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World Action on Salt. Sugar & Health

CASH: How Andrew Lansley and the coalition government derailed the UK’s successful salt reduction strategy


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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 is in desperate need of an independent agency to improve nutrition, which the responsibility deal has failed to do according to a new paper by CASH (Consensus Action on Salt and Health), published today in the BMJ [REF 1].

The UK’s salt reduction programme, started in 2005 and pioneered by the Food Standards Agency (FSA) and CASH, has been considered a worldwide success. The programme involved a collaborative effort with the food industry to reduce salt in the nation’s diet. This was done by setting up specific salt targets for 86 categories of food, with the aim of re-setting them every 4 years. Whilst the targets remained voluntary, monitoring of the food industry was maintained throughout, ensuring no company lagged behind. As a result, significant reductions in salt intake were made at a population level, consequently reducing blood pressure and resulting in fewer deaths from heart attack and stroke [REF 2].

Unfortunately under the coalition government, responsibility for nutrition was taken away from the FSA by Andrew Lansley, disturbing progress in salt reduction made by the FSA. Lansley’s decision to hand power back to the food industry as part of the flawed responsibility deal has meant potentially 4 years of salt reduction has been lost, putting an estimated 6,000 lives per year at risk and draining valuable NHS resources.

CASH is now calling for urgent action to protect and improve the nation’s health together with an independent agency for nutrition and a transparent monitoring programme to improve the food that we eat once and for all.

“The food industry is the biggest and most powerful industry in the world. Most of the foods that it currently provides are very high in salt, fat and sugars, causing increased risk of strokes, heart failure and heart attacks, and predisposing to cancer than healthier alternatives. It is therefore imperative that robust mechanisms should be set up immediately to control the food industry in a similar way to the tobacco industry” says Professor Graham MacGregor, Professor of Cardiovascular Medicine at Queen Mary University of London and leading author of the BMJ paper.

“If the food industry were forced to produce healthier food, it would result in major reductions in cardiovascular disease and cancer, as well as healthcare costs.”

In 2005, the FSA – the independent governing body responsible for nutrition at that time – developed the first set of voluntary salt targets for the food industry to follow. This was drawn up following strong evidence that salt intake raised blood pressure. Along with public awareness campaigns e.g. Sid the Slug, close monitoring and enforcement of the targets was made by the FSA and non-governmental organisations to ensure that all major food companies were involved. The targets were set up with the intention of gradually lowering them further every four years until the target for population salt intake of 6g/day was achieved.

In the 5 years after the policy was introduced the salt content of many food products has been gradually reduced by around 20-40%, with no reported loss of sales. Within the same period of time, average population salt intake has fallen by 15%, from 9.5g/day to 8.1g/day. This was accompanied by a fall in population blood pressure and mortality from stroke and coronary heart disease [REF 2]. As a result of these reductions, it is estimated that 9,000 deaths from stroke and coronary heart disease have been prevented each year, with annual healthcare savings of around £1.5bn in the UK [REF 3].

Disruption by the coalition government
Following the formation of the coalition government in 2010, Andrew Lansley was appointed secretary of state for health and transferred 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!

No further commitment to the salt targets were made by the responsibility deal, until Andrew Lansley was replaced by Jeremy Hunt and Anna Soubry was appointed minister for Public Health. New targets were eventually set in 2014 to be achieved by 2017, but the delay has meant momentum in salt reduction has been lost, with many companies stopping or slowing down their planned reductions in salt added to foods.

The outcome
This delay has disrupted progress in salt reduction. CASH estimates that over the last four years salt intake would have been further reduced by around 0.9g/day [REF 4]. Assuming no salt reductions have been made over this period, the lost 0.9 g/day corresponds to approximately 6,000 deaths per year from stroke and heart attack which could have been prevented [REF 3], over 4,000 per year of which would have been premature.

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.

Sonia Pombo, a nutritionist at CASH and joint author says “The responsibility deal is no longer fit for purpose. For too long the food industry have been allowed to police themselves, putting the health of our nation at risk. It is therefore imperative that responsibility for nutrition be handed back to an independent agency, where it is not affected by changes in government, ministers, or political lobbying. Let’s get the UK back on track with salt reduction and retain our status as world leaders.”

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National PR - David Clarke: M: 07773 225516
To speak to Professor MacGregor (07946405617,, it may be preferable to contact him through viber or skype (gmacgreg11,) as he may be abroad.

1 – MacGregor GA, He FJ, Pombo-Rodrigues S. Food and the responsibility deal: how the salt reduction strategy was derailed by Andrew Lansley and the coalition government. BMJ 2015;350:h1935.
2 – He FJ, Pombo-Rodrigues S, MacGregor GA. Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open 2014;4:e004549
3 – National Insititute for Health & Clinical Excellence. Prevention of cardiovascular disease. June 2010
4 – Based on the trend of salt reduction between 2005 and 2011 (1.4g/day, assuming no change between 2001 and 2005).

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