As part of National Salt Awareness Week 2020, Action on Salt hosted a panel discussion at the House of Commons on Wednesday 11th March. Many guests attended the event including NGOs, members of the food industry and healthcare professionals.
The members on the panel included:
- Tim Lang - Professor of Food Policy at City University London (Chairing the panel discussion)
- Jo Nicholas - PHE Team Leader for Dietary Improvement
- Amanda Ursell - Nutritionist & Consultant
- Juliet Bouverie - Stroke Association
The full discussion can be seen below:
Juliet Bouverie, Chief Executive, Stroke Association
Juliet opened the debate by acknowledging the link between stroke and salt. Strokes are increasingly prevalent and affects many people without any warning at all. Not only does stroke have visible effects but invisible as well. Many people are unaware of the fact that stroke is preventable and can be appropriately managed.
‘Over 9.5 million people in the UK are walking around with diagnosed hypertension but too few of them are being appropriately managed. 6 million other people have undiagnosed hypertension. Overall that’s about 15 million people that are at risk of having a stroke and sadly a stroke causes a quarter of all deaths in the UK.’
Juliet points out the economic benefits for promoting the benefits of reducing salt intake ‘we know that if we can reduce salt in food by as little as 1g a day, it could prevent up to 1,500 premature deaths each year and save the NHS over £140 million annually.’
The Stroke Association helps to rebuild people’s lives after their stroke. They support all public health initiatives and campaigns to reduce salt in the diet and thus they consistently repeat the message that one of the ways to avoid a second stroke is to adopt a healthier lifestyle and that includes reducing salt in your diet. This message needs to be heard louder by more people and there is a real role for healthcare professionals to make every contact count.
Amanda Ursell, Nutritionist & Dietician
Amanda reinforces the importance of the statistics mentioned by Juliet and how these are horrifying when taken at face value. She points out that by eating a healthy balanced diet we can lower a person’s salt or risk of hypertension. There are many nutritionists which echo this message endlessly and we need to find alternative ways to attract attention to it.
When the food industries make reductions in salt this should be brought to our attention by bringing it to the press - this was mentioned by Raymond Blanc to Amanda years ago ‘if we could just get McDonald’s to make some small changes that’s going to make a huge difference to the health of the nation’. Amanda agreed with this and reinforced that small changes in big chains make massive impacts at society level and more of this needs to be done.
Changes in the out-of-home sector (OOH) is crucial as it's where millions of people and children consume food. It is critical for caterers who are supplying to these venues to change the way they are making their food for example chefs are used to making the food a certain way for many years and this should be changed. Amanda works at CH&CO where they are lucky to have a qualified chef called Rory Largan who has a degree in nutrition as well. Rory has managed to show the other chefs that it is possible to make food well-seasoned without having to put in too much salt. Nutrition education should be embedded in chefs training courses, schools and colleges such as Westminster Kingsway, so the expectations are set at a certain level. Sustainability, healthy eating and nutrition goes hand in hand, if more people are aware of the levels of salt the whole system starts to change. This is an essential part of public health and there have been great examples from the past which we need to use as motivation to keep going to accomplish great achievements.
Jo Nicholas, Public Health England Team Leader for Dietary Improvement
Public Health England (PHE) oversees the reduction and reformulation programme on behalf of the government. The work on salt reduction began in the UK back in 2004 and moved over to PHE in 2017. In March that year, we re-published the 2017 salt reduction targets which were originally developed under the Department of Health and Social Care as the Public Health Responsibility Deal. It was the first time these targets included the out of home sector. From the progress report, there was mixed progress and a key element is monitoring which will be carried out consistently and transparently.
It is evident that there has been significant progress in reducing the salt content of food since the salt targets were set in 2006.
‘So, for example, the average salt content of bread reduced by about 20% between 2001 and 2011. There has been a stepwise lowering of salt targets for food by up to 54% between 2006 and 2014. Over the same time period, there has been a reduction in population salt intake of 11%.’ Joe pointed out we are waiting for new figures on the population so intakes which is due to be published on 25th of March. These figures will show if this type of progress has been sustained.
