Reducing Salt Intake: An Essay On Fighting Non-Communicable Diseases.

The Harmful Effects of High Dietary Salt Consumption

Discuss about the Global Initiative To Reduce Sodium Consumption.

High dietary salt consumption has been linked to harmful effects such as increased risk of stroke due to heightened blood pressure, renal disease, and ventricular left hypertrophy. There are studies that relate salt intake with obesity, with osteoporosis and renal stones and also as a cause of stomach cancer (Wyness et al., 2012). Because excessive salt consumption is known to contribute to these non-communicable diseases, the world is looking for ways to reduce salt intake. Studies have shown that there are 36million deaths caused by non-communicable diseases around the world which include cancer, diabetes, cardiovascular disease(CVD andchronic lung diseases (He et al., 2014). This accounts for close to two-thirds of an approximated 56 million deaths around the world among per year. CVDs the group of conditions leading to deaths globally with an estimated 17.5 million people having have died from CVDs in 2005 (He et al., 2014). Low-and middle-income countries have over 80% of the estimated deaths from CVD (He et al., 2015).

It has been assumed that use of salt shaker when eating is one of the greatest contributors to increased salt levels in your diet (Joffres et al., 2013). This, however, is not true, as packaged and restaurant foods contribute 75% of dietary sodium with only 11% contributed with addition when eating or cooking(Webster et al., 2014). Sodium exists in foods when purchase them and this may be reduced in the following ways: with over 1.65 million people dying every year of CVDs, there is a need for the stakeholders to look for all ways to fight this problem  (Strazzullo et al., 2009).  Improper usage of the salt is the problem as opposed to the use of salt alone and this gives the reason why the world struggles with this problem since the 1970s (Petersen., 2009).

• Reading the nutrition facts label would help to reduce salt intake as one is able to determine the amount present in the beverage or processed food. This would allow one to choose the products from manufacturers who have lower salt or sodium contents(World Health Organization, 2010).
• Buying fresh meat, seafood, poultry, then processed one is also advisable to avoid the increased amount of sodium in the food. It is also advisable to check if salt water or saline has been added to the fresh meat, seafood, and poultry(Webster et al., 2014).
• When cooking or eating, in the table on when baking adding salt should be avoided by using other flavors in food such as herbs and spices (Strazzullo et al., 2009).
• Reducing food portions since more food portion means more salt intake. Make sure you prepare a small portion of your meal when at home and sometimes share with a friend to avoid consuming the bigger amount of salts (Liem et al., 2011).
• Rinse sodium from foods such as beans, vegetables, and tuna before eating. This will help you reduce the amount of sodium content in your food.
• There is a need to increase public awareness on effects of salts on their health. Bruce Neal a Professor from UNSW Sydney and George Institute of Global Health says, "Most of the actions trying to contain how much salt people eat have been about trying to educate people and tell them about the problem. And that's important, but the food environment means that's not desperately helpful. It has almost no impact at all"(McKenzie-Mohr, 2011).
• The government should come up with policies which restrict processing industries using too much salt on the processed food but rather reduce it to a required amount.

Image courtesy of National Center for Chronic Disease Prevention and Health Promotion

Resource Mobilization

Describe what potential barriers/enablers could influence the implementation of on the initiative

Potential barriers

• Poor government policy implementation. Sometimes the government passes policies to protect and promote healthy eating but the concerned bodies for the enforcement fail to implement those policies to benefit people (Strazzullo et al., 2009). For instance, Thai government in 2008, passed regulation restricting unhealthy television and radio food advertisement to children. The following year it passed that those products which had reduced sodium content by 25% were to be advertised freely by the governments(Webster et al., 2011). However, the problem of implementation remains the letdown of these policies to date.
• Poor governance of systems which would support the implementation(Webster et al., 2011).
• Social factors such as lack of effective communication and insufficient involvements with stakeholders (government and NGOs) as well as lack of strengthened social support networks(Webster et al., 2011).
• Organizational structure instability as a result of a change of executive-level leaders may be a major blow for implementing the initiatives(Strazzullo et al., 2009).
• Unclear roles boundaries and too many levels of management (NGO, GO and AC)
• Executive's leadership inability of achieving the implementation (25% SFS: NGO and AC; RTA: NGO and AC),(Joffres et al., 2013).
• Government and NGOs insufficient funding for the implementation of policy (25% SFS: NGO, GO, AC and PV; RTA: GO),(Joffres et al., 2013).

