Salt watch: shaking up public health

With new data available on baseline salt intake levels, Discovery Vitality, industry experts and stakeholders, government and professional bodies recently met in Cape Town to discuss progress, challenges and the way forward to develop a roadmap for reducing salt consumption in South Africa.

“South Africa is at centre stage on salt reduction legislation,” said Dr Jacqui Webster, Director of the World Health Organization (WHO) Collaborating Centre on Population Salt Reduction at The George Institute for Global Health, at the consultation meeting on Friday, 2 September 2016.

“Salt reduction is working,” she said, “but it does require strong government support and leadership, as well as robust monitoring.”

Between one and ten studies about salt are published every week, and 95% support the need to reduce dietary salt.

How people use salt

Most South Africans have between 6 and 11g of salt a day, far more than the WHO recommendation of 5g a day.

A salt behaviour study done by public health nutrition expert, Karen Charlton, formerly of the University of Cape Town, now resident at the University of Wollongong, Australia found the following:

• 60% of people in the study group always or often add salt in cooking
• 22% add more at the table
• Only 7% said they consume too much salt
• 65% eat more salt than the WHO recommends

Candice Smith, Head of Vitality’s nutrition strategy, says eating patterns with a high salt content increase blood pressure and are linked to cardiovascular disease and stroke. “Reducing salt intake by 2 grams a day could reduce cardiovascular events by 20%. Reducing salt intake at a population level to the recommended 5 grams (one teaspoon) a day can help reduce the pressure on the health system and have large, positive public health effects”, she says.

Around the world

Owing to its importance for public health, many countries have programmes to get the food industry to reformulate foods – 36 have targets for salt levels in food, but only nine have mandatory legislation.

South Africa is first country in the world to regulate salt levels in a wide range of processed foods (tabled in June 2016). While many manufacturers say their production lines are already compliant, the exact levels of salt in these products are yet to be analysed.

The way forward

Multifaceted interventions with comprehensive targets, government-led education, ongoing monitoring and labelling seem to be the most successful.

Professor Charlton said: “We can’t rely on one strategy or the other; we need reforms in the food industry, and mass education aimed at consumers.”

The WHO’s ‘SHAKE’ salt-reduction strategies include:

• Surveillance: analyse, measure and assess current diets and food salt content
• Harness the industry: reforms at food preparation stage
• Adopt standards for labelling and marketing
• Knowledge: education and communication about salt reduction
• Environment: supportive settings, schools and hospitals to promote healthy eating

The goal is to reduce salt intake by 30% by 2025. For this to happen, in addition to industry regulations, consumers need the right information and tools to make healthy choices.

Vitality’s guidelines on salt reduction

Vitality’s food guidelines take a total approach and encourage choosing a variety of foods to make sure salt intake is within acceptable levels. This means eating whole foods that are minimally processed; high in fibre, micronutrients and good energy; and low in added salt, certain fats and sugar. A wealth of advice is available on the Discovery Vitality website, and includes:

• Eating fruit and vegetables daily
• Not adding extra salt
• Cutting back on sugar
• Eating more healthier proteins
• Including dairy for strong bones and muscles
• Understanding fats
• Replacing refined carbs with whole grains
• Eating more legumes

In partnership with Woolworths and Prue Leith Chefs Academy, Discovery Vitality launched the HealthyFood Studio. The HealthyFood Studio aims to combat the subsequent long-term health damage caused by poor diet by putting the fun back into the kitchen so that individuals and families experience the pleasure of creating meals and making healthier food choices in the process.