Disseminating sodium-monitoring data of the Australian food supply through periodic media releases enabled the VSRP to raise public awareness of the salt content of different foods by gaining access to mass media and engage food manufacturers in meetings to discuss product reformulation. Media releases are a cost-effective way to stimulate reportage of public health issues and reach millions of people with health promotion messaging . Through the six media releases disseminated by the VSRP over a two-year period, more than 750 media items about salt reduction were generated through radio, newspaper, online news, and television. This was much greater than the 58 media items that were generated by six media releases about tobacco control in New South Wales , which aimed to increase news coverage of tobacco and health in the media. However, in both cases the number of media items generated by each release varied, from 36 to 274 items for the salt reduction and from zero to 39 items for the tobacco control strategy . Further, the VSRP media coverage was estimated to reach between 2.3 million to 7.5 million Australians per release, approximately 9% to 30% of the population . This variability in media items and coverage between product categories could be the result of characteristics of certain media releases, including alignment with the VSRP strategy , or external factors affecting media interest outside of the control of the VSRP .
Our qualitative analysis provides insight into the characteristics of the media releases that may have influenced media coverage. Media releases that clearly and concisely explain the public health issue and why it is important have the potential to increase public awareness and influence public opinion and policy change . Every VSRP media release explained the link between salt and disease and the need for Australian’s to reduce salt intake, in line with the VSRP strategy . Each release also highlighted that most salt in the diet was from processed foods and focused on salt levels in one product category. By focusing on one product category, each media release was unique, which likely facilitated continued media interest in salt-related stories over time . These key characteristics likely contributed to the success of the VSRP media advocacy activities in gaining media coverage.
The framing of the media release can also be important for attracting media. Themes and frames that satisfy news values influence media coverage through journalist’s selection of stories that they perceive to be newsworthy [42, 43]. The processed meats release had the highest number of media items, cumulative audience reach, ASR, and social media engagement. This release may have attracted greater media coverage than others due to the framing of the press statement , such as the media angle chosen, where the headline mentioned “good health” rather than reducing salt intakes or the high salt content of the food category, or other key findings of interest, for example the reduction in the salt content of bacon but not sausages, over time. However, it could also reflect external factors, such as: the timing of the media release (Salt Awareness Week 2018 [44, 45]), a planned media event in Melbourne with a local chef , perceived newsworthiness , or general public or media interest in the category.
The dips and crackers release performed the poorest across all media coverage indicators. The press statement  was aligned with the VSRP strategy and similar to the other media releases, however the framing was different in that the salt content of dips was compared to seawater. Comparisons, or analogies, are a common framing strategy to gain media and consumer attention for public health issues . Comparing salt levels in specific food categories to the salt content of seawater or crisps have been done by other research and advocacy groups (e.g.  and ) and seems to be an effective strategy for engaging the media. Therefore, the potential reasons for lower media uptake are likely external. The timing of the dips and crackers media release, specifically other events occurring in the world at the time, with the Aztec High School shooting in America occurring on the same day , was likely a major factor. Other timing factors, including the lead up to Christmas, other health or nutrition related stories in the week, and the short space of time since the previous media release could have also contributed to the lower media pick-up . The perception from the media that because dips and crackers are discretionary or occasional foods  the salt content is a lesser a priority, may also be a factor.
Due to data limitations, we were unable to compare the media indicators for bread with other product categories, however possible factors influencing media outcomes include the focus on general salt information in the press statement rather than the key findings of the product category report (which may have contributed to less media interest ), less alignment with the VSRP strategy (e.g. no call to action for industry and government), and the release date, which was before the Unpack the Salt campaign launch . It is not always possible predict the contextual factors that will impact media coverage, however for future strategies it is important to consider and anticipate potential influencing factors and document and evaluate impact on media coverage.
Ten companies, including Australia’s four major retailers, three large manufacturers and three small manufacturers were engaged through the six media releases. Although this is a small number of companies, and only a quarter of those contacted by the VSRP, this engagement suggests that media publicity can be used by public health advocates to engage the food industry in discussions about food reformulation. In the UK, this ability to engage the food industry in salt reduction discussions influenced food industry action . Following the cooking sauces media release, as a direct result of engagement with the VSRP, one multi-national food company reformulated a range of cooking sauce products. It is not yet known if other companies reformulated as a result of the VSRP media advocacy activities.
