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Glasziou (previous letter) pleads for a description of what clinicians and patients need to do. It is not simply about adding salt at the dinner table but about understanding the considerable role that players such as the food industry play in public health.1 Health protection through national fiscal and legislative policies should have a higher priority than health promotion interventions applied to general, primary care, and workforce populations.
The high risk strategy, the traditional medical approach to prevention, identifies individuals at high risk of subsequent cardiovascular disease events who are then offered behavioural or pharmacological interventions. In contrast, the population strategy seeks to control the determinants of incidence in the population as a whole.2
Public health policies need to take into account the role that agriculture, trade, education, the physical environment, town planning, and transport have on cardiovascular disease aetiology. Political action is needed to change urban planning, education, and policies on the agriculture, food, and tobacco industries.3 Until then, interventions such as salt reduction campaigns and pleading to patients to throw away the salt cellar in afternoon surgery will make little difference to population salt levels.
Competing interests: None declared.