Food reformulation and the (neo)-liberal state: New strategies for strengthening voluntary salt reduction programs in the UK and USA

Public Health

Volumn 129, Issue 4, 2015, Pages 351-363

  Reeve, B ^a   Magnusson, R ^a  

^a UNIVERSITY OF SYDNEY   (Australia)

Author keywords

Food reformulation; Law; Non communicable diseases; Regulation; Salt reduction; UK; US

Indexed keywords

FOOD POLICY; MODELING; POLICY IMPLEMENTATION; REGULATORY APPROACH; SALT; STRATEGIC APPROACH; VOLUNTARY APPROACH;

ARTICLE; CARDIOVASCULAR RISK; CEREBROVASCULAR ACCIDENT; DIET SUPPLEMENTATION; DIETARY REFERENCE INTAKE; FOOD INDUSTRY; FOOD PACKAGING; FOOD QUALITY; FOOD REFORMULATION; GOVERNMENT REGULATION; HEALTH PROGRAM; HEART DISEASE; HUMAN; HYPERTENSION; MORTALITY; NUTRITIONAL VALUE; PUBLIC HEALTH; QUALITY CONTROL; RISK REDUCTION; SALT INTAKE; SODIUM RESTRICTION; UNITED KINGDOM; UNITED STATES; ADMINISTRATION AND DOSAGE; FOOD; HEALTH CARE POLICY; NONBIOLOGICAL MODEL; ORGANIZATION AND MANAGEMENT; STANDARDS; VOLUNTARY PROGRAM;

UNITED KINGDOM; UNITED STATES;

SALT INTAKE;

FOOD; FOOD INDUSTRY; GREAT BRITAIN; HUMANS; MODELS, ORGANIZATIONAL; NUTRITION POLICY; SODIUM CHLORIDE, DIETARY; UNITED STATES; VOLUNTARY PROGRAMS;

EID: 84928203836     PISSN: 00333506     EISSN: 14765616     Source Type: Journal    
DOI: 10.1016/j.puhe.2015.01.007     Document Type: Article

References (112)

