SHAKE (2nd edition)
The SHAKE technical package (2nd edition) is WHO’s updated guide to support countries in developing, implementing and monitoring comprehensive, government‑led sodium reduction programmes. It reflects the latest WHO evidence-based guidance, tools and “best buy” interventions for noncommunicable disease prevention.
The updated package provides a structured, step-by-step approach, including governance, stakeholder engagement, policy design and enforcement, alongside a strong emphasis on mandatory measures such as reformulation, labelling, marketing restrictions and fiscal policies.
It is designed primarily for policy-makers and programme managers, supporting the development of effective, context-specific interventions to reduce sodium intake, prevent cardiovascular disease and reduce health-care costs.
The SHAKE acronym reflects the key areas for action to reduce population sodium intake as part of comprehensive, government-led programmes:
- Surveillance: measure and monitor salt intake, sources of sodium in the diet, and policy implementation and impact.
- Harness industry: promote and, where appropriate, regulate the reformulation of foods and meals to contain less salt.
- Adopt standards for labelling and marketing: Implement effective, interpretive labelling and enforce restrictions on the marketing of foods high in salt.
- Knowledge: educate and communicate to empower individuals, support behaviour change, and increase demand for lower salt products.
- Environment: support healthier food environments through polices in public institutions and other settings (e.g. procurement standards and food service policies).
Additional resources
- WHO sodium (GIFNA summary) WHO’s Global database on the Implementation of Food and Nutrition Action (GIFNA) provides country-level data on sodium reduction policies and actions. It supports policy-makers and researchers by tracking progress on key interventions such as reformulation, labelling, public procurement policies and taxation measures to improve food environments and reduce sodium intake.
- Use of lower-sodium salt substitutes: WHO guideline (2025) This WHO guideline provides evidence-informed recommendations on the use of lower-sodium salt substitutes (LSSS) as a strategy to reduce sodium intake. It is intended for policy-makers, programme managers and health professionals to support public health actions that reduce hypertension and other noncommunicable diseases.
- WHO global report on sodium intake reduction (2023) This global report assesses country progress in implementing sodium reduction policies and highlights that most populations consume too much sodium. It provides policy recommendations and identifies priority actions to accelerate progress toward global reduction targets and improve cardiovascular health outcomes.
- Guideline: Sodium intake for adults and children This guideline provides updated global, evidence-informed recommendations on the consumption of sodium to reduce NCDs in most adults and children.
- Global sodium benchmarks for different food categories These benchmarks provide targets for sodium levels across food categories, supporting product reformulation and national policy development to reduce population intake.
Surveillance, monitoring and evaluation
Collecting data is important to inform the intervention, to monitor the extent to which it is being implemented effectively and having the intended effect, and to evaluate the impact of the intervention. It is important to do surveillance before (plan & design), during (monitoring & adaptation) and after (evaluation) program implementation. The figure below shows how the findings from surveillance and monitoring can be used at each stage of a program.
Creating healthy food environments in public institutions and other settings
Creating healthy food environments can lead to improvements in population diets though food supply changes and facilitating individual healthy food choices. Public institutions are an opportunity for creating
Policy action – labelling, marketing restrictions and fiscal policies
Prior to the implementation of nutrition policies such as front-of-pack labelling, marketing restrictions, and fiscal policies, it is important to understand the major sources of sodium in the local diet. The methods and resources for measuring the main contributors
Industry and Reformulation
In most high-income countries, and increasingly in low and middle-income countries, 70-80% of salt consumed comes from processed foods and meals (including meals eaten out of the home and takeaway foods)
Developing Strategies
Salt reduction strategies are much more likely to be effective and sustainable if time and effort is put into developing a strategic approach and ensuring stakeholder commitment. If you are clear about what you are trying to
Consumer Awareness and Behaviour Change
Targeted and sustained communication and behaviour change strategies can be used to empower people to improve their salt intake and diet, create consumer demand for lower salt food products, and improve uptake of