The enablers

• Individual support from the government officials(25% SFS: NGO, GO and AC; RTA: NGO and AC.
• If the policy is compatible with the intended users’ context (AC and GO).
• Mechanisms for good financial management tracking funding means available to support implementation (GO, NGO and PV)
• If there are strong inter-organization links across and within sectors (25% SFS: GO and PV; RTA: GO, NGO and AC)

Public education

What is most disturbing is that problems associated with salt intake affect both children and adults in the developing and developed countries. Although salt reduction has been shown to reduce cardiovascular occurrences many people are not interested in a salt reduction or are not aware of the needs to reduce their salt intake(Beaglehole et al., 2011). This endangers their lives even more and puts more burdens on the government and private sectors which are concerned about the reduction of risks associated with the increased salt intake(Joffres et al., 2013). The motivation for individuals in general population to decrease salt consumption through engaging them in sustained behavior change has been found difficult and challenging(He, Pombo-Rodrigues & MacGregor, 2014). General population behavior concerning the willingness to change must have a solid understanding and is important for targeted research and successful salt reduction initiatives(Wang &Labarthe, 2011). The public education on salt reduction started in 1970’s sponsored by Lung, Blood and National Heart Institute when they were backing education campaign for national blood pressure (Sørensen et al., 2012). Since then major efforts have been put in place to educate people on the importance of salt intake reduction(Joffres et al., 2013). Consumer awareness since raised from 12% in 1979 to 48% in 1984, though there has been difficult in sustaining these gains and raising fears that they may have reduced significantly higher in the recent years(He, Pombo-Rodrigues &MacGregor, 2014). For instance, in 2002, there was a reduction of these gains to 39%.

Non-Communicable Diseases and Salt Consumption

Other problems hindering the reduction of salt intake in the low percentage of consumer actively trying to reduce this behavior and has never increased beyond 33% which is linked with several Americans not aware of their own sodium intake(Strazzullo et al., 2009). Education is the easiest and most inexpensive strategy to implement; it requires the reduction of salt composition in the processed and packaged foods in order for it to be effective. This means the creation of awareness through education implementation initiative may not be the better option if there is a continued salt composition in these foods.

Counseling is important in changing attitudes, beliefs, and knowledge of salt intake habits since it is hard to estimate and monitor salt intake. There is a need for better understanding in developing interventions implementable on a large population scale, focusing on the barriers and motivators to change(World Health Organization, 2010). Individual dietary counseling can be done by the physician or healthcare providers as evident in smoking cessation and weight control that shows the significant role they play in reinforcing these and maintenance of these habits(Chen et al., 2009). To make effective the role of these physicians is to increase their skills, knowledge, optimistic approach towards sodium decline and other ways of life changes(Joffres et al., 2013). A barrier to this initiative is that clinicians might be restricted by the difficulty with patients’ adjustment behavior in their present nutrition supply(Pimenta et al., 2009).

Despite the effort of the governments and WHO to curb the salt intake amongst worlds’ population through industrial food labeling initiative, there remain excuses from these branded industries that manufacture processed foods(Fleischhacker et al., 2011). According to the chairman of Consensus Action on Salt and Health, Graham MacGregor “we feel that the food industry has done a terrific job but it still has further much to go, and we would like to see branded manufacturers taking a much more entrepreneurial and not come up with these excuses all the time” (Joffres et al., 2013). Gregory states that, the brands apart from technical issues may be too conservative in regard to changing consumers taste panel in their recipes (Chen et al., 2009). However, regarding tastes of consumers, Gregory says, “10% reduction cannot be detected by the salt tastes receptors.”Issues surrounding taste has been the main barrier to changing the amount of salt in the processed food with companies wondering whether to formulate CASH requirements for products with no salt at all. Gregory says that “We don’t accept that taste is a big problem without evidence” (He, Li & MacGregor, 2013). The major setback for this is that labeling systems such as Nutritional Facts Panel are poorly designed hence wrong information may be experienced.