Alongside monitoring, communication is key with other businesses organisations and the out-of-home sector to ensure continuing progress. We have engaged with certain sectors based on market share and as Amanda was saying in relation to the top sellers where we can see where the most impact can come. For example, coffee shops, food services, quick service and casual dining restaurants, our most recent engagement is with travel and leisure food businesses. Last summer the Government Prevention Green Paper highlighted that PHE is working towards the publication of the next set of challenging salt targets. Since it is the 5th wave of targets we have considered the salt reduction progress that has already been made was continuing to encourage businesses to do more which the government clearly wishes to see. The draft proposal for new targets has been shared with a range of stakeholders for commenting particularly on any technical challenges to further reduce salt and we will take all the feedback into account in our final advice to ministers of what the salt targets should be.
A recent campaign has shown that in order to meet the Governments Prevention Green Paper ambition of a further reduction of 1g in intakes down to 7g a day; a multi-facilitated approach is needed. To accomplish this, consumers will need to choose the lower salt options by checking labels and use less salt in cooking and at the tables. We need public sector procurement as Amanda was saying to lead the way in reducing the salt content in what’s available to their customers and other actions like restrictions on advertising and promotions for foods that are high in fat, salt and sugar. Only through a combination of these actions and others that will move intakes closer to recommendations. Salt reduction remains an important priority across our reduction and reformulation program.
Questions from the audience:
- We are able to influence catering services however with takeaways increasing how can this be controlled or influenced? How can we make Deliveroo and Uber Eats more responsible for the fact that they take almost as much money as farming does out of food?
- Caroline from LoSalt asked about consumer awareness. A consumer research survey was carried out recently.
9 out of 10 people do not know the recommended intake of salt is 6g per day.
6 out of 10 people instinctively add salt to their food without tasting it
1 out of 5 people are adding salt in a restaurant prior to tasting food
¼ of those 6 out of 10 people that’s equivalent to 10 million people do not want to give up salt
Amanda says it comes back to the key people which is children who have lower expectations with further education and educating chefs in catering services everybody plays a key part.
Tim says the commitment of Westminster Kingsway should be everywhere around the country however it isn't.
Amanda explains how some catering companies have nutrition as part of their curriculum, but others don't it is important to incorporate nutrition in all companies.
Juliet agrees with Tim and Amanda that a range of channels and measures should be utilised. We know that when you have a health scare it is a teachable moment and at that instant, we are very receptive to healthy lifestyle messages and the reach of health and social care workforce is absolutely enormous. We need to educate our health and social care colleagues as we are consumers to them. To understand simple and consistent messages about a diet and nutrition. Not many people actually understand that there is salt in our everyday diet like cereals and bread. Then adding salt on top is increasing our risk to some very serious diseases.
Jo explains that it is hard to get data from takeaways but engagement between decision-makers is happening to reduce the levels of salt, so people don’t have to think about it. By influencing McDonald’s, Deliveroo or Uber eats who are delivering food will have less salt in it. The message has been disseminated for example there are healthier catering guidance documents we have published to reduce salt for different types of businesses, and we are always thinking about what more we can do.
Salt has been around for a long time but not everyone knows about it! Especially in the OOH sector as it is so fragmented. The salt targets are published, and we are looking at what more we can do to reach it more mindfully.
From this, Tim asked Action on Salt if they had ever surveyed restaurants of where some offer salt on the table and some don’t.
Katharine from Action on Salt mentioned there has been a survey that has been previously conducted of whether you have to ask for salt or whether it is on the table. Those that didn’t have it on the table didn’t necessarily have salty food. Higher-end places were less likely to have salt on the table. Recommendations to have smaller sachets or low salt on the table to make a difference.
Jo said one of the key elements of salt reduction which first started with the Food Standards Agency was consumer awareness to raise awareness of the intake of salt. We should be having similar campaigns to ‘Sid The Slug’, not only was this campaign comprehensive but also effective. We do also have marketing campaigns such as Change4Life and One You and there is competition within these campaigns in terms of the messages to get out to the public. There is not currently or likely going to be lots of funding coming forward for those consumer awareness campaigns in terms of government. It is really important that we have the capability to include some of these messages in what they do. It’s the only way where we are eventually going to hopefully make that difference.
Salt has a lot of charities and there is an opportunity for PHE to work together with them such as the Stroke Association. It is about identifying those opportunities and using the resources we have in the most effective way.
