How reducing Australia’s salt intake could save lives – and money

Salt is sneaking into Australian diets, worsening our health outcomes from salt-related diseases. And while Australia has a target to reduce salt intake by 30 per cent by 2030, our food policies lag behind other countries.

But are our diets just a matter of personal responsibility? Or does the government have a greater role to play in reducing salt in our diets?

Listen to Peter Breadon, Health Program Director, Lachlan Fox, Associate, discuss Grattan’s latest report, Sneaky salt: How Australia can shake its salt habit. Hosted by Kat Clay.

Transcript

Kat Clay: Salt is sneaking into Australian diets, worsening our health outcomes from salt related diseases. And while Australia has a target to reduce salt intake by 30 per cent by 2030, our food policies lag behind other countries.

Grattan’s latest report, Sneaky Salt, shows how Australia can shake its salt habit. With me are the two authors of the report, Peter Breadon Health Program Director, and Lachlan Fox. So diets are getting worse across the board, Peter, and with them come diet related diseases.

How bad is the situation in Australia?

Peter Breadon: Kat, our diets are a disaster. We eat too few of the healthy things that are good for us, like fruit and vegetables, and on average far too much of the things that are bad for us in excess, like sugar, salt and fat. Today, more than a third of all the energy we consume comes from discretionary foods or junk foods, highly processed foods that are typically very high in sugar, salt and fat.

Two thirds of Australian adults are overweight or obese. Governments are spending 10 billion dollars a year on diseases associated with poor diet. And if you think about that, 10 billion is a heap of money. We could certainly spend that better. But those dollars are responding to a lot of sickness and suffering that affects millions of Australians every year.

So it’s, it really is a national crisis.

Kat Clay: So that’s our diets more broadly, but Lachie, what’s the impact of having too much salt in our diet?

Lachlan Fox: So eating too much salt is predominantly affecting our health because it increases our blood pressure. High blood pressure is something that affects lots of Australians. About 1 in 3 Australians have high blood pressure at the moment. And it’s a major risk factor for lots of diseases such as heart disease, stroke and other illness.

So salt is a big, contributor high blood pressure, and it’s such a big contributor in Australia because we eat so much salt. So Australians tend to eat about double the recommended limit of salt per day. We eat almost 10 grams per day compared to the WHO’s recommended limit of about 5 grams per day.

And the consequence is that a lot of Australians lives are cut short. because we die too young from these diseases, which are linked to high blood pressure and high salt intake. About 2500 Australians are estimated to die each year from diseases, predominantly from diseases such as coronary heart disease and stroke.

And it’s important to realise that death isn’t the only bad outcome from these illnesses, as many Australians would know the consequences of diseases such as stroke, even for survivors, can be really, really challenging for the individuals and their families. So salt can do a lot of harm, and it’s definitely in all Australians interests to try and reduce this harm.

Kat Clay: So the report is called Sneaky Salt. It talks about the hidden salt in our everyday foods. I mean, I know that if I go and eat a packet of, you know, corn chips that they’re probably gonna be pretty salty. But where is the salt sneaking into our diets, Peter?

Peter Breadon: Well, the first thing to know is that the culprit is not the salt shaker on your dinner table or the, the salt in your kitchen cupboard that you add during cooking. It’s actually manufactured food. So around three quarters of the salt that we eat comes from manufactured food. And you’re right. The reason we talked about sneaky salt is because it’s in all kinds of foods where you might not expect it.

For example, bread makes up nearly 13 per cent of Australian’s salt intake. And a lot of times, a ready made meal, for example, can have really high amounts of salt. So the pasta meal you might get out of the freezer at the supermarket, that could have more than half of your entire daily recommended intake just in that one serve.

So, looking across all these manufactured foods, whether it’s bread, it’s sauces, different kinds of meat, there’s, there’s lots of salt hidden away in a wide variety of manufactured foods, and we’re typically just not aware of it when we’re buying those products.

Kat Clay: Yeah, I think the one that shocked me from your report is the ravioli. I mean, I love a bit of that kind of, you know, store bought ravioli and apparently that’s very salty.

