Why it matters

In most developed countries, and in a growing number of developing ones, the bulk of the dietary salt (70−80%) comes from processed foods or foods eaten outside the home in restaurants and take-away outlet (1). Promoting the reformulation of food so that it contains less salt is essential to reduce population salt intake and should be one of the first actions considered. In order to achieve this, close collaboration with industry is important. Working closely with the food industry to reformulate food products was key to the success of salt reduction programmes in the United Kingdom (2), and significant progress was made when Argentina (3) and Kuwait (4) worked with industry to reduce the salt added to bread. All Member States of the United Nations, through the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, have recognized the need to reformulate food to produce more options that are consistent with a healthy diet (Figure 2) (5).

What needs to be done

Promoting the reformulation of food products involves developing a clear set of criteria or targets for salt levels in foods in order to provide a benchmark for the food industry to achieve. These targets can be met through either voluntary or legislative approaches. The key steps are selecting the target foods, engaging with industry, defining the target sodium levels, setting timelines for meeting the target salt levels, and deciding on the mechanisms of implementation. Monitoring changes in salt content across the food supply maintains pressure on the food industry and shows whether voluntary targets are working and whether mandatory targets need to be enforced. The SHAKE package contains guidance and practical case studies to help countries carry out these key steps. The package also contains examples of additional strategies countries could adopt – such as taxes on highsalt foods, and labelling and communication strategies which can encourage the food industry to reformulate.

UN Doc.

EXCERPT: “(b) Consider producing and promoting more food products consistent with a healthy diet, including by reformulating products to provide healthier options”

United Nations. Political Declaration on the Prevention and Control of Non-communicable Diseases

1. Mattes RD, Donnelly D. Relative contributions of dietary sodium sources. J Am Coll Nutr. 1991;10(4):383-93.

2. He FJ, Brinsden HC, MacGregor GA. Salt reduction in the United Kingdom: a successful experiment in public health. J Hum Hypertens. 2014;28:345−52.

3. Non-communicable diseases in the Americas: building a healthier future. Washington (DC): Pan American Health Organization; 2011.

4. Alhamad N, Almalt E, Alamir N, Subhakaran M. An overview of salt intake reduction efforts in the Gulf Cooperation Council countries. Cardiovasc Diagn Ther. 2015;5(3):172−7.

5. Resolution A/RES/66/2. Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. New York (NY): United Nations; 2012.