School-based salt education programme in China lowers blood pressure and offers huge potential for scale-up

A school-based salt education programme in China has worked with families, teachers and health educators to raise awareness about the risks of excess salt consumption and encourage people to reduce salt use in cooking.

‘EduSaltS’ reduced salt consumption and blood pressure in family members of the primary school children involved and is the first large-scale salt education programme to show such significant results. The approach is now being piloted in districts in Beijing and serves as a model which could be scaled up in China and other countries to help tackle cardiovascular disease – the biggest global killer.

Excessive salt intake is the leading dietary risk factor for premature death and disability in China, with 80% of dietary salt added during cooking. A high-salt diet is associated with raised blood pressure, which increases the risk of cardiovascular diseases (such as heart attacks and stroke), the leading cause of death in low- and middle-income countries.

The EduSaltS programme

The EduSaltS programme, implemented by The George Institute in China and its partners from 2019-24, built on earlier small-scale projects to develop an effective family health education programme on salt reduction.

EduSaltS covered more than 300 primary schools in three cities in northern, central and southern China, reaching more than 70,000 students and their families, and was supported by teachers, health educators and local education authorities.

The programme offered eight, five-minute cartoon lessons on salt reduction, delivered weekly through the ‘Health Cloud Classroom’ WeChat platform, as well as posters, leaflets, radio plays, and other digital content. These materials were backed up by off-line activities such as quizzes, drama performances, and art competitions – which were particularly important for those with limited access to digital technology. Children were encouraged to share what they had learnt with parents and wider family members.

Research results

End-of-programme evaluation showed that adult participants had increased their awareness of the benefits of reducing salt consumption, and their willingness to do so, by a quarter. A randomised controlled trial also showed that EduSaltS had helped reduce adult salt intake by 1g a day (from a baseline of 9g with WHO recommending adults consume no more than 5g daily) and lowered systolic and diastolic blood pressure by more than 2mmHg – a significant amount at the level of the whole population.

Policy engagement and impact

Researchers engaged with policy stakeholders throughout the project, building the effective collaboration needed for successful implementation and the foundations for future possible scale-up.

Research results have been disseminated through an end-of-project meeting, at global conferences and research workshops, and published in international scientific journals. A major policy paper, Deepening the Action on Salt Reduction in China, contributed to planning for the strategic Healthy China Action 2030 target of reducing salt intake by 20% by 2030.

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We continue to share our learning with researchers and policy makers and encourage others to follow the EduSaltS model. Now one of the participating cities, Zhenjiang, has integrated the approach into its ongoing Healthy China Policy, and we’re supporting the Beijing Centre for Disease Control to run a pilot project in 14 out of 16 districts in Beijing.

By: Puhong ZhangCo-principal investigator

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One of the objectives of GACD’s funding call for research proposals on interventions to tackle hypertension was to provide evidence to enhance programmes and policies that significantly reduce risk factors for the condition. We’re delighted to now have robust evidence that a school-based education programme such as EduSaltS can work at scale, not only raising awareness about the risk of salt use but reducing real-life salt intake and lowering blood pressure in family members.

By: Margaret BeeSenior Impact and Policy Manager, Global Alliance for Chronic Diseases (GACD)

Awards and recognition

The EduSaltS programme has received global recognition as an effective, low-cost, scalable intervention to reduce salt consumption.

• Global Alliance for Chronic Diseases (GACD) best practice intervention for salt reduction by the
• Featured in the BBC StoryWorks, Facing Forward series
• Helped achieve an Organizational Excellence Award in Population Global Hypertension Control 2024
• Presented as one of the best examples of health education capacity strengthening at the Chinese National Health Education and Health Promotion Conference 2023