Peter Breadon: Ready made meals can be a really big culprit, that’s right.

Kat Clay: so one criticism of government intervention in food policy is that people have an individual responsibility for what they eat. Why should governments take action instead of leaving it to the individual?

Peter Breadon: Well, it’s very tempting to think it’s just up to us as individuals to control our diets better. But if you take a step back and think about it, the rate of obesity has tripled in the last 40 years. And that’s happened in Australia, it’s happened in many, many countries of all kinds around the world. And it’s just not plausible that people’s willpower has completely dissipated or people have stopped caring about their health in that period.

What has happened is the environments around us have changed. So unhealthy processed foods, Often cheaper than healthy alternatives. They’re advertised more. They’re put at parts of the supermarket that are the most convenient and eye catching to tempt us and there’s more and more advertising. So all of these things have added up and that’s what’s really changed things not people’s changing attitudes So if you accept that it’s the environment that is driving this big change in the population’s diet and health Then you realize that more is needed. And then when you take a look at all of the policies over the years that have focused on individual responsibility, information for consumers, encouraging people to change their own behavior, again and again, those policies haven’t worked.

And furthermore, there’s strong public support for government to take action to make healthy choices easier. So if you put it all together, we see that, you know, the environment is to blame, and we see that people want more support from government to make it easier to stay healthy. And so that’s why our report recommends government’s policies change to help people stay healthy rather than putting it all on the individual.

Kat Clay: I think one of the interesting things is that, we can follow the examples from other countries and we’re going to talk about that in a little bit because it’s not a new experiment for us to do. Lachie, I want to talk about then what is the best policy here for Australia to reduce salt intake

Lachlan Fox: As Peter mentioned, about three quarters of our salt intake comes from manufactured foods. And some countries have tried to, for example, reduce salt intake through education campaigns and those sorts of things. But as Peter’s sort of mentioned, they’re not incredibly effective a lot of the time.

Partly because people aren’t aware of where all this salt’s coming from. And partly because they’re only adding a small proportion of the salt themselves. so instead, a lot of governments around the world have focused on policies to try and reduce the amount of salt. that manufacturers choose to put in their foods.

So sometimes governments have pursued labelling, so that manufacturers who put less salt in their foods either get a favourable label or avoid a warning label. Some have gone down the route of taxes, but there’s not a lot of evidence that’s been incredibly effective. But what most governments and what we think the Australian government should do is to set salt limits on food.

So salt limits are really straightforward. It just says for each category of food, category could be bread, or a specific type of cheeses, or savoury biscuits, there’s just a set limit that manufacturers can’t exceed of how much salt can be in that product, per 100 grams, for example. so manufacturers, if they are currently selling products which have more salt than that limit in them, will have to change their recipe.

And reduce the amount of salt in that product. And so the benefits of this are a few fold. One is that it’s quite a low cost way to reduce salt. We went to quite great lengths really to try and estimate how much this would cost. And it’s quite challenging. But, even when we use sort of the most conservative estimates we can.

Which industry reports, and may exaggerate. We find that the costs of this aren’t very high. For the recommendations, which we propose that we’ll get to a little bit later on, I’m sure, we think that it would probably cost, at an absolute limit, about 10 cents per week for the average household over a weekly shop.

Kat Clay: This is very small costs compared to the health gains that you can get. and when they’ve been implemented overseas, there’s really been no empirical evidence that, salt limits have contributed to rises in food prices. Just to ask about that, I mean, where has it been implemented? And, and what did we see when that was implemented?

Lachlan Fox: So there’s a couple of sort of standout countries that have implemented salt limits. South Africa and the UK are two that get cited quite a bit because they have better data on the health outcomes and have implemented quite comprehensive salt reduction strategies. The UK managed to lower salt intake by about 20 percent with limits.

It’s since bounced up a little bit afterwards, but the health gains they got… from that enormous reduction were really, really quite considerable. And their salt intake per person is still lower than Australia, despite starting at a similar point when they began that program. And more recently, South Africa through salt limits has reduced salt intake by about 10 to 15 percent over the past sort of five or eight years.

and that again, will be expected to have really big flow through benefits for the health of South Africans.

