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The Health Equity and Effectiveness of Policy Options to Reduce Dietary Salt Intake in England: Policy Forecast.

Gillespie DO, Allen K, Guzman-Castillo M, Bandosz P, Moreira P, McGill R, Anwar E, Lloyd-Williams F, Bromley H, Diggle PJ, Capewell S, O'Flaherty M - PLoS ONE (2015)

Bottom Line: Further voluntary reformulation was predicted to be less effective and inequality-reducing, preventing or postponing 1,500 (200-5,000) CHD deaths in total, with the effect greater by 100 (-100-600) deaths or 49% in the most deprived than in the most affluent.Mandatory engagement with industry to limit salt in processed-foods appears a promising and inequality-reducing option.For other policy options, our expert-driven forecast warns that future policy implementation might reach more deprived individuals less well, limiting inequality reduction.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.

ABSTRACT

Background: Public health action to reduce dietary salt intake has driven substantial reductions in coronary heart disease (CHD) over the past decade, but avoidable socio-economic differentials remain. We therefore forecast how further intervention to reduce dietary salt intake might affect the overall level and inequality of CHD mortality.

Methods: We considered English adults, with socio-economic circumstances (SEC) stratified by quintiles of the Index of Multiple Deprivation. We used IMPACTSEC, a validated CHD policy model, to link policy implementation to salt intake, systolic blood pressure and CHD mortality. We forecast the effects of mandatory and voluntary product reformulation, nutrition labelling and social marketing (e.g., health promotion, education). To inform our forecasts, we elicited experts' predictions on further policy implementation up to 2020. We then modelled the effects on CHD mortality up to 2025 and simultaneously assessed the socio-economic differentials of effect.

Results: Mandatory reformulation might prevent or postpone 4,500 (2,900-6,100) CHD deaths in total, with the effect greater by 500 (300-700) deaths or 85% in the most deprived than in the most affluent. Further voluntary reformulation was predicted to be less effective and inequality-reducing, preventing or postponing 1,500 (200-5,000) CHD deaths in total, with the effect greater by 100 (-100-600) deaths or 49% in the most deprived than in the most affluent. Further social marketing and improvements to labelling might each prevent or postpone 400-500 CHD deaths, but minimally affect inequality.

Conclusions: Mandatory engagement with industry to limit salt in processed-foods appears a promising and inequality-reducing option. For other policy options, our expert-driven forecast warns that future policy implementation might reach more deprived individuals less well, limiting inequality reduction. We therefore encourage planners to prioritise equity.

No MeSH data available.


Related in: MedlinePlus

Steps to policy effects.We modelled the steps to the effect of an intervention on dietary salt intakes in terms of: Efficacy, the largest potential effect; Coverage, the spread of the intervention through the population; Impact, the size of the outcome that results, if the intervention reaches its target, considering industry or individual responsiveness. We developed this model based on the discussion surrounding McLaren et al. [29] who followed Giddens’ [37] description of society by distinguishing structural from agentic policy options. We further applied Tugwell et al.’s [36] concept that socio-economic differentials could arise at each step of policy action. In doing so, we expand the policy detail in Diderichsen et al.’s [38] description of the maintenance of inequality.
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pone.0127927.g001: Steps to policy effects.We modelled the steps to the effect of an intervention on dietary salt intakes in terms of: Efficacy, the largest potential effect; Coverage, the spread of the intervention through the population; Impact, the size of the outcome that results, if the intervention reaches its target, considering industry or individual responsiveness. We developed this model based on the discussion surrounding McLaren et al. [29] who followed Giddens’ [37] description of society by distinguishing structural from agentic policy options. We further applied Tugwell et al.’s [36] concept that socio-economic differentials could arise at each step of policy action. In doing so, we expand the policy detail in Diderichsen et al.’s [38] description of the maintenance of inequality.

Mentions: We modelled the policy effects on dietary salt intake in three steps, illustrated in Fig 1. We based our framework on the staircase analogy of Tugwell et al. [36]. In it, we define the steps:


The Health Equity and Effectiveness of Policy Options to Reduce Dietary Salt Intake in England: Policy Forecast.

