A public health awareness campaign will also form part of the South African authorities’ campaign to meet the objectives.
The South African diet is generally high in salt content, with an average intake of of 8-10g per day.
Dr Aaron Motsoaledi, Minister of Health for South Africa, said that the government could allow salt reduction to be done through self-regulation by the industry, but he estimated it would be more effective to control the amounts of salt acceptable in different foods. He was speaking at a summit on the prevention and control of non-communicable diseases (NCD) in Johannesburg last week.
"Contrary to many people's belief, most salt intake is in processed food rather than added to it. This means that we need a combination of public education to encourage people to reduce the salt they add, but also [need] to regulate the food industry,” he added.
Professor Graham Macgregor, chairman of World Action on Salt and Health (WASH) reacted positively to the South African declaration:
“Salt reduction is the simplest and most cost effective measure to reduce NCDs.
"Developing countries need to take the lead from South Africa and set their own targets including salt reduction at the NCD summit in New York in order to prevent millions of deaths from strokes, and heart disease every year.”
Excess intake of dietary sodium is strongly linked to hypertension, a risk factor for the development of cardiovascular disease and stroke. Whilst there is also evidence suggesting that high sodium intake is linked to gastric cancer, decreased bone density, and higher rates of obesity.
In recent years, these health concerns have led to food industries globally investing heavily in salt reduction.
A review in the Journal of Hypertension provides an overview of salt reduction initiatives from around the world, describing the core characteristics of each strategy to develop a framework for future initiatives.
The authors, led by Jacqui Webster from the George Institute for Global Health, at the University of Sydney, Australia, found that both mandatory and voluntary programmes appear to have potential provided that there are clear mechanisms for monitoring and penalties for noncompliance.
“It is now widely accepted that reducing salt consumption will lead to lower blood pressure levels resulting in significant health benefits, and centrally implemented national salt reduction strategies are projected to be highly cost-effective in the prevention of non-communicable diseases,” said Webster and her team.
The authors, who published their review in May this year, identified 32 salt reduction initiatives globally, 19 in Europe, 6 in the Americas and 7 in the Western Pacific Region. They noted no salt reduction strategies identified in Africa.
Webster and co-workers noted that most strategies “are led by government organizations, involve industry-led food reformulation of food, have clear daily intake targets, and have strong communication strategies designed to change consumer behaviour.” They added that advocacy organizations have also played a key role in some reduction initiatives, most notably in the UK (CASH) and Australia (AWASH).
The reviewers noted that of the 32 schemes identified, 28 involved working with the food industry to reduce salt in foods, whilst 10 had front-of-pack labelling schemes.
Voluntary programme hailed in UK
The authors reported that the UK “provides a good example of how voluntary programmes can function,” whilst claiming that good examples of ‘effective legislation’ are those for bread in Portugal, “and the requirement for high salt warnings on salty foods in Finland.”
Many initiatives have industry reformulation of processed and catered foods at the core of their salt reduction efforts, said Webster and colleagues.
Webster and co-workers said that with processed and catered foods contributing to between 75 and 80 per cent of salt in the diet in developed countries, targets to reduce sodium levels in these foods represents a key component of any reduction strategy.
However, the authors said that providing low salt alternates, without category-wide reductions in salt content “is not acceptable since such products are typically very different in taste, will not be purchased by consumers and will be rapidly discontinued by manufacturers and retailers.”