According to the European Commission’s Directorate General for Health and Consumers (DG Sanco), the average salt intake in European countries ranges from 8 g to 12 g per day – much higher than the World Health Organisation (WHO) recommendation of 5 grams per day. But while some countries started working with industry and consumer awareness campaigns much earlier, the European Union Framework on voluntary national salt initiatives was only set in motion five years ago.
Today, 29 European countries – all EU Member States, plus Norway and Switzerland – have salt reduction initiatives in place, and these tend to focus on three main areas: Consumer awareness, labelling, and reformulation. The consensus among public health advocates is that a combination of these elements is likely to yield the best results.
Industry participation has remained voluntary, but some countries have put more pressure on industry to reduce salt content in processed foods than others – Portugal, for instance, has legislated to set maximum salt limits in bread.
It is estimated that some 75% of salt intake comes from processed foods, with bread, processed meat and cheese among the top contributors.
Wealth and health
According to the WHO, reformulation of processed foods has been more widely accepted in western European countries than elsewhere in the region – especially those with the greatest wealth – although there are exceptions.
The WHO highlights Turkey as one such example. It has the highest measured average salt intake of any country in the region, at 18 g per day, but over the past few years it has set in motion a consumer awareness campaign, as well as plans for a high-, medium- and low-salt logos, and is collaborating with the National Association of Bakers to establish a reformulation process.
Meanwhile, a major bread supplier, the People’s Bread Factory, has committed to reducing salt to less than 1.4% in its bread.
The UK has the most mature salt reduction programme in the region, with talks on reformulation dating back to 1996. Indeed, World Action on Salt and Health (WASH) says that the UK now has the lowest salt intake of any developed country in the world and salt intakes have fallen in adults from an average of 9.5g a day in 2005 to the current 8.1g a day.
WASH has urged other countries to follow the UK’s lead in the “rigorous setting of voluntary targets to be achieved by the food industry”.
As for what’s next, the WHO has recommended that national salt reduction initiatives should target the whole environment – including greater engagement with industry – to facilitate population-wide salt reduction. It has also said that national monitoring of salt consumption and salt content in the food supply in each European country will help identify missed opportunities for action.
However, even if a country has effective reformulation, labelling and awareness policies in place, trade in high-salt foods can scupper these efforts. Germany, for example, imports large quantities of bread from countries without salt reduction policies.
Therefore, the WHO says that trade flow – currently not included in any European salt reduction strategies – may be another item on the agenda for future policymaking.
Finally, policy cannot work if it asks more than is technically feasible. Leatherhead Food Research has said that no simple solution exists for some difficult food categories, and it may be some time before total solutions for low-salt formulations are commercially available.