Action on Salt China: Obstacles Encountered & Opportunities | Updated: 2023-11-14
The Action on Salt China (ASC) project is a noteworthy collaborative venture between China and UK, with the China CDC serving as a key partner. The objective of this report is to present a case study that demonstrates the significant role of ASC in bolstering the capacity of public health services in China. Furthermore, this study aims to offer valuable references and provoke thoughtful insight for potential international collaborations in the future.
Obstacles Encountered in the Execution of Salt Reduction Strategies
In China, the consumption of salt significantly exceeds the World Health Organization's (WHO) recommended limits, with intake levels twice as high. Prevailing evidence has underscored salt reduction as one of the most economical and practical preventative measures to stave off hypertension and cardiovascular diseases. In recent decades, certain nations such as the UK have successfully created and instituted nationwide salt reduction programs. In China, where consumers add approximately 80% of the salt during meal preparation, considerable strides have been made towards crafting salt reduction strategies and interventions under the umbrella of Healthy China 2030 Actions. However, several obstacles obstruct the comprehensive application of these strategies. One notable hurdle is the inadequate capability of the public health workforce to craft, enforce, and assess intricate interventions aimed at promoting salt reduction across varied settings. This includes a deficiency in necessary competencies and expertise to devise scalable and practical salt-reduction intervention initiatives based on need analysis. Furthermore, there's a crucial necessity for the capacity to effectively execute the package, bolstered by ongoing process evaluations, as well as assessments of effectiveness and health economics. As such, offering continuous education and training for public health workers is critical for them to effectively perform their roles in preventing and controlling noncommunicable diseases.
Opportunities Provided by ASC
ASC is a global health research unit jointly spearheaded by Professor Graham MacGregor and Feng J He of Queen Mary University of London (QMUL) and Professor Puhong Zhang of the George Institute for Global Health, China (TGI China). Being funded by the National Institute for Health and Care Research (NIHR) in the UK, ASC has aimed at addressing the public health challenge of excessive salt consumption through a spectrum of capacity building initiatives since its inception in 2017.
ASC was overseen by a senior steering committee, presided over by Professor Longde Wang, a member of the Chinese Academy of Engineering and the former Vice Minister of Health. In addition to the principal research institutes of TGI China and QMUL, ASC collaborates with partners such as the China CDC, the Chinese Center for Health Education, the China National Center for Food Safety Risk Assessment, and Beihang University. Further support is provided by regional collaborators in the provinces of Hebei, Heilongjiang, Jiangxi, Hunan, Sichuan, and Qinghai, as well as local partners located in 33 study sites at county and district levels.
ASC convened a multidisciplinary team of researchers with substantial expertise in various public health fields including salt reduction, trial design, community engagement, intervention development, mobile health, project management, data management and analysis, process evaluation, health economic evaluation, and implementation science. Equally important fields covered by the team include health education, communication, policy advocacy, and financial management. These specializations are crucial in building the competencies and skillset required for the successful implementation of effective salt reduction interventions.
Efforts to mitigate copious salt consumption in China, which primarily originates from home/ restaurants cooking and pre-packaged food, incorporated six distinct strategies within the ASC. These strategies encompassed four cluster randomized controlled trials (RCTs): an application-based intervention study directed at schoolchildren and their families (AIS); a home cook-centric intervention study (HIS); a restaurant-based intervention study (RIS), and a comprehensive intervention study (CIS). Two national health campaigns were also included: an educational campaign raising awareness about salt consumption and a campaign encouraging salt reduction in processed foods, buttressed by research on food sodium content to aid target setting and nutrition labeling. A comprehensive salt reduction intervention package, successfully proven by the aforementioned RCTs, was notably amplified across all six provinces in 2020–2021.