title: The Health Equity and Effectiveness of Policy Options to Reduce Dietary Salt Intake in England: Policy Forecast.
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.
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.
authors.forename: Duncan O S
authors.initials: DO
authors.lastname: Gillespie
authors.affiliation: Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, United Kingdom.
authors.forename: Kirk
authors.initials: K
authors.lastname: Allen
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Guzman-Castillo
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.
authors.forename: Piotr
authors.initials: P
authors.lastname: Bandosz
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.
authors.forename: Patricia
authors.initials: P
authors.lastname: Moreira
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.
authors.forename: Rory
authors.initials: R
authors.lastname: McGill
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.
authors.forename: Elspeth
authors.initials: E
authors.lastname: Anwar
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.
authors.forename: Ffion
authors.initials: F
authors.lastname: Lloyd-Williams
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Bromley
authors.affiliation: Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, United Kingdom.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Diggle
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
mesh_terms: D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004739:England / Q000453:epidemiology; D000069576:Health Equity / Q000331:legislation & jurisprudence*; D006801:Humans; D009026:Mortality; D018673:Nutrition Policy; D012959:Socioeconomic Factors; D017673:Sodium Chloride, Dietary
chemical_list: D017673:Sodium Chloride, Dietary