The coalition government derailed a successful programme that reduced salt content added to foods by industry, argue experts in The BMJ this week.
A poor diet is the leading cause of death and disability in the UK and worldwide. Large amounts of salt, for example, are added to food by industry and eating too much can raise blood pressure, a major factor associated with strokes, heart failure and heart attacks.
The UK's Food Standards Agency (FSA), established in 2000, became a "world leader" in improving nutrition and pioneered a salt reduction programme by working closely with the food industry. It set voluntary targets, monitored progress and ensured that all major food companies aimed for the same goal.
Its overall aim was to eventually reduce salt intake to 6g/day among the adult population.
Five years after the first targets were set in 2006, salt content was reduced in foods by around 10-40%. Average salt intake at the population level fell by 15% from 9.5 g/day in 2003 to 8.1 g/day in 2011 and blood pressure and death from stroke and ischaemic heart disease decreased.
Estimates suggest that salt reduction campaigns have prevented around 9,000 deaths due to stroke and ischaemic heart disease per year and made health care savings of around £1.5bn in the UK.
Despite this success, the new coalition government formed in 2010 transferred responsibility for nutrition from the FSA to the Department of Health, which disrupted the salt reduction programme.
Then in 2011 Andrew Lansley, health minister at the time, launched the responsibility deal which made alcohol and food industries responsible for reducing alcohol and improving nutrition.
But this move was "responsible for a major step backwards in public health nutrition," argues Graham MacGregor, professor of cardiovascular medicine, and colleagues from Queen Mary, University of London.
With the new responsibility deal, specific targets for salt reduction were not set, reporting mechanisms were relaxed and the majority of non-governmental organisations withdrew from the deal because of concerns that industry interests were prioritised over public health.
This led to a committee dominated largely by industry, explain the authors, and many companies stopped or slowed down their planned salt reductions over this period, and some failed to meet targets.
New salt targets were set in 2014 following the appointment of new health minister Anna Soubry, but these were not as low as originally suggested -- apparently, due to lobbying by the food industry, they explain.
In addition, there has been poor involvement in the 2017 targets by large food companies because of the lack of enforcement and proper monitoring.
The authors calculated that from 2010 to 2014, around 0.9 g/day of salt reduction was lost based on the trend of salt reduction between 2005 and 2011. If no salt reduction was achieved over this period, the lost 0.9 g/day corresponds to around 6,000 deaths from stroke and heart attack.
The food industry is the "biggest and most powerful industry in the world" and mechanisms should be in place to control it in a similar way to the tobacco industry, they argue.
They say there is an urgent need for an independent agency, similar to the FSA, with responsibility for nutrition with a transparent and effective monitoring programme that is also "free from political pressure and influence from the food industry."
They add that the agency should also aim to reduce sugars and fats in foods that would lead to a decrease in obesity, type 2 diabetes and cancer.
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