Levels of engagement with food manufacturers differed between reports, which could be due to the VSRP approach to engagement, manufacturer-specific factors, product category-specific factors or the policy environment. The number of manufacturers contacted by the VSRP per report varied depending on how many were named in the release as having the highest salt products [33-38], however, the number of manufacturers engaged per report did not reflect this. Both manufacturers contacted in relation to the processed meat report met with the VSRP compared to only one of 11 manufacturers of dips/crackers. Whether the press releases included a call for industry to act did not seem to influence the likelihood of manufacturers to engage with the VSRP. It is likely that manufacturer-specific factors, such as company philosophy, size and location (overseas, Australia-based), capacity and available resources for reformulation, and receptivity to the industry engagement approach (naming manufacturers and products in the media) influenced manufacturers’ decisions to engage with the VSRP. The feasibility of reformulation for specific product categories is also a likely factor influencing manufacturer engagement. Some foods are harder to reformulate than others due to technical and functional roles of salt, such as its use as a preservative in many products, role in the control of yeast growth and fermentation in bread, and role in sensory and textural properties in processed meats ; and manufacturers of these product types may be more likely to be looking for support. Lastly, the lack of sodium targets for these processed foods at the time of these media releases meant that there was no incentive for manufacturers to reformulate other than corporate social responsibility . After the VSRP campaign, in May 2020, the federal government announced the first wave of voluntary sodium targets for manufacturers to meet by 2024, which include four VSRP targeted categories: bread, cooking sauces, crackers (not dips), and selected processed meats . Our results indicate that media advocacy can be used as a tool to engage manufacturers in conversations about salt reduction reformulation, however industry’s responsiveness may depend on a number of factors and in the absence of sodium targets, uptake of VSRP support for reformulation was low.
The idea of utilising product category reports to advocate for salt reduction through mass media stemmed from a similar strategy in the UK, whereby regular surveys were undertaken by Action on Salt, and used to raise public awareness and put pressure on the food industry to reformulate in line with the UK’s salt targets . Between 2006 and 2011, the UK salt reduction strategy reduced population salt intake by 15% and salt levels in foods were reduced by up to 57% in some food categories . Building on concepts from the UK strategy, the VSRP utilised mass media to call consumers, industry and government to act to reduce population salt consumption.
Consumer messages in the press statements were based on evidence about salt levels in different food categories from the product category reports [13-18, 55] and were centred around concepts such as: raising awareness of the salt content of different foods, swapping to a reduced salt variety, replacing processed foods with fresh foods, and trying homemade options. Although the key messages are based on a successful strategy and media coverage indicators seem promising, it is currently unknown whether these messages were enough to trigger changes in consumer behaviour to reduce the salt intake . Media advocacy strategies were used to stimulate industry action to reformulate processed foods and government action to set sodium targets, as well as increase public demand for these actions, in line with the aim to reduce salt in the food supply. In four of six press statements, industry was called to act, with messages highlighting that reformulation is feasible within these product categories, and in three of six press statements, the federal government was also called to act, specifically to set targets for sodium levels in foods.
Worldwide, 61 countries have reported working with the food industry to reformulate products to include less salt . At least 23 countries have reported engaging in industry meetings as part of their national salt reduction strategy , the approach undertaken by the VSRP. However only two of these countries, France and Italy, have reported a reduction in the salt levels of selected food categories . Unlike the other 21 countries engaged in industry meetings, these countries also had voluntary sodium targets for bread, which likely influenced their success . In total, 19 of 36 countries that have established sodium targets reported a reduction in salt levels in foods and meals . This emphasises the importance of nutrient reformulation targets for reducing salt levels in the food supply, and consequently decreasing population salt intake and the burden of disease associated with excess salt consumption.
This study is a novel assessment of the outcomes of a media advocacy strategy in Australia. It provides insight into media coverage and industry engagement outcomes from six media releases based on salt levels in different processed food categories. It provides an in-depth understanding of the factors influencing the effectiveness of using media advocacy as a tool for engaging media and industry, which is a key element of a larger salt reduction intervention strategy. The methodology for assessing the media and advocacy strategy, both quantitatively and qualitatively, was based on items from a public health framework for evaluating complex public health interventions . A limitation of the study is that the indicators of media coverage for the bread release were unable to be compared to other media releases. For this report, average audience reach was recorded by The George Institute for Global Health, whereas cumulative audience reach, media items and ASR were collected by the Heart Foundation for the other reports.