Strong Public Health Leader Needed in Salt Reduction Effort


Momentum is building for a major salt reduction campaign to improve public health in America. Advocates for this campaign argue that decreasing salt consumption would limit the obesity epidemic, stem the rise in hypertension and heart attacks, and save significant health care costs. These proponents include the Institute of Medicine (IOM) and their recent report has caught the attention of policy-makers in Washington D.C. Should Americans rely on government to regulate national food sodium levels? Not necessarily. Other groups could take the lead and improve public health by cutting American salt intake, yet any group striving to make this change would need to rally a diverse set of players resistant to removing salt from plates in the US.

As Sarah pointed out in a recent Justmeans editorial post, the IOM released an influential report in April called, "Strategies to Reduce Sodium Intake in the United States." Congress commissioned this report and asked the IOM to develop strategies for reducing daily sodium intake below 2300 mg. This request was motivated by recent research showing that the potential benefits of reducing salt consumption are significant. A 2009 RAND study found that slight decreases in dietary salt would save upwards of $18 billion in health care costs. To achieve this savings the IOM recommended government intervention. Among other findings, the report called for bestowing responsibility upon the FDA to regulate salt content of packaged foods. (Check out the article "IOM Recommends Federal Regulation Over the Salt Content of Certain Foods" by Mike Mitka in last week's edition of JAMA for more details).

Despite the influence of the IOM many still wonder, is a government intervention the only way? Some persuasive evidence suggests otherwise. In the UK for example, salt reduction efforts started with food industry players. Many grocers now label foods with a "traffic light" system on the front of packages to indicate relative healthiness. Some researchers think this approach might successfully improve public health in the US. A recent Stanford University study argued that over $30 billion in medical costs might be saved by an food industry-led intervention.

The choice to save $30 billion and improve public health seems like an easy one, yet convincing industry players to cut salt is a difficult task. Even if grocers in the US adopted traffic lights on packaged foods others would pose barriers to a low-salt American diet. Restaurants are an example. A dish at the corner diner usually contains more salt than the same recipe prepared at home. This saltiness is part of the reason restaurant food tastes better and restauranteurs do not want to lose this appeal. Further, consumers themselves might resist salt changes. Michael Pollan writes frequently about consumers' struggles to avoid high-salt foods since our brains have evolved to enjoy and even crave this substance. And, as Peter Smith at GOOD points out, consumers are trained to reject foods labeled "low sodium" or "reduced salt." Despite the promise of a large public health payout, these groups would resist cuts in salt. An influential entity is needed to motivate their participation in any salt reduction campaign.

The FDA is likely to be this influential entity. Federal regulators will force food distributors, fresh food preparers, and food eaters to work together and reduce salt consumption by changing laws and overseeing industries. Yet it is not too late for another group to step in. If another group can find a way to extract value from that $30 billion in savings they would not only make a hefty profit but also make a significant contribution to public health in America.

Do you have other ideas about how to regulate salt intake in the US? Do you have experience with the UK's front-of-package, stoplight system? What do you think about the efforts of Justmeans-affiliated companies to reduce salt intake (including Campbell's, Sodexo, and Kraft)? Add your comments below.

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