1. In re N.Y. Statewide Coal. of Hispanic Chambers of Commerce v. N.Y.C. Dep't of Health and Mental Hygiene, No. 134, 2014 N.Y. LEXIS 1442 (N.Y. June 26, 2014).
2. Gostin L.O. Bloomberg's health legacy: urban innovator or meddling nanny?. Hastings Cent Rep 2013, 43(5):19-25.
3. Brownell K.D. Thinking forward: the quicksand of appeasing the food industry. PLoS Med 2012, 9(7):e1001254.
4. Wiist W.H. The corporate playbook, health and democracy: the snack food and beverage industry's tactics in context. Sick societies: responding to the global challenges of chronic disease 2011, 204-216. Oxford University Press, Oxford. D. Stuckler, K. Siegel (Eds.).
5. Clarke J. Dissolving the public realm? The logics and limits of neo-liberalism. J Soc Policy 2004, 33(01):27-48.
6. Lim S.S., Vos T., Flaxman A.D., Danaei G., Shibuya K., Adair-Rohani H., et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013, 380(9859):2224-2260.
7. World Health Organization NCD global monitoring framework 26 August 2014, [Internet], Available from:, [cited 23 December 2014]. http://www.who.int/nmh/global_monitoring_framework/en/.
8. Reeve B., Magnusson R. 'Legislative scaffolding': a new approach to prevention. Aust N Z J Public Health 2013, 37(5):494-496.
9. Hoyert D.L., Xu J. Deaths: preliminary data for 2011 2012, National Center for Health Statistics, Hyattsville, MD.
10. Knott C., Mindell J. Health survey for England - 2011, health, social care and lifestyles 20 December 2012, Chapter 3: hypertension, Health & Social Care Information Centre, [Internet]. Available from:, [cited 23 December 2014]. http://www.hscic.gov.uk/catalogue/PUB09300.
11. Valderrama A.G.C., King S., George M., Hong Y., Gregg E. Vital signs: awareness and treatment of uncontrolled hypertension among adults-United States, 2003-2010. MMWR Morb Mortal Wkly Rep 2012, 61:703.
12. Aburto N.J., Ziolkovska A., Hooper L., Elliott P., Cappuccio F.P., Meerpohl J.J. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 2013, 346:f1236.
13. He F., MacGregor G. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 2009, 23(6):363-384.
14. Loria C.M.M., Cogswell M., Gillespie C., Gunn J., Labarthe D., et al. Usual sodium intakes compared with current dietary guidelines-United States, 2005-2008. MMWR Morb Mortal Wkly Rep 2011, 60(41):1413.
15. US Department of Agriculture and US Department of Health and Human Services Dietary guidelines for Americans 2010, Government Printing Office, Washington DC. 7th ed.
16. US Department of Agriculture, Agricultural research service What we eat in America 29 July 2014, [Internet], Available from:, [cited 23 December 2014]. http://www.ars.usda.gov/News/docs.htm?docid=18349.
17. Sadler K.N.S., Steer T., Gill V., Bates B., Tipping S., et al. National Diet and nutrition survey: assessment of dietary sodium in adults (aged 19 to 64 years) in England, 2011 2012, Department of Health, London.
18. He F., Brinsden H., Macgregor G. Salt reduction in the United Kingdom: a successful experiment in public health. J Hum Hypertens 2014, 28(6):345-352.
19. Oparil S. Low sodium intake - cardiovascular health benefit or risk? [Editorial]. N Engl J Med 2014, 371(7):677-679.
20. DiNicolantonio J.J., Lucan S.C. The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart 2014, 1(1):e000167.
21. O'Donnell M.J., Yusuf S., Mente A., Gao P., Mann J.F., et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA 2011, 306(20):2229-2238.
22. Sodium intake in populations: assessment of evidence 2013, Institute of Medicine, Washington DC. B.L. Strom, A.L. Yaktine, M. Oria (Eds.).
23. The Editorial Board The debate on salty foods, continued 23 August 2014, New York Times, [Internet]. Available from:, [cited 19 December 2014]. http://www.nytimes.com/2014/08/24/opinion/sunday/the-debate-on-salty-foods-continued.html.
24. Taubes G. Salt, we misjudged you 2 June 2012, New York Times, [Internet]. Available from:, [cited 19 December 2014]. http://www.nytimes.com/2012/06/03/opinion/sunday/we-only-think-we-know-the-truth-about-salt.html?pagewanted=all.
25. Cobb L.K., Anderson C.A.M., Elliott P., Hu F.B., Liu K., Neaton J.D., et al. Methodological issues in cohort studies that relate sodium intake to cardiovascular disease outcomes. A science advisory from the American Heart Association. Circulation 2014, 129(10):1173-1186.
26. He F.J., Burnier M., MacGregor G.A. Nutrition in cardiovascular disease: salt in hypertension and heart failure. Eur Heart J 2011, 32(24):3073-3080.
27. He F.J., Li J., MacGregor G.A. Effect of longer term modest salt reduction on blood pressure: cochrane systematic review and meta-analysis of randomised trials. BMJ 2013, 346:f1325.
28. Mattes R., Donnelly D. Relative contributions of dietary sodium sources. J Am Coll Nutr 1991, 10(4):383-393.
