Quantifying the impact of the Public Health Responsibility Deal on salt intake, cardiovascular disease and gastric cancer burdens: interrupted time series and microsimulation study
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Author(s)
Type
Journal Article
Abstract
Background In 2011, England introduced the Public Health Responsibility Deal (RD), a public-private partnership (PPP) which gave greater freedom to the food industry to set and monitor targets for salt intakes. We estimated the impact of the RD on trends in salt intake and associated changes in cardiovascular disease (CVD) and gastric cancer (GCa) incidence, mortality and economic costs in England from 2011–2025. Methods We used interrupted time series models with 24 hours’ urine sample data and the IMPACTNCD microsimulation model to estimate impacts of changes in salt consumption on CVD and GCa incidence, mortality and economic impacts, as well as equity impacts. Results Between 2003 and 2010 mean salt intake was falling annually by 0.20 grams/day among men and 0.12 g/d among women (P-value for trend both < 0.001). After RD implementation in 2011, annual declines in salt intake slowed statistically significantly to 0.11 g/d among men and 0.07 g/d among women (P-values for differences in trend both P < 0.001). We estimated that the RD has been responsible for approximately 9900 (interquartile quartile range (IQR): 6700 to 13,000) additional cases of CVD and 1500 (IQR: 510 to 2300) additional cases of GCa between 2011 and 2018. If the RD continues unchanged between 2019 and 2025, approximately 26 000 (IQR: 20 000 to 31,000) additional cases of CVD and 3800 (IQR: 2200 to 5300) cases of GCa may occur. Interpretation Public-private partnerships such as the RD which lack robust and independent target setting, monitoring and enforcement are unlikely to produce optimal health gains.
Date Issued
2019-08-09
Date Acceptance
2019-05-24
ISSN
0143-005X
Publisher
BMJ
Start Page
881
End Page
887
Journal / Book Title
Journal of Epidemiology and Community Health
Volume
73
Copyright Statement
© 2019 Author(s) (or their
employer(s)). Re-use
permitted under CC BY-NC (https://creativecommons.org/licenses/by-nc/4.0/). No
commercial re-use. See rights
and permissions. Published
by BMJ.
employer(s)). Re-use
permitted under CC BY-NC (https://creativecommons.org/licenses/by-nc/4.0/). No
commercial re-use. See rights
and permissions. Published
by BMJ.
Subjects
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
PRIVATE PARTNERSHIP
FOOD
ALCOHOL
cardiovascular disease
chd/coronorary heart
diet
policy
1117 Public Health and Health Services
1604 Human Geography
Epidemiology
Publication Status
Published
Date Publish Online
2019-07-18