Meeting the 2025 salt and raised blood pressure reduction targets

Transcription

1 Meeting the 2025 salt and raised blood pressure reduction targets Dr Timothy Armstrong Coordinator Department of Prevention of Noncommunicable Diseases

2 Leading risk factors for global mortality Source: WHO's report on "Global health risks" 60% of global deaths due to NCDs

3 High blood pressure continues to go up % of population 40% 30% 20% 10% High-income countries Upper Middle-income countries Lower middle-income countries Low-income countries Raised blood pressure (2008) Source: WHO NCD Country Profiles (2010)

4 Strong evidence for the link between salt and health Primarily linked with CVD Sodium consumption increases BP BP increases CVD risk Age, sex and baseline BP specific effects Source: He et al. J Human Hypertension, 2008

5 Burden of High Blood Pressure in SEAR One out of three adults have hypertension Three out of four adults with hypertension do not have their blood pressure under control

6 Prevalence of high blood pressure South-East Asia Region, 2008 Prevalence (%) of High BP Females Males 0 Bhutan India Indonesia Myanmar Sri Lanka Thailand Systolic BP 140 or diastolic BP 90 or on medication Source: WHO Global Status Report on Noncommunicable Diseases, 2010; prevalence rate adjusted for 2008 based on country reported risk factor surveillance data

7 Percentage of Hypertensive Population with Blood Pressure (BP) Under Control, Selected States of India, % with BP under control Only 21% of hypertensives have their BP under control 0 Madhya Pradesh Uttarakhand Mizoram Maharashtra Tamil Nadu Andhra Pradesh Kerala Definition: Numerator=All individuals who were taking treatment AND had BP<140/90; Denominator=Individuals with BP reading 140/90 during the survey or on treatment. Source: Noncommunicable disease risk factor survey, , Phase I States, Government of India

8 New Delhi Declaration on High blood pressure signed by SEAR Health Ministers in 2013

9 Population intake of salt in Member Countries of South-East Asia Number of attributable deaths (000's) recommende d level 0 Dhaka, 2012 Ladakh, 1988 Delhi, 1988 Nepal, 1993 Sri Lanka, 2012 Thailand, 2009 Source: Global Health Risks, 2009, WHO

10 WHO Guidelines on Sodium Consumption for the General Population WHO recommends a reduction in sodium intake to reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults. WHO recommends a reduction to less than 2g/day (5g/day salt) in adults. WHO recommends a reduction in sodium intake to control blood pressure in children. The recommended maximum level of intake of 2g/day in adults should be adjusted downward based on the relative energy requirements of children when consuming less energy than adults. "Adults" includes individuals 16 years and older and "Children" includes individuals 2-15 years inclusive.

11 ..and it is a Best Buy

12 Successful Intervention programs Salt intake in Finland h urine, men 24h urine, women NaCl g/d Source: National Public Health Institute, Helsinki, Finland

13 Successful Intervention Programs United Kingdom Work on 2 main areas: 1. Reformulation through working with all sectors of the food industry 2. Ongoing public awareness campaign * UK now has the lowest salt intake of any developed country in the world * In 2012 salt intakes have fallen in adults from 9.5g to 8.1 g per day since 2005, approximately 1.5g per person, per day, and saving approximately 8,500 lives every year * Success of UK salt reduction is thanks to rigorous setting of voluntary salt targets to be achieved by the food industry Source: Ministry of Health, United Kingdom

14 Examples of Targets - South Africa Bread Food Category All breakfast cereals and porridges All fat spreads and butter spreads Ready to eat savoury snacks Flavoured potato crisps, excluding salt-and-vinegar flavoured Salt-and-vinegar flavoured Max sodium per 100g food 400mg Na 380mg Na 500mg Na 400mg Na 550mg Na 450mg Na 800mg Na 700 mg Na 650mg Na 550 mg Na 1000mg Na 850mg Na Date on which target becomes effective 30 June June June June June June June June June June June June 2019

