To legislate or not to legislate? A comparison of the UK and South African approaches to the development and implementation of salt reduction programs

Abstract

The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries.

Figure 1

Summary of the UK Food Standards Agency’s engagement with the food industry to develop salt reduction targets, 2003 to 2009. SACN, Scientific Advisory Committee on Nutrition.

Figure 2

The contribution of the bread and cereals food group to total non-discretionary sodium intake in surveys of South African adults, by ethnic group (this figure is reprinted from Charlton, et al., 2005 [56]. Copyright 2005, with permission from Elsevier Inc.).

Figure 3

Mean systolic blood pressure change in an eight-week RCT that provided reduced sodium variants of commonly consumed food products to hypertensive South Africans (confidence intervals reflect the SEM) (this figure is redrawn from Charlton, et al., 2008 [47], Copyright 2008, with permission from Cambridge University Press).

Figure 4

Venn diagram to show the similarities (areas of overlap) and differences between the UK and South African salt reduction strategies.