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Quantifying the impact of the Public Health Responsibility Deal on salt intake, cardiovascular disease and gastric cancer burdens: interrupted time series and microsimulation study
  1. Anthony A Laverty1,
  2. Chris Kypridemos2,
  3. Paraskevi Seferidi3,
  4. Eszter P Vamos1,
  5. Jonathan Pearson-Stuttard2,4,
  6. Brendan Collins2,
  7. Simon Capewell2,
  8. Modi Mwatsama5,
  9. Paul Cairney6,
  10. Kate Fleming2,
  11. Martin O'Flaherty2,
  12. Christopher Millett1
  1. 1 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
  2. 2 Department of Public Health and Policy, University of Liverpool, Liverpool, UK
  3. 3 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
  4. 4 MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
  5. 5 UK Health Forum, London, UK
  6. 6 Department of History and Politics, University of Stirling, Stirling, Scotland
  1. Correspondence to Dr Anthony A Laverty, Primary Care and Public Health, Imperial College London, London SW7 2AZ, UK; a.laverty{at}


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.

  • cardiovascular disease
  • chd/coronorary heart
  • diet
  • policy

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  • AAL and CK are joint first authors.

  • MO'F and CM are joint last authors.

  • Contributors Study design was by all authors with analyses by CK and PS. AL produced the first draft and all authors revised the manuscript for important intellectual content and approved the final version. AL and CK contributed equally to this manuscript as did MoF and CM

  • Funding UK Prevention Research Partnership. UKPRP Consortium Development Grant. UKPRP_CO1_105. QUEST: QUantifying Equitable Solutions To prevent Non-Communicable Diseases.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information.

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