley left the Department of Health in 2012, Anna Soubry was appointed minister for public health and agreed to reset the salt targets. New targets were set in 2014 to be achieved by 2017. But many of the targets were not as low as originally suggested by the Department of Health and CASH, owing to apparent food industry lobbying. Furthermore, the department refused to provide any funding to investigate technical problems raised by the food industry, such as the minimal level of salt necessary to inhibit Clostridium botulinum in meat products.

The lack of targets for 2014, and the fact that some food products had already met their 2012 targets, meant that companies had no need to make any further reductions. As a result, four years of the salt reduction programme were lost, says MacGregor. 

Additionally, there has been very poor sign-up to the 2017 salt targets, with big companies such as Unilever, McDonalds, and Kellogg’s failing to publicly commit to the responsibility deal. The food industry does not think that they or their competitors need to comply as there is no enforcement or proper monitoring of the programme.

The UK Food & Drink Federation (FDF) has defended the food industry today, saying that its voluntary action has helped to reduce salt intake by 15%.

Barbara Gallani, Director of Regulation, Science & Health at the FDF, said: “The UK has a world-leading salt reduction programme, thanks in no small part to the voluntary efforts of food producers. Voluntary action by companies over the past decade has helped to reduce adult intakes of salt by 15% and further work is on-going to help consumers meet dietary recommendations.

“It is common sense that food producers should be involved in shaping a salt reduction strategy as only a thorough understanding of ingredients and recipes can result in stretching but realistic targets. FDF and its members continue to support a voluntary approach in order to deliver more and more timely than any legislation could achieve.

“Having made great early strides to reduce salt in products, many companies are finding reductions harder to achieve without compromising product safety or jeopardising taste, texture or shelf-life. Increased funding for pre-competitive research would help companies overcome shared barriers to further salt reductions.

“Government support to upskill the UK's 6,000 small and medium sized food and drink businesses and help them to reduce salt, calories and saturates in their ranges would also deliver significant consumer benefit.”

MacGregor and colleagues conclude with a call for an independent agency for nutrition with a transparent monitoring programme, which is urgently needed to improve the food that we eat.