Analysis

Food and the responsibility deal: how the salt reduction strategy was derailed

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1936 (Published 28 April 2015) Cite this as: BMJ 2015;350:h1936

1. Graham A MacGregor, professor of cardiovascular medicine1,
2. Feng J He, senior research fellow1,
3. Sonia Pombo-Rodrigues, nutritionist1

Author affiliations

1. Correspondence to: G MacGregor g.macgregor@qmul.ac.uk

• Accepted 25 March 2015

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. Graham MacGregor, Feng He, and Sonia Pombo-Rodrigues discuss the Food Standards Agency’s successful salt reduction strategy and how Andrew Lansley and the coalition government’s responsibility deal has stalled its progress. They call for urgent action to protect and improve our nation’s health

Poor diet is now the biggest cause of death and ill health in the United Kingdom and worldwide.1 2 Eating too much salt and saturated fat raises blood pressure and cholesterol, respectively, both of which are leading risk factors for death.3 Consuming too much energy from unnecessary sugar and fat causes obesity and type 2 diabetes, a rapidly increasing cause of death and disability.4

Most of the foods that industry currently provides are very high in salt, fat, and sugars and are therefore more likely to cause cardiovascular disease and predispose to cancer than healthier alternatives.5 This is particularly true for people of low socioeconomic status as they tend to eat more cheap, processed foods.6 The food industry is the biggest and most powerful industry in the world, so robust mechanisms should be set up to control it in a similar way to the tobacco industry.7 If the food industry were made to produce healthier food, it would result in major reductions in both cardiovascular disease and cancer, as well as healthcare costs.5

The UK Food Standards Agency (FSA) was set up in 2000 to deal with bovine spongiform encephalopathy and was also made responsible for nutrition. It was made independent from ministerial control but could report to parliament through the public health minister. The independent Scientific Advisory Committee on Nutrition (SACN) was set up at the same time to advise both the FSA and the government on the evidence for nutrition and health. The FSA had an independently elected board, which decided on policy in open meetings. Policy was then actioned by the FSA in conjunction with the food industry and non-governmental organisations. The FSA became a world leader in improving nutrition, in particular pioneering the reduction in the amount of salt added to food by industry. In this article, we describe the UK’s successful salt reduction programme under the FSA and how Andrew Lansley and the coalition government have taken a major step backwards with the “responsibility deal.”