15 Population Salt Reduction Strategies WHAT 1 Creating enabling Environment 2 Evaluation and monitoring 3 Salt: vehicle for fortification HOW Consumer education Product Reformulation Sodium consumption Food Composition Data Iodine fortification Reduction of salt intake OUTCOME Practical approaches for: - Implementing an education & public awareness campaign - Engaging food and meal producers and distributors Framework for effective: - Monitoring sodium intakes - Monitoring sources of sodium - Monitoring consumer knowledge and behaviour Making the salt and iodine strategies work together & identifying alternative vehicles for iodization

16 Examples from the Pacific Fiji is implementing a campaign to raise awareness and provide practical tools to help reduce salt intake. Elements of the campaign include cooking demonstration to mothers and at schools; TV and radio ads; radio talk shows and advocacy with the food industry for voluntary reduction in salt in their respective products. Vanuatu has started their build-up using radio talk shows and community awareness, through posters and brochures. Solomon Islands began their salt reduction campaign in 2014

17 China Replacing sodium chloride with a potassium chloride mix 30/70. This mix is being sold at the same price as salt and within months they have seen reductions in Blood Pressure. Salt spoon initiative for families to regulate how much salt they use in the house each day reductions in sodium intake and blood pressure seen in rural communities using the spoon.

18 Salt reduction and iodine fortification strategies in public health Both programs aim to improve public health through a population wide approach i.e. Salt as a vehicle vs. salt as a risk factor Policies for salt iodization and reduction of salt to <5g/day are compatible, cost effective and of great public health benefit WHO and UNICEF will lead the development and coordination of a joint programme of work, with ICCIDD and WHO-CC as technical experts. The current recommendation that salt be fortified with iodine at a level of 20-40ppm is based on the assumption of an average salt intake of 10g/day at the population level. The level of iodine fortification needs to be adjusted by national authorities in light of their own data regarding salt intake The iodine concentration in salt should be determined considering both the level of salt consumption and median UI of population.

19 Main areas of complementarity at global, regional and national levels Policy development and implementation Coordinated strategies and programmes of work Close collaboration and exchange of experience Shared forums with relevant sectors of the food industry Monitoring and evaluation Shared surveillance of salt and iodine intake Coordinated evaluations of programmes Communication and advocacy Shared coordinated strategies, avoiding conflicting messages Research

20 Development of Population Salt Reduction Strategies African Initiative Salt Observatory of the Americas Eastern Mediterranean Initiative European Salt Action Network South East Asia Initiative Western Pacific Initiative Regional Meeting June 2012 PAHO Salt Expert Group Meeting January 2013 TAG Meeting April th European Network May 2013 Regional Meeting December st Preparatory Meeting June 2010

21 S A LT urveillance, evaluation & monitoring wareness abeling, legislation and industry commitments ackling fortification Toolkit

22 Population salt reduction strategy pathway Conduct consumer knowledge awareness campaign on salt & hypertension Evaluate consumer knowledge & behaviours Determine reduction required to reach 2025 National Target Monitor Progress over time YES YES Are the sources of sodium in the diet known? Is the amount of sodium consumed by the population known? NO Conduct salt intake analysis NO Re-analyze recent Food Consumption Survey Are the main sources coming from processed foods or added salt? Conduct Food Consumption Survey or re-analyze recent one Conduct consumer education campaign on ways to ass less salt in diet Evaluate behaviour change Set reformulation targets with private sector Main sources are processed foods Conduct consumer education campaign on how to identify lower salt foods Legislate that salt/sodium be included in all product nutrition labels Conduct training for catering industry on using lower salt options in menus Review institutional settings menus & reformulate to lower salt content Main source is added salt Negotiate with private sector on use of salt alternatives Monitor sales of salt and salt alternatives Monitor reformulation & ensure availability & affordability is universal Evaluate campaign on its objectives and adjust accordingly Monitor compliance by private sector to legislation Monitor reformulation of restaurant menus Monitor reformulated menus S A L T Toolkit Chapter 1 Chapter 2 Chapter 3 Chapter 3

23 Thank you