Gillespie DO, Allen K, Guzman-Castillo M, Bandosz P, Moreira P, McGill R, Anwar E, Lloyd-Williams F, Bromley H, Diggle PJ, Capewell S, O'Flaherty M - PLoS ONE (2015)

Steps to policy effects.We modelled the steps to the effect of an intervention on dietary salt intakes in terms of: Efficacy, the largest potential effect; Coverage, the spread of the intervention through the population; Impact, the size of the outcome that results, if the intervention reaches its target, considering industry or individual responsiveness. We developed this model based on the discussion surrounding McLaren et al. [29] who followed Giddens’ [37] description of society by distinguishing structural from agentic policy options. We further applied Tugwell et al.’s [36] concept that socio-economic differentials could arise at each step of policy action. In doing so, we expand the policy detail in Diderichsen et al.’s [38] description of the maintenance of inequality.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4488881&req=5

pone.0127927.g001: Steps to policy effects.We modelled the steps to the effect of an intervention on dietary salt intakes in terms of: Efficacy, the largest potential effect; Coverage, the spread of the intervention through the population; Impact, the size of the outcome that results, if the intervention reaches its target, considering industry or individual responsiveness. We developed this model based on the discussion surrounding McLaren et al. [29] who followed Giddens’ [37] description of society by distinguishing structural from agentic policy options. We further applied Tugwell et al.’s [36] concept that socio-economic differentials could arise at each step of policy action. In doing so, we expand the policy detail in Diderichsen et al.’s [38] description of the maintenance of inequality.
Mentions: We modelled the policy effects on dietary salt intake in three steps, illustrated in Fig 1. We based our framework on the staircase analogy of Tugwell et al. [36]. In it, we define the steps:

Bottom Line: Further voluntary reformulation was predicted to be less effective and inequality-reducing, preventing or postponing 1,500 (200-5,000) CHD deaths in total, with the effect greater by 100 (-100-600) deaths or 49% in the most deprived than in the most affluent.Mandatory engagement with industry to limit salt in processed-foods appears a promising and inequality-reducing option.For other policy options, our expert-driven forecast warns that future policy implementation might reach more deprived individuals less well, limiting inequality reduction.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.

ABSTRACT

Background: Public health action to reduce dietary salt intake has driven substantial reductions in coronary heart disease (CHD) over the past decade, but avoidable socio-economic differentials remain. We therefore forecast how further intervention to reduce dietary salt intake might affect the overall level and inequality of CHD mortality.

Methods: We considered English adults, with socio-economic circumstances (SEC) stratified by quintiles of the Index of Multiple Deprivation. We used IMPACTSEC, a validated CHD policy model, to link policy implementation to salt intake, systolic blood pressure and CHD mortality. We forecast the effects of mandatory and voluntary product reformulation, nutrition labelling and social marketing (e.g., health promotion, education). To inform our forecasts, we elicited experts' predictions on further policy implementation up to 2020. We then modelled the effects on CHD mortality up to 2025 and simultaneously assessed the socio-economic differentials of effect.

Results: Mandatory reformulation might prevent or postpone 4,500 (2,900-6,100) CHD deaths in total, with the effect greater by 500 (300-700) deaths or 85% in the most deprived than in the most affluent. Further voluntary reformulation was predicted to be less effective and inequality-reducing, preventing or postponing 1,500 (200-5,000) CHD deaths in total, with the effect greater by 100 (-100-600) deaths or 49% in the most deprived than in the most affluent. Further social marketing and improvements to labelling might each prevent or postpone 400-500 CHD deaths, but minimally affect inequality.

Conclusions: Mandatory engagement with industry to limit salt in processed-foods appears a promising and inequality-reducing option. For other policy options, our expert-driven forecast warns that future policy implementation might reach more deprived individuals less well, limiting inequality reduction. We therefore encourage planners to prioritise equity.

No MeSH data available.


Related in: MedlinePlus