DiabetesHypertensionScale Up SU14, 2019 – 2023

School-based education programme to reduce salt: Scaling-up in China (EduSaltS)


Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Raised blood pressure(BP) is a major cause of CVD. Dietary salt intake is the major factor that increases BP. Salt intake in China is very high, more than twice the WHO recommended level of 5 g/d. About 80% of the salt in the Chinese diet is added by the consumer. It is very difficult to reduce salt intake in such settings.
One innovative approach to address this public health challenge has been successfully tested in a MRC-funded project-School-EduSalt, a cluster randomised controlled trial in northern China, in which primary schoolchildren were educated during their usual health education lessons about the harmful effects of salt on health and how to reduce salt consumption. Children then instructed the families to reduce salt intake. After one school term, salt intake decreased by 1.9 g/d in children and 2.9 g/d in adults, accompanied by a significant fall in systolic BP. This approach, if implemented across China, could prevent ˜200,000 CVD deaths per year, resulting in major cost-savings.

The team will carry out a study with an aim of developing, implementing and evaluating a scale-up package, in order to scale up the School-EduSalt program in multiple settings at regional and eventually national level in China. We will use pre-post design with both qualitative and quantitative methodologies, in a stepwise and structured approach with 4 phases spanning preparation, pilot, scale-up and sustainment in 4 years.

Using an implementation science approach, with the application of the key elements and principles from WHO’s Conceptual Framework for Scaling up, we will develop and test an adaptable, feasible and sustainable scale-up package with the core component being the refined School-EduSalt program supported by robust policies and a set of management and evaluation system in 3 large regions covering a population of 3.2 million (1.1 million children and 2.1 million adults) in the north and south, rural and urban areas of China. The implementation partners are the education/health authorities in the 3 regions (including China’s Capital City of Beijing), who will take initiative during the research process, with strong technical support from UK and China, including Chinese Centre for Health Education (CCHE, a governmental organisation). Implementation and sustainability will be ensured by integrating the scale-up package into the existing school health education system (education curriculum and Health Promoting School Initiative).

Our study fits well with the aims of the call, particularly as it targets the major cause of hypertension, i.e. high salt intake, focusing on the prevention of hypertension and CVD through school education system, reaching a wide range of the population from children to adults. This will prevent hundreds of thousands of unnecessary deaths from CVD, and result in major cost savings to individuals, their families and the health service.”

Programme Team

  • Feng He Queen Mary University of London
  • Puhong Zhang The George Institute for Global Health at Peking University Health Science Center
  • Graham MacGregor Queen Mary University of London
  • Yinghua Li China Centre for Health Education
  • Yuan Li The George Institute for Global Health at Peking University Health Science Center
  • Haijun Wang Peking University
  • Xiangxian Feng Changzhi Medical College
  • Xian Li The George Institute for Global Health at Peking University Health Science Center
  • Yu Liu Beihang University, China.
  • Changning Li Chinese Centre for Health Education

Funding organisations

  • DiabetesHypertensionScale Up SU14
  • China
  • 2019 – 2023

Programme contact
Feng He