Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
J Epidemiol Community Health. 2019 Sep;73(9):881-887. doi: 10.1136/jech-2018-211749. Epub 2019 Jul 18.
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.
We used interrupted time series models with 24 hours' urine sample data and the IMPACT microsimulation model to estimate impacts of changes in salt consumption on CVD and GCa incidence, mortality and economic impacts, as well as equity impacts.
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.
Public-private partnerships such as the RD which lack robust and independent target setting, monitoring and enforcement are unlikely to produce optimal health gains.
2011 年，英国引入了公共卫生责任协议（RD），这是一种公私合作伙伴关系（PPP），给予食品行业更大的自由来设定和监测盐摄入量目标。我们估计 RD 对 2011-2025 年期间英格兰盐摄入量趋势、心血管疾病（CVD）和胃癌（GCa）发病率、死亡率和经济成本的影响。
我们使用 24 小时尿液样本数据的中断时间序列模型和 IMPACT 微观模拟模型来估计盐消耗变化对 CVD 和 GCa 发病率、死亡率和经济影响的影响，以及公平影响。
在 2003 年至 2010 年期间，男性的盐摄入量每年平均下降 0.20 克/天，女性下降 0.12 克/天（趋势 P 值均<0.001）。在 2011 年 RD 实施后，男性盐摄入量的年下降速度明显放缓至 0.11 克/天，女性下降至 0.07 克/天（趋势差异的 P 值均<0.001）。我们估计，RD 导致 2011 年至 2018 年间 CVD 增加约 9900 例（四分位距（IQR）：6700 至 13000），GCa 增加 1500 例（IQR：510 至 2300）。如果 RD 在 2019 年至 2025 年期间保持不变，可能会增加约 26000 例（IQR：20000 至 31000）的 CVD 和 3800 例（IQR：2200 至 5300）的 GCa。
缺乏稳健和独立的目标设定、监测和执行的公私合作伙伴关系（如 RD）不太可能产生最佳的健康收益。
