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Case study: How we got a town to reduce its salt intake by ten per cent

"We believe our research affirms the potential for motivated communities, supported with basic advocacy tools, to change their diets for the better."

 

What was the problem?

Australian adults are thought to consume 7-12 grams of salt per day, far exceeding the four grams suggested by the Australian government and the five grams suggested by the World Health Organisation. From high blood pressure and stroke to heart attack and stomach cancer, the health risks of excess salt are well-established. This is why practical ways of bringing levels down are so keenly sought.

How did The George Institute get involved?

Worldwide research was already underway in establishing if national efforts could reduce salt consumption, but there was limited data on the effectiveness of community based programs. The city of Lithgow in NSW was selected to trial a salt reduction program based on applying the Communication for Behavioural Impact framework to an entire community. Salt Swap was launched in 2011 after extensive community consultation and backed by both Lithgow City Council and NSW Health.

What did we do?

The salt reduction program led by The Food Policy Division was based on the idea that by supplementing community advocacy with practical tools, it would be possible to translate knowledge into actual behavioural change. Working on the project were Bruce Neal, Jacqui Webster, Mary-Anne Land, John Chalmers, Jason Wu, Mark Woodward and Michelle Crino.

In our case, we provided two such tools:

  • The first was a smartphone app – FoodSwitch – which allowed people to scan the barcodes of packaged foods, receive colour-coded ratings for the food components, such as salt, and see a list of lower-salt alternatives. Few people used it.
  • The second was a salt substitute – a blend of sodium and potassium salts – which has, gram-for-gram, 70% less sodium than regular salt. Working with Nutek Salt, we were able to provide free samples to local medical practices, workplaces, businesses, cafes, restaurants, pubs, clubs and homes as a reminder of the need to reduce salt.

We supplemented these with public messages, including the benefits of avoiding processed foods and swapping salt for spices.

Who else was involved?

The project was supported by NSW Health, The University of Notre Dame Rural Clinical School-Lithgow and Lithgow City Council.

Results and success

In 2011, based on urine samples from 400 people, the town of Lithgow in NSW consumed a mean 8.8 grams of salt per day. Three years later, following our program which combined community advocacy with some practical everyday tools, samples from 500 people showed that this had dropped to eight grams – a mean reduction of 0.8 grams per day, or roughly 10% (95% confidence interval −1.2 to −0.3; p < 0.001).

The change was highly significant and robust to various types of subsidiary analyses. We concluded that it was likely to be real and to have been produced in part, at least, by the program we implemented which had the strong support of local government and community leaders.

We believe our research affirms the potential for motivated communities, supported with basic advocacy tools, to change their diets for the better.

Is follow-up worked planned?

We are now working in Victoria at the state level using many of the lessons learnt from the Lithgow project. But, we need clinicians around Australia to work with local governments to develop and implement these types of initiatives. The challenge, as always, lies in securing funding, because while the interventions was not costly it did require day-to-day coordination and specific resources, such as the salt substitute.