Whilst much is made of conscious eating (healthy diet awareness levels and consumers desire to eat better) the reality is that behaviour isn’t ultimately changing at the right pace. This is especially the case when it comes to salt and sodium intake, which has direct links to the ‘silent killer’ of hypertension and high blood pressure.
In 2019, 10.8 million deaths were associated with high blood pressure or hypertension. More than 1 billion people globally have hypertension and fewer than 1 in 5 have it under control. Hypertension is particularly challenging because it is an asymptomatic, silent killer that slowly damages blood vessels and is a major risk factor for several types of cardiovascular disease (including stroke, heart attack and heart failure), as well as end organ damage (including renal failure and vision loss). A modelling study published in the open access journal BMJ Nutrition Prevention and Health suggests a modest cut of just one gramme in daily salt intake could ward off nearly nine million cases of heart disease and strokes and save four million lives by 2030.
The average person’s salt intake is nearly twice the recommended level. In 181 of 187 countries—covering 99% of the world’s population—the average level of salt intake exceeds the World Health Organization’s (WHO) recommendation of 5 grams (or just under one teaspoon) per day2. To assist countries in controlling the threat that salt poses to public health, WHO has created the SHAKE technical package: a set of common sense, evidence-informed policy options and interventions which support governments to lower salt consumption.
As shown by early salt reduction work in the UK, one effective intervention is reformulation. Last year the US Food and Drug Administration issued sodium reduction goals for the food and beverage industry but with these being voluntary the concern is that little will be done by the industry without a ‘level playing field’ being in place. This has actually played out in the UK as since targets became voluntary, the decreasing trajectory of population salt consumption stalled and has now in fact reversed. Interestingly 10 countries in Europe currently have mandatory initiatives against high salt levels. Taxes, warning labels, ceiling levels and refreshed and official sets of guidance are all mooted or occasionally implemented.
But reformulation is only part of the story being effective where countries have high consumption of pre-packaged food. On a global level, the majority of dietary sodium is consumed as discretionary, with more than 50% the reality for most of Asia, Africa and South America, and between 25% and 50% for most of Western Europe. We therefore have to consider what alternatives there are to salt both in and out of home.
In many cases the reality of taste and flavour impact – or even perceived impact – is what can partially contribute to low levels of change, and high levels of consumption.
Meaning it’s time to shift the narrative and the platform.
And specifically champion more low salt alternatives that don’t compromise on that taste need, but that do significantly reduce core sodium intake and significantly impact health.
This is a space gathering traction, but one that needs more collaborative support and leadership action.
In one of the largest dietary interventions ever conducted, The George Institute for Global Health China Salt Substitute and Stroke Study (SSaSS) found that replacing salt with a reduced-sodium, added-potassium ‘salt substitute’ significantly lowers the risk of stroke, heart disease and death. 3
Discussing the findings, principal investigator Professor Bruce Neal, believes “salt substitutes are one of the most exciting opportunities in salt reduction. If salt substitutes were adopted worldwide, several million premature deaths could be prevented each year.”
The ‘Resolve to Save Lives’ organisation, with funders including The Gates Foundation and Bloomberg Philanthropies, work with global organisations, society and business to produce and promote policies that maximise health gains. As part of this they produce a `sodium reduction framework’ that champions awareness, education and advocacy of sodium alternatives as key.
So, with the right energy and opinion ‘already live’ around lower salt alternatives, there are opportunities to work with the food and retail industry to make a significant difference, flip the script and change the future around sodium reliance for significant health good.
We have the collective power to help save lives, make a radical difference and be leaders of positive change, and all without radical brand disruption for manufacturers. For this reason, I joined the Collaboration for Healthier Lives Coalition of Action (CHL) at The Consumer Goods Forum to put collaboration into action at the global scale to address salt reduction in our diets. It’s not just following what might be currently understood as ‘reformulation’, but it’s a fast track switch to a fresh platform of low salt alternatives.
Leading reduced sodium alternative, LoSalt®, is collaboratively working with chefs, medical professionals and health charities in their Season with SenseTM initiative – helping to reframe mindsets, talk taste, health and self-responsibility in the kitchen for the right reasons. Education can go a long way when packaged in the right formats and with the right storytellers behind it.
But scale is always the challenge, and any collaboration for healthier lives has to start with the mass availability routes to create a rounded picture of action.
And of course, bridge back to what really matters. That one gramme reduction in daily salt intake to help save four million lives by 2030.
What better call to action for a fresh collaboration.