29. Havas S., Dickinson B.D., Wilson M. The urgent need to reduce sodium consumption. JAMA 2007, 298(12):1439-1441.
30. Strategies to reduce sodium intake in the United States 2010, Institute of Medicine, Washington DC. J.E. Henney, C.L. Taylor, C.D. Boon (Eds.).
31. Cobiac L.J., Vos T., Veerman J.L. Cost-effectiveness of interventions to reduce dietary salt intake. Heart 2010, 96(23):1920-1925.
32. Webster J.L., Dunford E.K., Neal B.C. A systematic survey of the sodium contents of processed foods. Am J Clin Nutr 2010, 91(2):413-420.
33. Dunford E.K., Eyles H., Mhurchu C.N., Webster J.L., Neal B.C. Changes in the sodium content of bread in Australia and New Zealand between 2007 and 2010: implications for policy. Med J Aust 2011, 195(6):346-349.
34. Bibbins-Domingo K., Chertow G.M., Coxson P.G., Moran A., Lightwood J.M., Pletcher M.J., et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010, 362(7):590-599.
35. World Health Organization Global status report on noncommunicable diseases 2010 2011, WHO, Geneva.
36. Webster J.L., Dunford E.K., Hawkes C., Neal B.C. Salt reduction initiatives around the world. J Hypertens 2011, 29(6):1043-1050.
37. Angell S.Y., Farley T.A. Can we finally make progress on sodium intake?. Am J Public Health 2012, 102(9):1625-1627.
38. New York City Department of Health and Mental Hygiene. National salt reduction initiative [Internet]. Available from:. Undated [cited 23 December 2014]. http://www.nyc.gov/html/doh/html/diseases/salt.shtml.
39. New York City Department of Health and Mental Hygeine National salt reduction initiative: frequently asked questions 31 July 2014, [Internet], Available from:, [cited 23 December 2014]. http://www.nyc.gov/html/doh/downloads/pdf/cardio/cardio-salt-nsri-faq.pdf.
40. Levings J., Cogswell M., Curtis C.J., Gunn J., Neiman A., Angell S.Y. Progress toward sodium reduction in the United States. Rev Panam Salud Publica 2012, 32(4):301-306.
41. Sanderson M., Bartley K., Immerwahr S., Eisenhower D., et al. The community health survey, heart follow-up study methodology report 2012, The New York City Department of Health and Mental Hygiene, Available from:. http://www.nyc.gov/html/doh/downloads/pdf/cardio/hfus-methodology.pdf.
42. Farley T.A. The public health crisis hiding in our food 20 April 2014, New York Times, [Internet]. Available from:, [cited 19 December 2014]. http://www.nytimes.com/2014/04/21/opinion/the-public-health-crisis-hiding-in-our-food.html.
43. Office of the Mayor, Mayor Bloomberg Deputy Mayor Gibbs and Health Commissioner Farley announce results of national effort to reduce sodium in pre-packaged food 11 February 2013, [Internet], Available from:, [cited 23 December 2014]. http://www1.nyc.gov/office-of-the-mayor/news/058-13/mayor-bloomberg-deputy-mayor-gibbs-health-commissioner-farley-results-national.
44. Jacobson M.F., Havas S., McCarter R. Changes in sodium levels in processed and restaurant foods, 2005 to 2011. JAMA Intern Med 2013, 173(14):1285-1291.
45. Rudelt A., French S., Harnack L. Fourteen-year trends in sodium content of menu offerings at eight leading fast-food restaurants in the USA. Public Health Nutr 2014, 17(8):1682-1688.
46. 21 C.F.R. § 182.1(a) (listing salt as GRAS).
47. Approaches to reducing sodium consumption; establishment of dockets, request for comments, data, and information. Federal Register [Internet]. 2011 31 July 2014;76:[57050-4 pp.]. Available from:. http://www.gpo.gov/fdsys/pkg/FR-2011-09-15/html/2011-23753.htm.
48. Amidor T. News update: FDA hints at releasing long-awaited salt guidelines 18 June 2014, On food network's healthy eats [blog on the Internet], Available from:, [cited 23 December 2014]. http://blog.foodnetwork.com/healthyeats/2014/06/18/news-update-fda-hints-at-releasing-long-awaited-salt-guidelines/.
49. Jalonick M.C. FDA prepping long-awaited plan to reduce salt 31 July 2014, Associated Press, [Internet]. Available from:, [cited 23 December 2014]. http://bigstory.ap.org/article/fda-prepping-long-awaited-plan-reduce-salt.
50. Watson E. Industry to FDA: think again before setting category-by-category sodium reduction targets 3 June 2014, Food Navigator, [Internet] Available from:, [cited 23 December 2014]. http://www.foodnavigator-usa.com/Regulation/Industry-to-FDA-Think-again-before-setting-sodium-reduction-targets.
51. European Commission Collated information on salt reduction in the EU 2008, European Commission, Available from:. http://ec.europa.eu/health/ph_determinants/life_style/nutrition/documents/compilation_salt_en.pdf.
52. Wyness L.A., Butriss J.L., Stanner S.A. Reducing the population's sodium intake: the UK Food Standards Agency's salt reduction programme. Public Health Nutr 2012, 15(2):254-261.
