Review ArticleCurrent salt reduction policies across gradients of inequality-adjusted human development in the WHO European region: minding the gaps

Abstract

Objective: To assess current salty reduction policies in countries of the WHO European Region against the backdrop of varying levels of human development adjusted for income, education and health (longevity) inequalities. Design: Population-based, cross-sectional study, with data gathered through systematic review of relevant databases and supplementary information provided by WHO Nutrition Counterparts. Setting: Member States of the WHO European Region. Subjects: Inequality-adjusted Human Development Index scores were analysed against assessed levels of development and implementation of national nutrition policies and initiatives targeting population-level salt reduction. Results: Within the WHO European Region, Inequality-adjusted Human Development Index values among countries with no existing salt reduction initiatives (mean 0?643 (SE 0?022)) were significantly lower than among those with either partially implemented/planned salt initiatives (mean 0?766 (SE 0?017), P , 0?001) or fully implemented salt initiatives (mean 0?780 (SE 0?021), P , 0?001). Conclusions: Where salt reduction strategies are implemented as an integral part of national policy, outcomes have been promising. However, low-and middle-income countries may face severe resource constraints that keep them from emulating more comprehensive strategies pursued in high-income countries. Care must be taken to ensure that gaps are not inadvertently widened by monitoring differential policy impacts of salt policies, particularly regarding trade flows.

Socioeconomic inequality in salt intake in Britain 10 years after a national salt reduction programme

“…A behavioural approach to healthy eating is unlikely to bring about the changes necessary to halt and reverse the non-communicable diseases epidemic and it may widen inequalities 11 32 54. SES inequalities in dietary access and consumption of healthy foods are widely documented28 both within countries3 and between countries,55 and for salt intake are detectable in children56 as well as adults 35. Australian children from a low SES have on average 9% greater intake of salt from food sources compared to those from a high SES 56.…”

Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network

“…Compared to the overall original cohort, the sodium cohort had fewer participants from India (5 vs 18%) and more from China (42% v 30%), with unbalanced distribution across sodium groups (Table 4). The potential confounding by socioeconomic status between countries [30] and within country [31e33] is an important risk when assessing the relationship between sodium consumption and illhealth. Given the study design in PURE and the lack of sufficient adjustments for socio-economic indicators, the lack of adequate adjustment for socio-economic status is a serious problem in PURE.…”

Sodium intake and its reduction by food reformulation in the European Union — A review

“…Strategies adopted to date by these nations include increased taxation of foods high in sodium, mandatory labeling of sodium content, and regulation of nutrition-related health claims [110,111]. An obligatory food reformulation program has demonstrated more success in practice and in models of potential intervention outcomes indicating that legislation is likely to be more effective than a voluntary approach [112][113][114].…”