Mary-Anne Land and Terry Slevin – PHAA
This week it is national stroke week in Australia.
There is unequivocal evidence that excess sodium intake leads to raised blood pressure and that raised blood pressure results in increased risks of cardiovascular diseases, including stroke. The totality of the evidence also indicates that decreasing dietary sodium intake will reduce these risks. It is projected that lowering sodium intake from the estimated global average of 3950 mg/day to the World Health Organization (WHO) recommended maximum of 2000mg/day would avert at least three million premature deaths each year and possibly many more. Consequently, policies to reduce population sodium intake have been identified as an action that should be undertaken immediately to produce accelerated results in terms of lives saved, disease prevented, and costs avoided.
Such policies include voluntary or mandatory legislative measures that reduce sodium in the food supply or encourage consumers to make healthier food choices about sodium.
WHO now monitors countries’ progress in implementing policies and measures to reduce sodium intake through the WHO Global database on the Implementation of Nutrition Action (GINA) and has developed the Sodium Score Card to track countries’ performance on a continuous basis.
- Score 1 – have made a national policy commitment towards sodium reduction
- Score 2 – have implemented voluntary approaches to reduce sodium in the food supply or encouraged consumers to make healthier food choices
- Score 3 – have implemented mandatory declaration of sodium on pre-packaged food and implemented at least one mandatory measure for sodium reduction
- Score 4 – have implemented mandatory declaration of sodium on pre-packaged food and implemented multiple mandatory measures for sodium reduction as well as all the sodium-related WHO ‘best buys’ for tackling noncommunicable diseases
- Measures adopted but not yet in effect – have adopted mandatory measures for sodium reduction that will bring the country to Score 3 or 4, but where not all have yet gone into effect
As at August 2021, mandatory measures to reduce sodium in the food supply or encourage consumers to make healthier food choices are currently in effect for 45 countries. Of these, two countries have multiple mandatory measures, including mandatory declaration of sodium on pre-packaged food, and all related WHO ‘best buys’ for tackling noncommunicable diseases. Another two countries have adopted similar measures that will go into effect in 2022. A total of 51 countries have voluntary measures to reduce sodium in place and 67 countries have a national policy commitment in place that expresses a commitment to reduce sodium intake.
Almost 1.8 billion people are protected by mandatory measures towards sodium reduction, but not Australians. Australia is allocated a score of 2, as only voluntary policies and measures are implemented.
The current average daily sodium intake in Australia is estimated to be approximately 3850mg/day. If sodium intake was reduced by just 400mg/day across Australia, the number of saved lives each year is estimated to be 1,364, with an estimated 2,626 strokes and coronary heart disease events avoided.
Evidence shows, to achieve population sodium reduction implementation of multi-component policies is required. Despite some interest to act on sodium reduction, there is still a long way to go to fully implement WHO recommended best-practice policies in Australia.
With this relatively poor outcome for Australia by way of international comparison, a question stands – what is the way forward? The only current option that seems to be on the table is through the “Health Food Partnership”. As an entirely voluntary initiative with a predominance of food industry influence, and despite the efforts of the minority at the table providing a health perspective, it has given no encouragement to expect meaningful progress.
Minimum standards and regulation seems a more likely path to reducing sodium in the Australian food supply.