When Sione was taken to Vaiola Hospital in Tonga, the victim of a stroke, his whole family was shocked – he is only 39 years old. His doctor explained that the stroke was likely caused by his high blood pressure which is fuelled by consuming too much salt.
And Sione is not alone. Across the Pacific island countries, the number of patients with stroke, heart disease and hypertension is increasing, and the victims are younger and younger. High salt intake contributes to raised blood pressure and hypertension which is a key risk factor for heart disease and stroke. High blood pressure is a public health problem in many Pacific island countries and areas. In some countries, the prevalence is as high as 60% of the adult population.
The noncommunicable diseases crisis in the Pacific
Noncommunicable diseases (NCD) are a health and economic crisis in the Pacific. NCD, namely cardiovascular disease (CVD), cancer, diabetes and chronic respiratory disease, are responsible for approximately 75% of deaths in the Pacific island countries and territories This heavy burden of mortality reflects the alarmingly high prevalence of the risk factors for NCDs, particular high rates of tobacco use, physical inactivity, unhealthy diets and the harmful use of alcohol. Most deaths related to NCDs are premature and can be prevented proven, effective measures, called ‘best buys’.
Targets to reduce salt consumption
The rates of high blood pressure in the Pacific are astonishingly high, but the rest of the world is not far behind. Reducing salt intake in the region would reduce blood pressure, saving thousands of lives every year. This is one of the ‘best buys’ for combatting the NCD crisis. As part of the fight against NCDs, countries in the Pacific have agreed to a global target of 30% reduction in population salt intake by 2025. This will also help reach the global NCD target of a 25% reduction in high blood pressure.
To help countries in the Pacific achieve the global target, WHO has developed maximum acceptable regional targets for salt levels in selected food categories. Salt levels need to be reduced in all food products as much as possible, but special attention needs to be paid to products high in salt and products that are frequently consumed by Pacific people. These include foods such as sausages, snack foods, canned meat and instant noodles.
How to make the change happen
As Sione’s family tries to reduce its salt intake, they have found this is not so easy – salt is ‘hidden’ in many products consumed on a regular basis. And cooking with a lot salt is very common; some foods are even cooked in seawater.
An important first step in controlling the escalating rates of high blood pressure in the Pacific countries is to create awareness of the issue, change behaviour and implement measures to improve the food environment. This includes implementation of voluntary and regulatory policy measures such as food standards, labelling, price incentives and marketing controls.
WHO’s recent publication – Salt matters for Pacific island countries –is a toolkit to help raise awareness and provoke change. The tool kit provides people with an interest in public health the information and tools required to implement advocacy activities on salt reduction and sets out the key elements needed for an advocacy strategy.
A two-pronged approach to reducing salt intake
Reducing salt intake requires action on two fronts. First people need to reduce the amount of salt they add to food. This includes table salt and other sources of sodium such as soy sauce used during cooking, as well as at the table just prior to eating.
The second approach is to reduce salt intake from processed foods, either by eating less of them or reducing the salt content of the most commonly consumed products high in salt. In the Pacific, instant noodles are a favourite product which is frequently consumed. However the salt content is very high. In Fiji, the Ministry of Health, supported by WHO, is working closely with the food industry to reduce salt in frequently consumed processed foods. One of these is noodles and the major producers have shown good progress and willingness to make a change.
Measuring change is salt consumption
To measure progress and ensure salt reduction strategies are having the desired impact, monitoring and evaluation are needed. In the Pacific this has already started with baseline survey conducted in the Cook Islands, Fiji, Kiribati, Samoa and Vanuatu.
At the same time, popular food items that are high in salt are identified in each country. This information will be used for targeted awareness to reduce consumption. Follow up surveys will describe progress and identify further areas of action.
For now, Sione’s family, and many others just like them across the Pacific, are learning about the negative impact of high levels of salt consumption on health, and they are working to adjust food preparation and eating habits for a healthier diet.