Nearly 10,000 cases of heart disease and stroke and 1,500 cases of cancer could have been avoided in England if the coalition government had not switched to a voluntary deal with the food industry to cut salt in food, say researchers.

The Responsibility Deal was introduced in 2011 by Andrew Lansley, then health secretary. The deal asked food and drink manufacturers and supermarkets to volunteer their own pledges to make their popular products healthier, such as by reducing salt and sugar content.

Until that time, the Food Standards Agency (FSA) had pushed companies hard to meet specific targets on salt reduction. A paper in the Journal of Epidemiology & Community Health says that under the FSA, from 2003 to 2010, salt intake levels fell by 0.2g each year for men and by 0.12g for women – from an average of 10.5g for men and 8g for women per day in England.

But between 2011 and 2014, annual reductions in dietary salt intake slowed to 0.11g for men and to 0.07g for women.

The authors, from Imperial College London, estimate that the slowdown may have led to about 9,900 extra cases of heart disease and stroke, plus 710 associated deaths, between 2011 and 2018. It could also have been responsible for 1,500 additional cases of stomach cancer and 610 associated deaths.

If this continued, the researchers said, there would be an estimated 26,000 extra cases of heart disease or stroke and 3,800 additional stomach cancer cases by 2025, affecting the least affluent people in society the most, and adding up to more than £1bn in healthcare and lost productivity costs.

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Anthony Laverty, of Imperial College’s public health policy evaluation unit, said their paper fitted into the debate over whether industry could, by itself, be depended upon to make products healthier.

“I would say, not really. If they haven’t got an incentive to do it, why would they reformulate?” he said.

“I would say the lesson both in salt and other nutritional matters is that we need an independent and robust system to say to industry you need to hit these ambitious targets.”

The paper, he said, was “another piece of evidence that says relying on these voluntary, loose arrangements with industry really isn’t the way to improve public health”.

Graham MacGregor, chair of the campaigning group Action on Salt, and a professor of cardiovascular medicine, said the paper showed that the Responsibility Deal was a disaster for public health.

He said: “It slowed down salt reduction in the UK, resulting in thousands of strokes, heart failure and heart attacks every year, particularly in the more socially deprived, many of which could have been prevented.

“This reinforces the urgent need for a robust system where we generate worthwhile reductions in salt intake which make a positive and lasting impact.

“It is now up to the health minister, Public Health England and the government to set up a coherent strategy where the food industry is instructed what to do, rather than the food industry telling the government what to do, which currently seems to be the case.

“The UK currently has no active salt reduction strategy, which is appalling. In fact, the last set of salt reduction targets expired at the end of 2017. It goes without saying we now need to get our salt reduction strategy back on track for the benefit of public health, our overburdened NHS and the economy.”

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The authors say their study had some limitations. It was an observational modelling study which could not establish cause, and the researchers did not collect long-term data on salt intake in the same people, a factor that could affect the findings.

Alun Hughes, professor of cardiovascular physiology and pharmacology at UCL, agreed there were limitations but said the study was overall of good quality.

“Despite acknowledged limitations, this study casts doubt on the effectiveness of the public health Responsibility Deal in terms of reducing dietary salt intake.

“The findings should contribute to thinking about future public health strategies and underlines the importance of careful evaluation of any public health intervention.”



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