Prevention of cardiovascular disease at population level Implementing policy goals June 2010 NICE public health guidance 25

What this presentation covers Background Recommendations for policy Costs and savings Discussion Find out more

Background CVD led to nearly 160,000 deaths in England in 2007 Most premature deaths from CVD are preventable 5.6 million adults in the UK are living with CVD In over 90% of cases, the risk of a first heart attack is related to nine modifiable risk factors

National framework for action on CVD Salt Saturated fats Trans fats Marketing and promotions aimed at young people Commercial interests Product labelling Health Impact Assessment Common Agricultural Policy Active travel

Accelerate reducing salt intake among the population to a maximum of 6g per day per adult by 2015 and 3g by 2025 Ensure children’s salt intake does not exceed age- appropriate guidelines Establish the principle that children should consume substantially less salt than adults Salt

Promote the benefits of a reduction in the population’s salt intake to the European Union (EU) Introduce national legislation if necessary Ensure national policy on salt is not weakened by less effective action in parts of the EU Support the Food Standards Agency in continuing to promote the development of EU-wide salt targets for processed foods Promote best practice as exemplified in these recommendations, to the wider EU Salt – influencing EU policy

Ensure food producers and caterers continue to reduce the salt content of commonly consumed foods Establish an independent system for monitoring national salt levels Ensure low-salt products are sold more cheaply than their higher salt equivalents Clearly label products which are naturally high in salt and cannot meaningfully be reformulated Salt – food production

Substantially reduce the amount of saturated fat in all food products Encourage the production of dairy products low in saturated fat Ensure lower saturated fat products are cheaper than those high in saturated fat Continue to promote semi-skimmed milk for children aged over 2 years Saturated fats

Eliminate the use of industrially-produced trans fatty acids (IPTFAs) for human consumption Introduce legislation to ensure IPTFA levels do not exceed 2% of the fats used in food manufacturing and cooking Direct bodies responsible for national surveys to measure consumption of IPTFAs by different population subgroups Establish guidelines for local authorities to monitor IPTFA levels in local food provision using existing statutory powers Trans fats

Develop a comprehensive set of principles for food and drink marketing Extend TV advertising restrictions on food and drink high in fat, salt or sugar to 9pm Develop equivalent standards to restrict such activities via all non-broadcast media Ensure standards are supported by legislation Marketing aimed at children and young people

Encourage best practice for all meetings, including lobbying, between the food and drink industry and government (and government agencies) All parties should make a full disclosure of interests and all information provided should be auditable and available for the general public Commercial interests

Establish the FSA’s traffic light labelling system as the national standard for food and drink products in England – consider using legislation to achieve this Introduce nutritional labelling for shelves or packaging used for loose or unwrapped products or for products packed on the premises Product labelling

Assess all public policy and programmes for their potential impact on CVD and related chronic diseases Monitor outcomes after the assessment and use them to follow-up and amend future plans Make health impact assessment mandatory in specific scenarios Health Impact Assessment

Negotiate at EU and national level to ensure the CAP takes account of public health issues Support the principle that ‘pillar two’ funds reward production of highly nutritious foods such as fruit, vegetables, whole grains and leaner meats Negotiate to ensure the European Commission’s impact assessments take health issues into account Common Agricultural Policy

Guidance for local transport plans should support physically active travel Allocate a percentage of the integrated block allocation fund to schemes supporting walking and cycling as modes of transport Create an environment and incentives which promotes physical activity Address factors which discourage physical activity Physically active travel

Ensure publicly funded catering departments meet FSA-approved dietary guidelines If the ‘Healthier food mark’ pilot is successful, implement it on a permanent basis Public sector catering guidelines

Encourage local planning authorities to restrict permission for take-aways and other food retail outlets in specific areas Help them implement existing planning policy guidance in line with public health objectives Tackle the concentration of outlets in a given area by reviewing and amending ‘classes of use’ orders to prevent disease Establish guidelines for local authorities to monitor IPTFA levels in local food provision using existing statutory powers Take-aways and other food outlets

Monitor the intake of salt, trans fatty acids, saturated fatty acids and mono- and polyunsaturated fatty acids and fruit and vegetables among different population groups Ensure CVD prevention data is available and that new econometric data (including pooled consumer purchasing data) are rapidly available Ensure the CVD module – including lipid profile measures - routinely appears in the ‘Health surveys for England’ Monitoring

Savings Up to £20 billion could be saved annually through meeting nutritional guidelines on fruit and vegetable consumption, saturated fat, added sugar and salt Reducing daily salt intake from 9.5g to 8.6g could save over £1.5 billion per year Banning industrially-produced trans fatty acids could result in a gain of 1.4 million life years for the population in England

Discussion How can we communicate the fact that population-wide CVD prevention activities will save money? How can we encourage colleagues from local government policy and planning departments to get involved in CVD prevention? How can we reassure food producers and distributors that they can increase profits while helping to improve the public’s health?

Regional CVD prevention programmes The NICE guidance also features recommendations on providing comprehensive regional and local CVD prevention programmes. Full details of these recommendations are included in the slide set ‘Prevention of cardiovascular disease at population level: implementing recommendations for practice’ available from:

Find out more Visit for the: guidance quick reference guide costing report and template audit self-assessment tool checklist for overview and scrutiny committees