Reducing Salt Intake for Better Health

Calls for industrial voluntary action for salt reduction have been futile in countries like the US. There is evidence that shows that for this to be effective companies should be held responsible for their pledges toward coordinated voluntary action and backed by authoritative bodies. Data from the Public Interest Center for Science found that only 5% reduction in the amount of sodium in packed food from 1983 to 2004 where from 1994 the levels increased(Batcagan-Abueg et al., 2013). To achieve salt reduction of the restaurant and packaged food in this initiative there should be there should be no limitation of consumer choice and acceptance(Liem, Miremadi&Keast, 2011). The amount of salt added back with the salt shaker is said to be only a portion and this means if people are given food with small amount of sodium in their food they will, therefore, adapt slowly to average salt needed(Aburto et al., 2013).

The other possibility for this initiative becoming effective is through government creating processed food database on daily basis, 24-hour urine collection periodic measurements of peoples’ sodium intake and company reports (Strazzullo et al., 2009). The 2010 targets have today been achieved by many UK companies which saw approximated 10% drop intake of sodium from 2000 to 2008(Webster et al., 2014). This initiative was adopted by National Salt Reduction Initiative for the United States which aimed in achieving sodium content reduction to between 20% and by 25% reduction in restaurant and packed foods by 2014(Bibbins-Domingo, 2010). This target for sodium reduction has been achieved by some large national players such as Target, Subway, and Kraft with a total of 28 packaged food and restaurant companies today(Webster et al., 2014). The committed companies and restaurant are asked to give a report on their progress in nutrition information every target year(Strazzullo et al., 2009). The other application by the NSRI is the creation of national restaurant and packaged food databases which help to assess the amount of sodium independently.

There are advantages that are associated with this initiative and they include; one, less controversial compared to regulation, for both public and food companies.  Two, it makes companies be responsible for their commitments (Webster et al., 2011). Three, it targets on the content of sodium in restaurant and packaged food, instead of shopper decision, and four, it is a gradual system of minimizing intake, enabling adjustments and differentiating of tastes for various types food, while consumer variety and choices remain unchanged (Fleischhacker et al., 2011).

Potential Barriers and Enablers to Salt Reduction

This initiative has a challenge of voluntary initiative not requiring the industry to participate making sodium reduction limited to the number of companies involved. It is also not compulsory for the commitment even if it is publicized and monitored(Joffres et al., 2013). This initiative has been found to face a lot of opposition for instance in US groups like Salt Institute and Centre for Consumer Freedom and opposed NSRI.

The UK’s program for salt reduction reduced average salt intake in its population and also boosted consumer awareness. There are however significant challenges that remain towards achieving an average salt intake of 6g/d among its population which is recommended by UK’s scientific advisory committee on nutrition (Pimenta et al., 2009).  Other worlds have started implementing this approach as the UK demonstrated the success of this program(Puska&Ståhl, 2010). This initiative is achievable by the government if it includes sodium standards in their procurement policies, which also means private and non-profit institutions doing the same.

One of the best methods which seem to have the potentiality to this initiative is the US government annual purchases of a large amount of food, of more than $800 million in its program for feeding employees in military and 1.9 billion pounds used for purchasing for feeding school lunch program(Petersen, 2009). There are also food purchases for schools, child-care centers, senior centers, correctional institutions, and other institutions by both local and state governments(Stolarz-Skrzypek,2011). If these programs require that inclusion of specific sodium standard is adhered to, it can contribute towards achieving voluntary coordinated reductions through demanding low quantity of sodium products and there is not a single company which can stand to lose this opportunity(Fleischhacker et al., 2011).

Policies for procurement increases demand low sodium food, high healthy food, which ensures food industries adhere to it when producing and marketing their products as well as ensuring that people depending on government for food can get low sodium and balanced diet(Legetic& Campbell,2011). This initiative has however very small impact as it targets only a fraction of countries population making it not to be fully reliable.

