“Dead customers don’t shop.” That was the bald business case Graham MacGregor deployed to persuade food manufacturers to reduce the salt and sugar content of their products. Combining a rigorous regard for evidence with a gift for persuasion and a refusal to take no for an answer, MacGregor, who has died aged 84, was a key figure in advocating for industry agreements that would cut heart attacks, strokes and obesity by getting us all to consume less salt and sugar.
In 1994, the government’s committee on medical aspects of food and nutrition policy (Coma) published a report on nutritional aspects of cardiovascular disease. It included evidence that blood pressure rose with salt intake, and that the effect increased with age. High blood pressure is a leading cause of death from heart attacks and strokes. The Coma report recommended a gradual reduction in salt intake from 9g to 6g per day.
At the time MacGregor was professor of cardiovascular medicine and director of the blood pressure research unit at St George’s Hospital Medical School in London. To his fury, the chief medical officer for England, Kenneth Calman, who chaired Coma, rejected the idea of lower targets for salt consumption. It subsequently emerged that food industry lobbyists had opposed the targets.
MacGregor responded by founding Consensus Action on Salt and Health (Cash, later renamed Action on Salt), a research and advocacy charity. In 1998 the new Labour government made salt reduction a key aim, and it became a priority for the Food Standards Agency, set up in 2000 in response to the BSE crisis. The FSA set voluntary salt reduction targets and a “name and shame” approach for the food industry, while its public campaigns sought to persuade people to add less salt to food at home.
MacGregor was a key player, sitting in on meetings with industry representatives, giving media interviews, and keeping up the pressure for change. In 2009 he moved to the Wolfson Institute of Preventive Medicine at Queen Mary, University of London, as professor of cardiovascular medicine, with Action on Salt as a research and advocacy arm of his blood pressure research unit.
“Many people think he was an adversary to the food industry,” said Katharine Jenner, chief executive of the Obesity Health Alliance, who was director of Action on Salt from 2009 until 2022, “but he had some great relationships with people in the industry who were trying to make the business and economic case for salt reduction.” Action on Salt is grounded in evidence, but MacGregor was equally committed to training people in advocacy, learning about effective communication from his industry contacts.
By 2014, the salt content of many foods had been reduced, and people had cut their salt intake by 15% since 2003 when the programme started (though it was still well above the 6g target). One study estimated this to have prevented 20,000 strokes and heart attacks per year, 8,500 of which would be fatal, while another suggested that the salt reduction programme had already saved the NHS £1.5bn.
MacGregor and his colleagues took the message to other countries, founding World Action on Salt and Health (now World Action on Salt, Sugar and Health) in 2005 and working with the World Health Organization. He worked directly with researchers and advocates in countries including China and Australia who were adopting a model that combined voluntary or mandatory targets, clear labelling and public education.
In 2014 MacGregor expanded the work of his team to focus on the global problem of obesity, founding Action on Sugar and submitting a proposal that formed the basis of the government’s childhood obesity plan. This included the soft drinks industry levy and the sugar reduction programme. Action on Sugar’s research showed that between 2014 and 2018 the mean sugar content of 83 soft drink brands had decreased by 42%. MacGregor argued that this reduction could prevent a million adults from becoming obese, and reduce cases of diabetes by 300,000 in the next two decades. It was Action on Sugar’s campaign that led to the recent ban on energy drinks for under-16s in the UK, because of their high sugar content.
Born in St Albans, Hertfordshire, Graham was the son of of Sybil (nee Hawkey), a botanist, and Alexander MacGregor, a maxillofacial surgeon. The family, which included Graham’s elder sister, Frances, lived in various places, including Hertford and Edgbaston, Birmingham, as Alexander moved from one hospital to another. Graham went to school at Marlborough college in Wiltshire before choosing a medical career and training at Trinity Hall, Cambridge, and the Middlesex Hospital Medical School.
When his father died of a heart attack aged only 55, while MacGregor was just finishing his clinical studies, he made it his mission to specialise in cardiovascular and preventive medicine. In 1979 he joined the blood pressure and metabolic unit at Charing Cross and Westminster Medical School, and worked with Hugh de Wardener, a renowned kidney specialist who introduced dialysis to the UK and showed that salt raised blood pressure. MacGregor cited De Wardener’s example of compassion and persistence as a profound influence on his own career. The two of them later published a book, Salt, Diet and Health (1998), which the British Medical Journal’s reviewer called “one of the most informative and entertaining books that I have read”.
MacGregor held the chair in cardiovascular medicine at St George’s Hospital Medical School from 1989 to 2009, when he moved to Queen Mary, University of London. In 2001 he founded the Blood Pressure Association (now BPUK), a patient-focused organisation that urged everyone to “know their numbers” – systolic and diastolic blood pressure – in the same way they know their height or weight, and try to achieve a healthy blood pressure through diet and exercise.
Progress on salt had stuttered since 2014, but, Jenner said, he did not let it get him down: “He knew it was a long game, and was in it for the long haul.” He was made CBE in 2020.
Outside work he enjoyed practical activities such as gardening and DIY, as well as comic novels and opera.
MacGregor met Christiane Bourquin when they were both students at Cambridge, and they married in 1968, the year he qualified as a doctor. Together they published The Low Salt Diet Book (1991), a collection of healthy recipes.
Christiane survives him, as do their children, Annabelle, Vanessa and Christopher, and three grandchildren.
• Graham Alexander MacGregor, doctor and public health campaigner, born 1 April 1941; died 1 September 2025
