BY: Dunya Tomic, Chief of Editorials and Publications PMSA
High salt consumption is a well-documented major risk factor for hypertension and cardiovascular disease. Salt reduction on a population level is a potentially cost-effective measure that can be taken to reduce the incidence of cardiovascular disease from an upstream perspective (1), and such strategies have been successfully implemented in numerous countries including France and the UK, with their respective populations’ salt intake reducing significantly since implementation of salt-reduction programs (2). The World Health Organisation recommends salt intake of less than 5 grams per day on average in adults, and encourages national intervention as seen in France and the UK (3). Examples of such intervention include negotiation with food industry stakeholders to lower the salt content of foods, targeting consumer behaviour, and using monitoring and evaluation approaches.
It appears, from the limited data available on the issue, that the Pacific Islands have had limited progress in reducing salt intake (4), which is of particular concern considering the high impact of hypertension and cardiovascular disease in the region. To address the literature gap, a recent study surveyed all 22 Pacific Island nations and identified, if any, their salt reduction strategies (5). The study showed that only a small percentage of the Pacific countries had made any progress in this domain. Fiji was the sole country identified as having a thorough intervention program, and even then, only one single worker was specifically tasked to deal with this. With regards to negotiation with the food industry, few of the Pacific countries have their own substantial food manufacturing, with the majority of food in the region being imported. Again, Fiji appeared to have been the only country to demonstrate working with the industry to address the issue, and several Fijian companies had already reported reducing salt in their food products (6). However, other Pacific nations with notable manufacturing sectors, such as Guam, Papua New Guinea and the Solomon Islands, claimed they were unable to make any changes to food composition on a national scale, believing that such change needed to be made on a regional basis.
Overall, the impacts of high salt consumption are well known across the globe, however, although the Pacific Island nations are aware of the significance of the issue, few countries have actually made any substantial steps towards addressing this important factor in the development of cardiovascular disease. The recent study in the area identified lack of capacity as a major factor preventing large-scale action, with most countries having a single person dedicated to all non-communicable disease prevention strategy, encompassing diet, physical activity and alcohol and tobacco consumption. Fiji is the clear leader in terms of progress in salt reduction, and this is largely owing to the health minister’s allocation of resources to a dedicated nutritional program, with liaison between government assistants and the national food and nutrition centre in tackling salt reduction. It is important in the years to come that other Pacific nations follow in the footsteps of the Fijians and specifically allocate their resources to salt reduction, ensuring additional support and manpower is provided to the task. This may be supplemented by regional action, supporting regulatory changes in order to reinforce the benefits of salt reduction across the Pacific so that the whole area can strive to match the global actions on this important contributor to the non-communicable disease epidemic.
Webster J, Dunford E, Chalmers J, Corbett S, Neal B. Cost benefit of salt reduction to complement existing clinical hypertension programs. Hypertension. 2009;55(6):1512.
UK Food Standard Agency. 2008 Dietary Sodium Levels Survey: Available at: http://www.food.gov.uk/science/dietarysurveys/urinary [cited October 9 2018].
World Health Organisation. Reducing salt intake in populations: report of a WHO forum and technical meeting. World Health Organisation, Geneva 2007.
Webster J. Salt reduction in the western Pacific region: strategies for action. WHO background briefing report, 2009.
Christoforou A, Snowdon W, Laesango N, Vatucawaqa S, Lamar D, Alam L et al. Progress on salt reduction in the Pacific Islands: from strategies to action. Heart, Lung and Circulation. 2015;24(5):503-9.
Rawalai L. Reduction in food salt. Fiji Time. Available at: http://www.fijitimes.com/story.aspx?id=244367