By Dr. Gyan Pathak
Despite commitments made to reduce the hazardous level of common salt, also called table salt, chemical name Sodium Chloride (NaCl), intake leading to increased health risks of heart diseases, stroke, and premature deaths, India has only a provision of mandatory declaration of sodium on pre-packaged food but no other mandatory measures in place, and therefore remains in score 2 in a first-of-its-kind WHO global report.
Score 2 for India means the county is at the second lowest level of performance in Sodium country score. Score 1 is the worst level. Score 4 is the highest level of policy implementation and the Score 3 is the second highest level of progress. Such a low score is a serious matter of concern for the country in view of its being the largest populated country in the world with about 1.42 billion population.
Moreover, the food habit of its people consuming food preparations with very high quantity of salt in them is another source of concern. The average salt intake in India is 9.8 gram per day which is almost double the WHO recommendation of less than 5 g/d ie one teaspoon daily. The global average intake is estimated to be 10.8 gram per day.
On government level there is no serious concern is shown despite increasing number of deaths by heart, kidney and other diseases in the country. There are little public campaigns to inform the people of the dangers of taking large quantity of salt in their food items, and no mandatory provisions to control the level of salt in the foods sold or purchased from the market. People are being fed high quantity of salt even in hospital supplies, what to talk about other events orgainised by even the Ministry of Health or the governments apart from the private celebrations and in hotels.
The first-of-its-kind report titled “WHO Global Report on Sodium Intake Reduction” warns that implementing sodium reduction policies could save an estimated 7 million lives globally by 2030. However, the sodium intake reduction shows that the world is off-track to achieve its global target of reducing sodium intake by 30 per cent, by 2025.
Sodium reduction plays a key role in protecting populations from the burden of noncommunicable diseases, namely, cardiovascular disease which is the number one cause of death and disability globally. The evidence is clear: the more sodium we consume the more our blood pressure rises, and blood pressure is reduced when dietary sodium intake is reduced. Reducing sodium intake is one of the most cost-effective ways to improve health, as it can avert millions of deaths every year at very low total programme costs.
On average, we consume over 4 mg sodium every day, which is double the amount recommended by WHO. In 2013 all 194 WHO Member States committed to reducing population sodium intake by 30% by the year 2025. Since then, progress has been slow and only a few countries have been able to reduce population sodium intake, but no one has been able to achieve the target. As such, it is being considered to extend the target to 2030.
“We can reduce sodium intake by deciding to add less salt to the food we prepare and by deciding to buy foods that contain less sodium. People’s behaviour change is important, and mass media campaigns to alter consumer behaviour around sodium are needed. However, several public policies need to make this choice an easier one. Food manufacturers need to reduce sodium content in food products; products with high sodium content need to be easy to identify through front-of-pack labelling; meals offered in public institutions such as schools, hospitals, and public offices should contain less sodium. If the WHO recommended policies were implemented, we would see sodium consumption reduced by over 20%, getting close to the target set in 2013, “ Dr Francesco Branca, Director, Department of Nutrition for Health and Development WHO has said.
In many high-income countries, and increasingly in low- and middle-income countries, a significant proportion of sodium intake can be attributed to processed food. In 2022WHO developed benchmarks for sodium content in 18 food categories and called on food operators to implement them globally. The benchmarks are based on real life experiences, so that their implementation is safe and technologically feasible. Some of the large food manufacturers have committed to make steps to achieve those benchmarks, but again bolder action and engagement from more actors is needed to see measurable public health impact, Dr Branca said.
All 194 WHO member countries have committed to reducing salt as life-saving strategy, but the report reveals the progress is very slow. It is despite the fact that WHO have long been emphasising on the fact that the global burden of unhealthy diets constitutes a major public health and development challenge, and the greatest concern is excess consumption of sodium, sugar and unhealthy fats, particularly trans-fatty acids (trans fats) and saturated fatty acids, and low consumption of whole grains, pulses, vegetables, and fruits.
The largest number of diet-related deaths, an estimated 1.89 million each year, is associated with excessive intake of sodium, a well-established cause of raised blood pressure and increased risk of cardiovascular disease.
As of October 2022, 5% of Member States (n = 9) have implemented at least two mandatory sodium reduction policies and other measures, and all WHO sodium-related best buys for tackling noncommunicable diseases. A further 22%of Member States (n = 43) have implemented at least one mandatory policy or measure. At the same time, 33% of the remaining Member States (n = 64) have implemented at least one voluntary policy and other measures to reduce sodium intake, while 29% (n = 56) have made a policy commitment towards sodium reduction.
Modelling indicates the estimated potential impact of policy implementation on sodium intake to be a 23% reduction, and on cardiovascular death a 3% reduction, globally, by 2030. (IPA Service)