In a recent meeting convened by the WHO Regional Office for the Eastern Mediterranean to discuss the regional agenda for noncommunicable diseases, the crucial role of high salt intake was highlighted. This is quite appropriate considering the emphasis of this year’s World Health Day (held April 7th) on hypertension. Among the leading risk factors in the Global Burden of Disease Study 2010, hypertension was the leading cause of overall burden, increasing 27% since 1990. This was no different in this region (defined as Middle East and North Africa in the study). Something needs to be done about this based on a population and social determinants lens.
High salt intake plays an important role in the current rates of hypertension prevalence (exceeding 25% in 11 EMR countries). Among world regions, this region is considered a high consumer of salt. Daily salt intake per person per day ranges from 7.2 g in Lebanon to 19 g in Jordan, well above the maximum recommended by WHO, 5 g.
Why so much salt? Anyone who has spent time in the region understands how the Mediterranean diet consumed in many countries is quite healthy and green. However, a considerable proportion of the foods we consume are too salty. The main sources of salt intake vary nationally and sub-nationally but table salt, bread, cheese, pickles, fast food, and processed food are the main ones. Interestingly, about 30% of the average salt intake comes from bread and dough-based foods. Many favorite national dishes and snacks, such as man’ousheh in Lebanon, are full of salt. And we don’t get the best salt either; only 43% of the salt consumed in the region is iodized while the rest is refined. We know enough to act to reduce salt intake at the population level but there is still a lot missing in our knowledge about salt. Studies of national and sub-national intake figures, based on validated and comparable food questionnaire, and of 24-hour urine sodium excretion are still limited.
The good news is that there is much that can be done about salt. The main promise comes from the “industrial strategy” to reduce salt contents in foods through regulation. And region-wide initiatives are underway. For example, building on discussing in November 2012, each country is supposed to set up salt target in bread by December of this year and start implementation, beginning with at least 10% reduction, in January 2014 before moving on to the next food item in July. Studies from other settings show that consumers don’t usually mind gradual reduction of salt content in popular foods.
This is not to say that food regulation is the only approach. Anticipating industry resistance, broad coalitions including civil society are needed to ensure policies are developed and implemented. Engagement of health professionals is crucial in these coalitions but also to supply credible evidence and raise awareness within a scope of health promotion.
Will governments and various groups including health professionals face up to the challenge? The next months and years will tell.
-Ends-
Samer Jabbour, MD, MPH
Associate Professor of Public Health Practice
American University of Beirut
Tahira Malik says
Food regulation is a much called for approach in countries with that involve high salt content in their daily food intake as is the case in the Middle East and the South East Asia. I think the British model of reduced salt intake is an excellent example for us. Also educating the people through the media is an underestimated source.