Kat Clay: Did anyone complain about the taste is the question?

Lachlan Fox: So there’s been a few, one or two studies that have looked at this, but for the most part there doesn’t seem to be much evidence that the taste is, is really that affected. there was one study in the UK that looked at how people changed their, purchasing decisions and whether they switch what products they were buying as the salt of different products dropped.

And there’s a very small effect of people choosing to buy saltier products than they otherwise would. But it’s very, very marginal, and it’s much less than the overall reductions that are made to products. and there’s a few reasons people aren’t too bothered by the taste. The first is, manufacturers are very good at making their food taste good.

And they have all these strategies they can use to try and make food better. There’s some quite innovative things that some companies are doing, like Pepsi. and the other companies they own have trialed using different finer crystals of salts which taste saltier for a smaller amount of salt.

and there’s also things that they can do using salt substitutes. so there’s some different types of, products such as potassium salts that taste salty but don’t have the sodium, which is the main kind of health issue with salt. And the other thing is that people’s taste buds adapt. So we have become used to these very high salt diets because we’ve gradually over time eaten more and more salt.

And I think a lot of people have a friend or a grandparent that they know has got quite used to eating a hell of a lot of salt and just doesn’t taste it anymore. And things can go the other way. There’s quite a bit of evidence that slowly changing people’s diets over time they become accustomed to lower salt diets and things quite literally don’t taste very different.

Peter Breadon: I’ll just add straight away, removing salt doesn’t always make people think the food tastes worse. We talked before about how bread is a really big source of salt in Australians diets, and there are studies that show if you take 20 or 30 percent of the salt out of bread, people eating it, taste trials, they don’t actually notice the difference.

So, as Lachie said, there’s so many ways to, to keep food tasting just as healthy, whether it’s through, you know, changing the nature of the salt, using salt substitutes, or just reducing the salt. Will often not result in people having any kind of, noticeable change in, in how the food tastes.

Kat Clay: We all like to think that we’re, you know, gourmands, but in the end. I suspect most of us wouldn’t be able to tell the difference if, if you reduce the salt in the food we were eating. Lachie, the report says that we do have the policy of, reducing salts, but why isn’t it working right now?

Lachlan Fox: As you mentioned in the introduction, we have a target to reduce salt intake by 30 per cent by 2030, and we have, also a group of sort of voluntary targets, which are meant to help us get there. Voluntary targets have sort of been around since 2009 in Australia in different forms. The current scheme, has been going for a couple of years now, but really isn’t proving to be very effective, and there’s a few reasons for this.

So firstly, the targets are very narrow, they’re quite weak, and they’re voluntary, and on top of that there’s also loopholes. What I mean by narrow is that our targets don’t cover very many food categories. So, we have 32 subcategories here. By comparison, the UK has 84, Canada has 117. And in these countries, they cover probably about twice as much of the daily salt we eat under salt limits, then under our targets. On top of that, our targets are quite weak where we do have them. over 50 percent of products which are in this voluntary scheme at the moment already met targets when they were set. So they haven’t had to do anything to meet them.

and in some categories, such as savory biscuits, the limits are essentially not doing anything because almost every product already met them when the, when the target kind of came into play. On top of that, there’s also a loophole. Companies can exclude 20 percent of their products by sales volume, and there’s no real reason as to why that should be the case.

And then probably the biggest contributing factor as to why the scheme isn’t working is because the targets are voluntary. So the industry doesn’t really have any incentive to comply with this scheme. Only 27 percent of the products that are eligible for targets, the companies are sort of putting forward as complying, as sort of participating in the scheme.

And only 4 percent of all the products that should be covered by targets have actually been reformulated to have a lower amount of salt in them. So, all together, these problems mean that the salt reductions we’ve had have been tiny. It’s estimated it’s about 0. 03 grams of salt per person per day, which is a very small percentage of our daily salt intake, and, for a bit of context, is about the same as two grains of sand.

