By Davis Buyondo
Kampala-Uganda
Agatha Namuli, 45, is a cook at a local restaurant in Kampala, Uganda’s administrative and commercial capital. She prepares a variety of dishes for her customers using about 100 grams of salt every day as one of the most essential ingredients.
This includes table salt which customers add to their food to get a better taste. “Due to the health risks, we urge our customers to reduce their salt intake, but some of them find this advice quite insulting and disrespectful,” she recounts.
While salt continues to be a necessary nutrient for the body and a key flavour enhancer in cooking, the World Health Organization (WHO) points out that its excessive consumption raises the risk of heart disease, stroke, and premature deaths.
According to WHO’s 2023 Global Report On Sodium Intake Reduction, the global effort to reduce salt (Sodium chloride) consumption by at least 30% in 2025 is not advancing as planned. The report also states clearly that sodium is mostly obtained from table salt.
“Only 5% of WHO Member States have mandatory and comprehensive salt reduction policies yet 73% of WHO Member States do not fully implement these policies,” the report states.
Presently, only nine countries including Chile, Czech Republic, Lithuania, Malaysia, Mexico, Saudi Arabia, Spain, and Uruguay have an extensive set of recommended policies aimed at lowering sodium intake.
However, implementing highly cost-effective salt reduction policies might prevent the deaths of an estimated seven million people globally by 2030, according to the report.
The organisation further reaffirms the need for the world to achieve the Sustainable Development Goal of reducing deaths from non-communicable diseases.
“Unhealthy diets are a leading cause of death and disease globally, and excessive sodium intake is one of the main culprits,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
According to Tedros, most countries have not adopted mandatory sodium reduction policies, leaving their people at risk of heart attack, stroke, and other health problems.
“WHO therefore calls on all countries to implement the ‘Best Buys’ for sodium reduction, and the manufacturers to implement the WHO benchmarks for sodium content in food,” says the director-general.
Adopting mandatory policies is a component of a comprehensive salt reduction strategy according to the orgnisation. In addition, WHO’s four “best buy” interventions related to sodium can greatly contribute to preventing non-communicable diseases.
These include; (1) Reformulating foods to contain less salt, and setting targets for the amount of sodium in foods and meals (2) Establishing public food procurement policies to limit salt or sodium-rich foods in public institutions such as hospitals, schools, workplaces and nursing homes (3) Front-of-package labelling that helps consumers select products lower in sodium and (4) Behaviour change communication and mass media campaigns to reduce salt/sodium consumption.
Countries are, therefore, encouraged to establish sodium content targets for processed foods, in line with the WHO Global Sodium Benchmarks and enforce them through these policies.
Mandatory salt/sodium reduction programmes are more effective because they achieve wider coverage, protect against commercial interests and give equal opportunities to food manufacturers.
As part of the report, WHO created a sodium country scorecard for Member States based on the types and numbers of sodium reduction strategies they have in place.
To achieve the worldwide goal of reducing salt consumption by 2025, governments must act quickly to put ambitious, obligatory, government-led sodium reduction policies into place, according to Dr. Tom Frieden, President and Chief Executive Officer of Resolve to Save Lives, a non-profit organisation.
The organisation draws its reputation from collaborating with several countries globally with the goal of preventing epidemics and saving 100 million people from cardiovascular diseases.
“There are proven measures that governments can implement and important innovations, such as low sodium salts. The world needs action, and now, or many more people will experience disabling or deadly—but preventable—heart attacks and strokes,” says Frieden.
While WHO recommends less than 5 grams of salt per day (one teaspoon), the global average salt intake is estimated to be 10.8 grams per day, more than double the recommended quantity. Therefore, the main risk factor for food and nutrition-related deaths is eating too much salt.
WHO further observed that despite this, there is growing evidence demonstrating linkages between high sodium intake and a higher risk of various health conditions such as kidney disease, osteoporosis (fractures), stomach cancer, and obesity.
“Member States should implement sodium intake reduction policies without delay and to mitigate the harmful effects of excessive salt consumption. Still, food manufacturers should set ambitious sodium reduction targets in their products,” WHO appeals.
Benchmarks For Reducing Salt Intake
Benchmarks are simply standard or reference points that can be used to compare one thing to another.
In May 2021, WHO released a set of global benchmarks for sodium levels in more than 60 food categories that would help countries reduce sodium content in foods to improve diets and save lives.
These international standards supplement existing national and local initiatives to establish salt/sodium objectives. Global sodium benchmarks are meant to aid countries in developing their own national policies and strategies along with the ongoing discussions between the WHO and the corporate sector on a global scale.
It is, however, perplexing that similar processed food products frequently have varying salt contents in different countries.
To move towards the WHO target of a 30% decrease in global salt/sodium intake by 2025, the guidelines encourage the industry to reduce the sodium level in processed foods in accordance with how countries can gradually scale back their goals based on their local food environments.
“Most people don’t know how much sodium they consume, or the risks it poses,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General at the launch of the guidelines, adding that countries need to establish policies to reduce salt intake and provide people with the relevant information that can help them make the right food choices.
Uganda
Like many other African countries, Uganda is fighting to persuade its citizens to eat less salt in order to cut down on the number of sodium-related deaths.
And reducing the consumption of salt and sodium is one of the major targets that the Uganda Nutrition Action Plan II 2019–2025 seeks to achieve by 2025.
Other targets include a 40% reduction in the number of children under-5 who are stunted, a 50% reduction of anaemia in women of reproductive age, and a 30% reduction in low birth weight as well as reducing and maintaining childhood overweight to less than 3%.
The campaign managed under the Ministry of Health further looks at achieving an increase in the rate of exclusive breastfeeding in the first six months up to at least 70%, a 25% relative reduction in the prevalence of raised blood pressure, a 10% reduction in the prevalence of insufficient physical activity in addition to lessen the prevalence of obesity and diabetes among others.
However, Uganda is taking a multi-pronged approach to reducing sodium intake. The country is trying to implement mandatory labelling of packaged foods with nutrition information, including sodium content. This enables consumers to make informed choices about the sodium content of the foods they purchase.
In addition, different public awareness campaigns have been launched to raise educate the masses about the health risks associated with high sodium intake. These campaigns aim to educate consumers about the importance of reducing sodium intake and the types of foods that are high in sodium.
Still, the Ministry of Health is collaborating with the food industry to reduce the amount of sodium in processed foods.
With this, the industry has been encouraged to reformulate its products to reduce the amount of sodium added during production. Still, there are regulations in place to limit the amount of sodium in certain food products, such as bread and margarine.
In addition, Uganda is promoting traditional foods, which tend to be low in sodium, as a way to reduce sodium intake. This includes encouraging the consumption of whole grains, fruits, and vegetables.
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