FDA regulations

This approach has a big advantage which is, FDA approves food staffs prepared with additives lacking GRAS status before marketing, modifying. Despite this advantage, it is not clear if it will implement IOM recommendation which required regulation of the content of salt in both packed and restaurant food to decrease sodium intake(He, Li&MacGregor, 2013). There is a likelihood of opposition by food industries in case of any changes to regulatory environments because the modification would affect large numbers of the industry(Wyness, Butriss&Stanner, 2012). However, FDA’s implementing this recommendation is likely to take years to draft and be approved.

Public Education on Salt Reduction

Evaluating the initiative using qualitative study design

Objectives

It is important to reduce sodium contents in our diet for public health intervention that will help to reduce chronic disease and blood pressure. To understand how Americans population purchases are influenced by how they perceive sodium contents in diet will inform future strategies of sodium reduction.

Design

The contemporary qualitative study has used an in-depth questionnaire to adults ‘population in exploring peoples’ knowledge, understanding of food purchasing behavior and food labels with regards to dietary sodium.

Setting

United States

Subjects

A convenient sample of 80 adult supermarket shoppers

Results

Detailed analyses of the receipts showed that American adults lacked knowledge that is necessary for recognizing and adjust their own intake of salt and could not interpret the existing food labels in regards to dietary sodium.

Conclusion

There is further weight added from the findings to calls for food labels that do not need knowledge or numerical skills with highlighting the needs for peoples’ based interventions for public health. This approach would be complemented by the education for Americans people on the health benefit of reducing sodium contents.

Describe which outcomes would be used to examine the impact of the initiative on the health priority area

• Cardiovascular diseases dropping from the current 17 million deaths reported per year(Legetic& Campbell, 2011).
• The decrease in high blood pressure among individuals who have raised blood pressure and few or no new cases for high blood pressure reported as a result of sodium consumption
• Reduction of cases of heart diseases and stroke(Pelikan,2012).
• Consumers becoming more cautious about reading food labels to choose from the one with the required amount of sodium contents(Pimenta et al., 2009).
• People starting to avoid using salt shakeups when eating (Trieu et al., 2015).
• Reduced restaurant and processed food purchases.

Describe how these outcomes would be assessed

A total of 75 countries have a strategy for national salt reduction a double of the reported in 2010

• Taxation on high salt foods (3)
• Interventions in public institutions (54)(Strazzullo et al., 2009).

• Front-of-pack labeling schemes (31)
• consumer education (71)
• Establishment of sodium content targets for foods (39)
• industry engagement to reformulate products (n = 61)
• Regulations related reduction of salt intakes like front pack labeling, mandatory targets, taxation, and food procurement policies have been implemented in over 33 countries. Reductions in salt intake have been reported amongst populations in 12 countries, 19 having reduced content of salt in foods and 6 improvements in consumer attitude, behavior, and knowledge on salt(Strazzullo et al., 2009).

Describe which strategies you would use to disseminate the outcomes of the public health initiative

• Establishing a learning community in conjunction with public health partners, public health practitioners from SRCP awardees and food industry experts
• Hosting a national web series of forums
• Organize in-person training for SCRP awardees featuring cooks, chefs, and administrators from different food services outlets
• Producing a series of instructional videos to help reduce sodium in food service settings
• Do networking calls with SRCP awardees to support sharing best practices and peer learning and
• Create a disseminated sodium reduction tip sheets to an estimated audience

Conclusion

Excessive salt intake is a global problem that contributes to more risks of contracting cardiovascular-related diseases. The WHO recommends 2g salt intake per day and excess of this is dangerous to human life as it raises risks of high blood pressure and other related diseases. Studies show that 90% of Americans consume salt above the WHO recommended amount. However, there are global means which can be used as the best initiative to reduce salt consumption. They include FDA Regulation, Government, and private sector food procurement policies, Coordinated, voluntary industry sodium reduction, public education and individual dietary counseling. Salt despite the negatives discussed in this report has varied benefit in our bodies including stimulating muscle contraction, retains water in the body, help in digestion and absorption of nutrients. Salt is only dangerous if taken excessively or is also taken in small amount inadequate in the body.

References

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