Kat Clay: So Lockie, that sounds like a very small reduction, two grains of sand. One of the major recommendations of your report is clearly to make these voluntary salt limits mandatory.

Peter, can you take us through this recommendation?

Peter Breadon: Well, the reason for having mandatory limits is because the voluntary limits have failed so completely, as Lachie just talked about, having almost no impact. And it’s not just salt. For food policy, there’s a lot of ways that the government relies on the industry to set rules for itself.

If you look back over the last couple of decades, there are a few good examples. There’ve been calls, mounting, around the world to put a tax on sugar sweetened drinks. and that will have benefits in terms of reducing obesity and diabetes.

And these drinks have no real nutritional value. And in 85 countries around the world, they have taxes on these drinks. When those calls started growing within Australia, the sugary drinks industry got together, and an industry body set up its own voluntary scheme. They pledged to reduce sugar by 20 percent over 10 years.

And then they hit their targets, which sounds great, and they said it was a triumph. But in reality, they fudged the stats. They counted gains that had already been made before that pledge, started. And then they only set a very low target for themselves, a bit like we were talking about with salt just now.

So all that was required was to just continue pre existing trends. So although they claimed success, meanwhile in the UK, they introduced a tax on these kind of drinks. Sugar fell more than twice as much in about half the time.

We’ve seen it happen with other aspects of food policy, and interestingly, a majority of people in Australia, according to polls, support these kind of mandatory salt limits.

Kat Clay: So if we were to implement these mandatory salt limits, what kind of impact could we see?

Peter Breadon: We partnered with the University of Melbourne’s SHINE program to model the impact of these salt limits. First, we proposed that the current voluntary limits become mandatory and then we’d add to those limits over time. And the results that the university found were quite encouraging. So for starters, over 20 years, we would add 36, 000 healthy years of life to the Australian population.

By the end of the period, three to 400 deaths every year would be delayed. And the best news of all is, it pays for itself. Both governments and consumers will be financially better off. Lachie spoke before about how there might be a very small… additional costs to the weekly shop for the period during which food companies are revising their recipes.

But consumers would have that cost far outweighed by being healthier, living longer, working more, and having higher income. And the government would benefit from higher income taxes as well as a 35 million dollar reduction each year in healthcare expenditure because the population would be healthier.

So we get a healthier, fairer, and richer Australia by implementing these salt limits.

Kat Clay: So this sounds, I mean, like low hanging policy fruit, it sounds like a win win if these policies were implemented, but do you think the government will take action? And if they don’t, what? would be the blockers here.

Peter Breadon: Well, I’m trying to remember all the benefits I listed off Kat, but I think it might be a win win win win. so we’d hope the government would, would take action. I think some of the blockers might be, the industry may resist this and claim that it’s problematic or too hard, but as we’ve talked about, other countries have done it.

They’ve met and exceeded the targets we’ve talked about. We’ve made these, these targets quite conservative, so we know they can be achieved and around the world as we’ve talked about we haven’t had consumers rebelling against the taste or even noticing a difference from what we can tell. We haven’t seen food prices increase.

So we don’t think there’s really a reason not to do it. We talked at the top of this podcast about how diet is really causing massive suffering, disease and illness across Australia. And it’s only been getting worse and worse for decades now. So it is time for a step change. We’ve done something like this for tobacco, and over years it took a lot of small policies that gradually got tougher, adding up to make a huge difference to people’s health.

And that’s what we need with food policy. So this salt measure is just one start, over time we can make those salt limits tougher, but we really need this to be the start of a big agenda for policy over the next 10 or 20 years.

Kat Clay: And I think that is an easy choice on an individual level is more salt and food or more years with a loved one because of the better health outcomes. And I know which one I’d choose. Thank you so much, Peter and Lachie for your input on this. If you’d like to read the report, it is on our website at grattan.edu.au. If you’d like to talk about any of the issues we’ve raised today, find us on social media at Grattan Institute. And please. Take care, and thanks so much for listening.