53. Department of Health Healthy lives, healthy people: our strategy for public health in England 2010, The Stationery Office, London, Available from:. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_121941.
54. Department of Health. About the Public Health Responsibility Deal [Internet]. Available from:. [cited 31 July 2014]. https://responsibilitydeal.dh.gov.uk/about/.
55. Petticrew M., Eastmure E., Mays N., Knai C., Durand M.A., Nolte E. The Public Health Responsibility Deal: how should such a complex public health policy be evaluated?. J Public Health 2013, 35(4):495-501.
56. Department of Health F2. Salt reduction 3 February 2012, [Internet], Available from:, [cited 4 August 2014]. https://responsibilitydeal.dh.gov.uk/f2-factsheet/.
57. Department of Health Responsibility Deal: three new catering pledges launched 27 July 2012, [Internet], Available from:, [cited 4 August 2014]. https://www.gov.uk/government/news/responsibility-deal-three-new-catering-pledges-launched.
58. Department of Health. F.5. Salt catering Public Health Responsibility Deal. [Internet]. Available from:. Undated [Cited 23 December 2014]. https://responsibilitydeal.dh.gov.uk/pledges/pledge/?pl=42.
59. Department of Health. F5(c). Salt catering: procurement. [Internet]. Available from:. Undated [Cited 4 August 2014]. https://responsibilitydeal.dh.gov.uk/pledges/pledge/?pl=28.
60. Department of Health. F.10. Out of home maximum per serving salt targets. [Internet]. Available from:. Undated [Cited 4 August 2014]. https://responsibilitydeal.dh.gov.uk/pledges/pledge/?pl=50.
61. Department of Health. F9. Salt reduction 2017. [Internet]. Available from:. Undated [Cited 4 August 2014]. https://responsibilitydeal.dh.gov.uk/pledges/pledge/?pl=49.
62. Sutherland J., Edwards P., Shankar B., Dangour A.D. Fewer adults add salt at the table after initiation of a national salt campaign in the UK: a repeated cross-sectional analysis. Br J Nutr 2013, 110(3):552-558.
63. Panjwani C., Caraher M. The Public Health Responsibility Deal: brokering a deal for public health, but on whose terms?. Health Policy 2014, 114(2):163-173.
64. Jaworowska A., Blackham T., Stevenson L., Davies I.G. Determination of salt content in hot takeaway meals in the United Kingdom. Appetite 2012, 59(2):517-522.
65. Nuffield Council on Bioethics Public health: ethical issues 2007, Nuffield Council on Bioethics, London.
66. Doll R., Peto R., Boreham J., Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 2004, 328(7455):1519.
67. Yach D., Hawkes C., Epping-Jordan J.E., Galbraith S. The World Health Organization's Framework Convention on Tobacco Control: implications for global epidemics of food-related deaths and disease. J Public Health Policy 2003, 24(3-4):274-290.
68. Stuckler D., Nestle M. Big food, food systems, and global health. PLoS Med 2012, 9(6):e1001242.
69. Department of Health. Responsibility deal plenary group [Internet]. Available from:. Undated [Cited 9 August 2014]. https://responsibilitydeal.dh.gov.uk/category/plenary-group/.
70. Department of Health. Food Network [Internet]. Available from:. Undated [Cited 9 August 2014]. https://responsibilitydeal.dh.gov.uk/category/food-network/.
71. Council of Better Business Bureaus Children's food and advertising initiative. Program and core principles at a glance June 2014, [Internet], Available from:, [cited 23 December 2014]. http://www.bbb.org/council/the-national-partner-program/national-advertising-review-services/childrens-food-and-beverage-advertising-initiative/.
72. Magnusson R., Reeve B. 'Steering'private regulation? A new strategy for reducing population salt intake in Australia. Syd Law Rev 2014, 36(2):255-289.
73. Gostin L.O. Public health law: power, duty, restraint 2000, University of California Press, Berkeley.
74. Gostin L. Legal foundations of public health law and itsrole in meeting future challenges. Public Health 2006, 120(Suppl. 1):8-14.
75. Griffiths and West, this issue.
76. Braithwaite J. Regulatory capitalism: how it works, ideas for making it work better 2008, Edward Elgar Publishing, Cheltenham.
77. Braithwaite J. The regulatory state?. The Oxford handbook of political institutions 2006, 407-431. Oxford University Press, New York. R.A.W. Rhodes, S.A. Binder, B.A. Rockman (Eds.).
78. Bartle I., Vass P. Self-regulation within the regulatory state: towards a new regulatory paradigm?. Public Admin 2007, 85(4):885-905.
79. Black J. Constitutionalising self-regulation. Mod Law Rev 1996, 59(1):24-55.
80. Gunningham N., Rees J. Industry self-regulation: an institutional perspective. Law Policy 1997, 19(4):363-414.
81. Sinclair D. Self-regulation versus command and control? beyond false dichotomies. Law Policy 1997, 19(4):529-559.
