The Role of Public Health Nutrition through the lens of UK Salt Reduction

Public health is a multi-disciplinary field that aims to 1) prevent disease and death, 2) promote a better quality of life, and 3) create environmental conditions in which people can be healthy by intervening at the institutional, community, and societal level. (BH).

Becoming a registered dietitian requires completing either a four-year Bachelor’s or a 2-year MSc, involving long hours of course material, personal study time and placement hours.  Throughout the dietetic curriculum, students spend most of their time studying a range of topics including physiology, biochemistry, advanced diet therapy, communication skills and public health modules. At the end of your degree, you can work alongside other healthcare professionals in hospitals to help manage clinical conditions or work on a broader scale in a multitude of roles in the public health sector. The role of public health dietitians is an area often seen as less critical or complex than the traditional clinic route however, public health dietitians play a vital role in the prevention of diseases and their role in society is needed more than ever.

What is public health?

“In public health, researchers, practitioners, and educators prevent disease and injury at the community and population level. We identify the causes of disease and disability, and we implement large-scale solutions” (1).  

In other words, healthcare workers in clinic roles help one patient at a time whereas those in public health roles aim to improve the health of a whole population by creating environmental conditions in which people can be healthy.

Public Health Nutrition/Dietetics

As defined by The Academy of Nutrition and Dietetics, Public health nutrition is the application of nutrition and public health principles to design programs, systems, policies and environments that aim to improve or maintain the optimal health of populations and targeted groups (2).

Nutritionists and Dietitians working within the public health sphere use their skills to assess, diagnose and treat diet and nutrition-related problems in society to optimize population health, just as they would individual health. This is accomplished through various routes at the government, state, and community level. For example, epidemiological research is conducted on risk factors for disease, including quality of diets and accessibility to food and physical activity (amongst others). This data is then analyzed and used to inform policy aimed at improving said diseases. Policies can then be used to create programs at the state or borough level which support the promotion of health throughout individual communities. The implementation of programs at the community level requires consideration of the specific context of the population, barriers to health and implementing strategies to overcome these barriers. 

Examples of PHN – UK Salt Reduction Program

Cardiovascular Disease and Sodium

Cardiovascular disease causes a quarter of all deaths in the UK (3,4) and affects 7.6 million individuals in the UK (3) making it a severe public health concern. Data has shown that increased dietary salt intake is a major cause of the increased risk of high blood pressure and hence cardiovascular disease (5,6).

In 2002, the Food Standards Agency (FSA), an independent government department working across England, committed to a nationwide salt reduction initiative to reduce the dietary salt intake to 6g/day (7) in response to the evidence presented highlighting the causal relationship between salt intake and blood pressure. About 75% of the salt we eat is already added to the food we buy (8), so although changes to individual habits are important, this statistic sheds light on the ways our environment determines may contribute to or prevent disease and thus requires interventions at the government level. Considering this, the FSA set voluntary salt reduction targets of ~40% for the food industry, with the intention to be met by 2010. This was accompanied by the implementation of consumer-friendly labelling and public health campaigns such as salt awareness week (March 14-20 2022). In 2008, the NDNS reported that the average salt of the general population was 8.6g/day – 10% lower than when first reported at 9.5g/day (9). This impressive reduction is estimated to reduce the risk of stroke and heart attacks by 22% and 16%, respectively, saving 17,000 lives in the UK (7).

These accomplishments were supported by organizations such as Action on Salt which work along all levels of public health from conducting and disseminating research, to advocating for policy at the governmental level and providing consumer awareness and education, to “reach a consensus with the food industry and government over the harmful effects of a high salt diet and bring about a reduction in the amount of salt in processed food as well as salt added to cooking, and the table” (7).

In conclusion, the integration of dietetic therapy onto population level can be accomplished through the assessment, diagnosis and treatment of diet and nutrition problems in society. Working throughout all levels of public health is integral to achieve efficient implementation and success of public health interventions to optimize population health which can reduce the pressures on clinical and social services and allow all to live a high quality of life. Public Health Dietitians may be overlooked, but it is evident that their involvement among all levels of public health is crucial to the improvement in health and health-related outcomes amongst whole populations.

References

1. What Is Public Health? | Johns Hopkins [Internet]. Johns Hopkins Bloomberg School of Public Health. 2022 [cited 24 March 2022]. Available from: https://publichealth.jhu.edu/about/what-is-public-health

2. Public Health and Community [Internet]. Eatrightpro.org. 2022 [cited 24 April 2022]. Available from: https://www.eatrightpro.org/practice/practice-resources/public-health-and-community

3. Facts and figures [Internet]. Bhf.org.uk. 2022 [cited 24 March 2022]. Available from: https://www.bhf.org.uk/what-we-do/news-from-the-bhf/contact-the-press-office/facts-and-figures

4. Nicholas J, Knowles B, Rayson Z. Salt reduction targets for 2024 [Internet]. London: Public Health England; 2020 [cited 24 March 2022]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/915406/2024_salt_reduction_targets_070920-FINAL-1.pdf

5. Salt reduction [Internet]. Who.int. 2022 [cited 24 March 2022]. Available from: https://www.who.int/news-room/fact-sheets/detail/salt-reduction

6. Grillo, Salvi, Coruzzi, Salvi, Parati. Sodium Intake and Hypertension. Nutrients. 2019;11(9):1970.

7. Action on Salt - Action on Salt [Internet]. Actiononsalt.org.uk. 2022 [cited 24 April 2022]. Available from: https://www.actiononsalt.org.uk/

8. Salt [Internet]. Bda.uk.com. 2022 [cited 24 March 2022]. Available from: https://www.bda.uk.com/resource/salt.html

9. National Diet and Nutrition Survey Assessment of salt intake from urinary sodium in adults (aged 19 to 64 years) in England, 2018 to 2019 [Internet]. London: Public Health England; 2020 [cited 24 March 2022]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/876252/Report_England_Sodium_Survey_2018-to-2019__3_.pdf

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