Amanda pointed out that if we don’t ever get back to the levels of funding we had for ‘Sid the Slug’ campaigning it makes it even more important for everybody to do their absolute best to reduce salt for example chefs, retailers and contract caterers.
Juliet explained that no one knows what 6g of salt is but if you say a teaspoon everybody can identify with that. We need to reinforce the importance of us working in partnership, not one single organisation. We need a collective effort and different organisations should be working in partnership to get consistent messages out there. Social media is a really important channel to influence public attitude and there is more to do through social media. We need to get the message out as so many people consume Facebook, Twitter and Instagram. If we had some simple infographics or little messages could go a long way. We tend to think about traditional channels which have limited reach.
Joe from National Food Strategy raises the topic of the abundance of available information and how the public is confused
National Food Strategy (NFS) is an independent review led by Henry Dimbleby the co-founder of Leon and carried out a review of the school meals plan with Michael Gove. The NFS looks at the food system and also how we can keep what is good about the food system, so food is broadly affordable. However, we do have poverty in large existents of society, but food is safe as we have the lowest rates of food poisoning in the world. Although we do have unintended consequences of that namely we are getting overweight, increasing rates of obesity, carbon emissions and also falling biodiversity. The NFS will look at how we can keep what is good about the food system and keep the complexity of the supply chain, food security and tackle these unintended consequences and produce a food system that we will hopefully be happy to leave for our children.
From this Tim questions whether salt will be included in the NFS as a footnote or actually part of the health program.
Jo explained that part 1 is still in progress which will set out the vision of the report and part 2 which will be undertaken in summer will focus on the plan. Thus, salt will be added to part 2 which will happen in due course.
Jo continues to focus in on the stress people are having of choosing their food in terms of the complexity of the food environment they experience. This has been shown by the public dialogues NFS have been having around the country (East Anglia, Bristol, Grimsby, Lewisham). Are there any thoughts of how Action on Salt and other NGO’s can work to make that experience less stressful so people can make the right choices but in an easier way?
Tim adds is it time to revise the Eatwell Plate?
Jo from PHE emphasises the key reason that our program (reduction and reformulation) is in existence is precisely to take away the decision-making that adds to the stress of the individual. If we can make a difference and reduce the salt levels in foods that people eat every day the public doesn’t then think about it. That is the key aim of our program but isn’t the only thing happening. If everyone was to follow the Eatwell plate we wouldn’t have an issue with salt intakes. There are so many different elements to all of this and the environment is such a key feature. The Childhood Obesity Plan looks at the environment and the ways to try and change it, so the responsibility doesn’t fall so much on the individual. Of course, we all need to take responsibility and we need a combination of things aimed at individuals. There is more happening behind the scenes to make it easier for everybody.
Joe from NFS states that the retail sector has been successful and asks whether with the amount of information out there is still confusion that exists and is it wise to add more information?
Jo from PHE explained as Amanda said that it isn’t complicated to follow a simple message to eat a healthy balanced diet. The complication and confusion aren’t from the information that we are putting out but from how it is portrayed in the media. We keep saying to eat a healthy balanced diet, but it remains a challenge to get across.
Juliet agrees that the message needs to be simple! People don’t understand the link between stroke and hypertension, not even people suffering from a stroke. It needs to be in an accessible way to the public.
Tim mentions that we have spent a lot of time discussing the micro-environment, complexities of eating environment and immediate choice; rightly there is attention on this.
Although there is a great big elephant in the room which is death. The prevalence of disabilities and deaths are massive and although they have improved slightly, but not a lot. The frameworks need to change.
Helena Kipling from British Heart Foundation asked what one action would we like to see to reach that longer-term goal of 6g/day?
Amanda explains that we should stop talking about the recommended level and instead talk about the maximum amount it’s the rephrasing of this word so people can inspire to eat less.
Juliet said the message is simple, we need to get the message out that salt is bad for you
Jo from PHE reiterates that there isn’t one action. If people were eating better diets generally then we would have more people who aren’t eating more than the maximum of 6g of salt daily. It isn’t just the one action and that is the advantage of having a variety of people in the room today. Working together where we are all looking to do as much as possible is the best way of making use of all the resources, we have available. It would be lovely if there was one thing but unfortunately not.