82. Black J. Decentring regulation: understanding the role of regulation and self-regulation in a "post-regulatory" world. Curr Leg Probl 2001, 54(1):103-146.
83. Cohen D. The role of the state in a privatised regulatory environment. Voluntary codes: private governance, the public interest and Innovation 2004, 35-56. Carleton Research Unit for Innovation, Science and Environment, Carleton University, Ottawa. K. Webb (Ed.).
84. Gunningham N., Grabosky P.N., Sinclair D. Smart regulation: designing environmental policy 1998, Clarendon Press, Oxford.
85. Australian Competition and Consumer Commission (ACCC) Guidelines for developing effective voluntary industry codes of conduct 2011, ACCC, Canberra, Available from:. http://www.accc.gov.au/system/files/Guidelines%20for%20developing%20effective%20voluntary%20industry%20codes%20of%20conduct.pdf.
86. Taskforce on Industry Self-Regulation Industry self-regulation in consumer markets 2000, Consumer Affairs Division, Department of Treasury, Canberra, Available from:. http://archive.treasury.gov.au/documents/1131/PDF/final_report.pdf.
87. Gunningham N., Sinclair D. Leaders & laggards: next-generation environmental regulation 2002, Greenleaf Publishing, Sheffield.
88. Morain S., Mello M.M. Survey finds public support for legal interventions directed at health behavior to fight noncommunicable disease. Health Aff 2013, 32(3):486. 93-94.
89. Gunningham N., Sinclair D. Regulatory pluralism: designing policy mixes for environmental protection. Law Policy 1999, 21(1):49-76.
90. Baldwin R., Black J. Really responsive regulation. Mod Law Rev 2008, 71(1):59-94.
91. Ayres I., Braithwaite J. Responsive regulation: transcending the deregulation debate 1992, Oxford University Press, New York.
92. Braithwaite J. To punish or persuade: enforcement of coal mine safety 1985, State University of New York Press, Albany.
93. Johnston Y.A., McFadden M., Lamphere M., Buch K., Stark B., Salton J.L. Working with grocers to reduce dietary sodium: lessons learned from the Broome County Sodium Reduction in Communities Pilot Project. J Public Health Manag Pract 2014, 20(1):S54-S58.
94. US Department of Health and Human Services. Proposed changes to the Nutrition Facts Label [Internet]. Available from:. Last updated 8 January 2014 [cited 23 December 2014]. http://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/labelingnutrition/ucm385663.htm.
95. Nathan R., Lichtenstein A.H., Yaktine A., Wartella E.A. Front-of-package nutrition rating systems and symbols: promoting healthier choices 2011, National Academies Press, Washington, DC.
96. Karppanen H., Mervaala E. Sodium intake and hypertension. Prog Cardiovasc Dis 2006, 49(2):59-75.
97. US Department of Health and Human Services, Office of Inspector General. Corporate integrity agreements. [Internet]. Available from:. Undated [Cited 23 December 2014]. https://oig.hhs.gov/compliance/corporate-integrity-agreements/index.asp.
98. Ludwig D.S., Nestle M. Can the food industry play a constructive role in the obesity epidemic?. JAMA 2008, 300(15):1808-1811.
99. Moodie R., Stuckler D., Monteiro C., Sheron N., Neal B., Thamarangsi T., et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet 2013, 381(9867):670-679.
100. Department of Health. Food network's high-level steering group. [Internet]. Available from:. Undated [Cited 8 September 2014]. https://responsibilitydeal.dh.gov.uk/food-networks-high-level-steering-group/.
101. Hashem K. The irresponsibility deal? Why the government's responsibility deal is better for the food industry than public health 2011, 13. Sustain, Available from:. http://www.sustainweb.org/publications/?id=188.
102. Bryden A., Petticrew M., Mays N., Eastmure E., Knai C. Voluntary agreements between government and business-a scoping review of the literature with specific reference to the Public Health Responsibility Deal. Health Policy 2013, 110(2):186-197.
103. Campbell N., Legowski B., Legetic B., Ferrante D., Nilson E., Campbell C., et al. Targets and timelines for reducing salt in processed food in the Americas. J Clin Hypertens 2014, 16(9):619-623.
104. Gunningham N., Johnstone R. Regulating workplace safety: system and sanctions 1999, Oxford University Press, Oxford.
105. Sugarman S.D. Salt, high blood pressure, and performance-based regulation. Regul Gov 2009, 3(1):84-102.
106. Sugarman S.D. Enticing business to create a healthier American diet: performance-based regulation of food and beverage retailers. Law Policy 2014, 36(1):91-112.
107. 21 U.S. Code § 321(s).
108. 21 U.S. Code § 348; 21 C.F.R. § 170.3(i).
109. 21 C.F.R. § 170.35 (affirmation of GRAS status).
110. 21. C.F.R. § 170.38 (determination of food additive status).
111. 21 C.F.R. § 170.35(b)(4); 21 C.F.R. § 170.38(c).
112. 21 C.F.R. § 170.30(j).