Table 1 Impact scorecard for the Pacific Salt project intervention, Fiji and Samoa, Pacific
Metrics | Outputs/outcomes | ||
|---|---|---|---|
Domains of Benefit | Advance knowledge | • Peer-reviewed publications • New datasets established | • 14 papers in total: 7 papers resulting directly from the research programme (1 protocol, 2 baseline, 2 impact, 2 process evaluation) and 7 papers linked to the project (2 systematic reviews, 1 methods paper on developing targets, and 4 cross-cutting papers in collaboration with other researchers) • Presentation at the World Congress on Public Health in Melbourne in 2017 and the Australian Food Governance Conference in 2016 and workshops for staff at the George Institute and University of New South Wales • 2 new national datasets established, including baselines on population salt levels for two Pacific countries where no previous data available |
Capacity-building | • Academic qualifications • Knowledge and capabilities of health workforce | • 1 PhD (Sydney) and 2 Masters (1 Sydney and 1 Fiji) qualifications • 4 authors from Fiji and Samoa included on 7 academic publications, including 1 led by a Fijian author • 6 salt reduction training sessions for health staff, Ministry of Health managers, health volunteers • 4 research assistants trained in data collection related to salt monitoring in each country • 3 project staff from Fiji and Samoa attended training on implementation science • 14 Samoan staff attend data-analysis training in Samoa | |
Healthy eating: education, behaviour change and healthy food environments | • Consumer knowledge and awareness of health risk associated with salt • Salt intake (g/day) • Hospital’s food environment | • 9% increase in population understanding of adverse effects of salt in Samoa • 16% reduction in population that always/often add salt to foods in Samoa • 28% increase in population reporting using spices instead of salt during cooking in Samoa • 70% of people in both countries aware of the salt reduction campaign and reported having seen promotional materials • 1 hospital (Fiji) removes salt shakers from staff dining room, and salt content of hospital meals reduced • No salt shakers on tables introduced into Fiji’s restaurant grading scheme but no data on compliance | |
Engagement and networking | • Public–private dialogue on food policy | • 2 forums and 10 face-to-face meetings with individual companies in Fiji each year • Multi-sectoral working groups (Agriculture, Trade and Commerce, Education, Finance, Women and Culture) convened to oversee programme implementation in Fiji and Samoa | |
Economic impact | • Reduced health system costs • Current and future income of staff associated with study • New research financing | Unable to calculate due to lack of data but could be done using the following approach: • Model economic value of reduced salt intake based on reduced burden of hypertension and associated decrease in health system costs • Additional lifetime income of 2 PhD students (vs. Masters) and 1 Masters (vs. Bachelor) • New grant of AUD$ 150,000 secured | |
Social Return on Investment | Cost of research | Total project cost (a) | AUD$ 1.2 million |
Cost of using research outcomes | Based on cost of the interventions trialled in the research (b) | Total cost of salt reduction campaign implemented during project: AUD$ 177,000 or AUD$ 0.19 per capita Scaled up campaign costed at approximately AUD$ 500,000 per year per country (2.5 million over 5 years per country) | |
Benefit converted AUD$ values | Change in salt consumption converted to DALYs saved over life of cohort (c) | Could be completed using the following approach: Economic modelling based on low, medium and high reductions in salt intake, which should occur if health promotion activities modelled on those piloted in this study are delivered, and if legislative and regulatory changes are implemented. This would provide an estimate of avoided morbidity over a specified period, and from this health systems costs can be estimated | |
Social return on investment | c / a + b | Not possible due to lack of data | |
Case study | Need: Approximately 40% of the adult population in Samoa and 31% in Fiji have high blood pressure (BP). Excess salt intake is known to be a key contributor to raised BP, which is in turn a major risk factor for cardiovascular disease (CVD). No accurate information was previously available on salt intake in either country. Further, while reducing salt intake is a known cost-effective intervention to prevent CVD, very little is known on how to achieve this in low- and middle-income countries (LMICs) and no Pacific country had run a successful salt reduction campaign. Research response: Researchers collected the first baseline survey on salt consumption in each country and used this to design a multi-pronged salt reduction campaign to increase consumer awareness of health risks of salt, and reduce salt content in processed foods through engaging food manufacturers. Educational materials, including pamphlets, posters, DVDs and presentations, were produced for each country. In Samoa, the research team worked with Government to amend the Food Act to introduce labelling of salt content and introduce mandatory salt targets. A rigorous evaluation process was carried, providing the first ever evaluation of a national salt reduction campaign in a LMIC. Outcome: The project delivered new knowledge on salt levels in two Pacific countries and showed (for the first time) that it is possible to achieve some level of behaviour change in a relatively short timeframe and at low cost in a Pacific context. Consultations between food industry and Government were the first public–private consultation on salt and health in these countries. Training and capacity-building outcomes were extensive, and likely to yield an economic return in Australia and the Pacific through improved employability. Academic networks between Australia and the Pacific were established and new funding secured. Impact: The health promotion campaign had high penetration in both countries leading to significant improvements in consumer knowledge and some changes in behaviours. In Fiji, the new Food and Health strategy (2018–2022) commits to reduce salt, fat and sugar intakes. Health workers – a key source of information for the public on healthy eating – demonstrated increased knowledge of health risks of salt. Pacific specific guidelines on measuring salt intake have been produced, endorsed by WHO, and lessons from this project contributed to WHO’s “SHAKE” guidance on salt reduction. Lessons: Three years is too short to demonstrate a reduction in mean population salt intake; any future campaigns would need to expand coverage and run for longer. Further, high consumption of processed food in the Pacific suggests that changes to discretionary salt intake will be insufficient – broader changes to the food environment will require strong government engagement since food industry stakeholders are unwilling to change practice voluntarily, preferring to wait for clear direction from Government. | ||