Eating less salt saves lives, but many people in the WHO European Region find it difficult to change their diets. On the occasion of Salt Awareness Week 2021, WHO/Europe shares the experience of Dr Joana Ferreira, who is helping her patients in Portugal find healthier alternatives for processed or traditional foods to reduce their salt intake.
Reducing salt in our diets is a vital step in reducing the risk of developing raised blood pressure; associated cardiovascular diseases such as stroke, heart failure and heart disease; and chronic kidney disease.
WHO recommends that we consume less than 5 g of salt per day, yet the average daily salt consumption in the European Region ranges between 8 g and 19 g per day – well above this recommendation. Evidently, more action must be taken to stem the health risks of a high-salt diet.
Health workers can play a critical role by educating patients and raising awareness of the dangers of excessive salt consumption. Clear guidance can empower people to take control and reduce salt in their diets by changing their salt-adding behaviours and choosing less salty foods.
A core priority of the European Programme of Work 2020–2025 – “United Action for Better Health in Europe” is ensuring health and well-being for all at all ages, which is supported by lower salt consumption.
High salt consumption decreases quality of life
Dr Joana Ferreira is a family doctor in Portugal who sees the impact of excessive salt consumption in her patients on a daily basis. “Excessive consumption of salt manifests in patients with high blood pressure (even without a diagnosis of hypertension), headache due to increased blood pressure, electrolyte disturbances, acute or chronic renal failure, and angina pectoris, which naturally decreases quality of life,” she explains.
“The reduction of salt intake is crucial to lowering the incidence of arterial hypertension in the population and, consequently, all associated cardiovascular comorbidities such as stroke, heart failure, coronary heart disease and chronic kidney disease,” adds Dr Ferreira.
Lowering salt intake is recognized as a WHO “best buy”: a cost-effective public health intervention for reducing noncommunicable diseases (NCDs). In 2013, the World Health Assembly established a global target for a 30% reduction in salt intake by 2025, towards the WHO <5 g recommendation. Even a 15% decrease in salt intake would lower blood pressure and prevent up to 8.5 million premature deaths within a decade in low- and middle-income countries.
Health inequity – when the “affordable” food is harmful
Cheaper, processed foods tend to have high salt levels. The “affordable” option can therefore be the most harmful to health. In many countries in the European Region, more than 50% of salt in diets comes from processed foods.
Dr Ferreira works mainly with primary-sector workers in rural areas. She explains how they often opt for certain traditional foods which are also high in salt and fat. “It is very difficult to control or change these established cultural habits,” she says. “Also, due to the scarcity of economic resources, the food patients choose tends to be the cheapest, with patients struggling to find healthier alternatives.”
Salt and the associated health risks are part of a broader pattern of health inequity. Beyond government action on the social determinants of health, a salt-reduction strategy requires a combination of efforts to change consumer behaviours and regulate the food industry. Easy-to-understand nutrition labelling is a key tool to help consumers identify and select foods that are lower in salt.
Health literacy as a policy cornerstone
Health workers can educate patients about the dangers of eating too much salt and which foods contribute to salt intake, and share practical tips to improve their diets. These health literacy interventions can be incorporated into a wider strategy of policy interventions.
“A lot of work needs to be done in the smallest communities, with partnerships between municipalities and primary health care,” says Mr Alberto Silva Cardoso, who was diagnosed with arterial hypertension 2 years ago. As a retired primary school teacher in Portugal, he is aware of the importance of education.
Thanks to initiatives by health professionals in Portugal to counter low awareness of the risks of excess salt intake, the country’s health literacy on salt consumption is improving.
World Salt Awareness Week
WHO/Europe supports World Salt Awareness Week 2021 under the slogan “More Flavour, Less Salt”, encouraging consumers to celebrate home cooking as an opportunity to get creative and eat healthily. Yet, while it is important for individuals to be informed and conscientious about what they consume, the responsibility of a low-salt diet should not rest solely with the consumer.
Action at a national level is required to both educate consumers and work with the food industry to reduce salt levels in commonly available foods. Complementary interventions such as front-of-pack food labelling and taxation measures can further encourage food manufacturers to lower the salt content of food products and meals.
WHO/Europe established the European Salt Action Network to convene countries committed to salt reduction, share experiences and take steps to extend best practices to reduce salt intake in the whole Region.
Reducing salt intake is a priority for the prevention and control of NCDs, which contribute to an estimated 86% of deaths and 77% of disease in the Region. National and local action is required to empower consumers to make healthy choices, and to make the healthy choice the easy choice.
