Sodium Reduction Off-track Warns WHO

Although sodium is an essential nutrient, excessive consumption increases the risk of heart disease, stroke, and premature death. Sodium is mainly found in table salt (sodium chloride) and other condiments like sodium glutamate, a flavour enhancer.

Why is sodium reduction important?

Implementing highly cost-effective sodium reduction policies could save an estimated 7 million lives globally by 2030. 

It is also important if we are to achieve the Sustainable Development Goal target of reducing deaths from noncommunicable diseases. However, today, only nine countries – Brazil, Chile, Czech Republic, Lithuania, Malaysia, Mexico, Saudi Arabia, Spain, and Uruguay – have a comprehensive package of recommended policies to reduce sodium intake. That’s just 5 per cent of WHO Member States.

“Unhealthy diets are a leading cause of death and disease globally, and excessive sodium intake is one of the main culprits,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This report shows that most countries are yet to adopt any mandatory sodium reduction policies, leaving their people at risk of heart attack, stroke, and other health problems. 

WHO calls on all countries to implement the ‘Best Buys’ for sodium reduction, and on manufacturers to implement the WHO benchmarks for sodium content in food.”

The global average salt intake is estimated to be 10.8 grams per day, more than double the WHO recommendation of less than 5 grams of salt per day (one teaspoon). Eating too much salt makes it the top risk factor for diet and nutrition-related deaths. More evidence is emerging documenting links between high sodium intake and increased risk of other health conditions such as gastric cancer, obesity, osteoporosis, and kidney disease.

Commenting on the report, John Maingay, director of policy and influencing at the British Heart Foundation, said: “It is well established that high salt intake contributes to high blood pressure, which is associated with around half of all heart attacks and strokes in the UK.” 

“This important new report from the WHO highlights the enormous potential benefits in accelerating salt reduction to meet global targets”, he continued. “This would help to make headway in reducing the huge burden of heart and circulatory diseases.”

What policy measures can reduce sodium intake?

A comprehensive approach to sodium reduction includes adopting mandatory policies and WHO’s four “best buy” interventions related to sodium that greatly contribute to preventing noncommunicable diseases. 

These include reformulating foods to contain less salt, setting targets for the amount of sodium in foods and meals, establishing public food procurement policies to limit salt or sodium-rich foods in public institutions such as hospitals, schools, workplaces, and nursing homes, front-of-package labeling that helps consumers select products lower in sodium, and behavior change communication and mass media campaigns to reduce salt/sodium consumption.

Countries are encouraged to establish sodium content targets for processed foods in line with the WHO Global Sodium Benchmarks and enforce them through these policies.

Mandatory sodium reduction policies are more effective as they achieve broader coverage, safeguard against commercial interests, and provide a level playing field for food manufacturers. As part of the report, WHO developed a Sodium country scorecard for Member States based on the type and number of sodium reduction policies they have in place.

Implementation of policies is done at the national level.  The UK has mandatory measures to reduce sodium in the food supply or encourage consumers to make healthier food choices, including mandatory declaration of sodium on all pre-packaged food.  This is similar to other countries such as the USA, Bahrain, Ukraine or Iran.  EU countries differ in their measures, with some such as Austria and Belgium having the same measures in place, while others such as Denmark and Italy only have voluntary measures in place.

John Maingay, director of policy and influencing at the British Heart Foundation, continued: “While the UK has taken steps in the right direction with voluntary labelling and reformulation policies, we could go much further and faster, especially in areas where the food industry has not done enough. We urgently need to look at mandatory reformulation and front-of-pack labelling, to help us meet UK and international targets and better protect the nation’s heart health.”

Dr Tom Frieden, President and CEO of Resolve to Save Lives, a not-for-profit organization working with countries to prevent 100 million deaths from cardiovascular disease over 30 years commented: “This important report demonstrates that countries must work urgently to implement ambitious, mandatory, government-led sodium reduction policies to meet the global target of reducing salt consumption by 2025.  There are proven measures that governments can implement and important innovations, such as low sodium salts. The world needs action, and now, or many more people will experience disabling or deadly—but preventable—heart attacks and strokes.”

Resolve to Save Lives has created a global nutrition database which currently presents packaged food nutrient data for 25 countries.