Photo: Dr. Norm Campbell introduces Dr. Andrew Pipe of the University of Ottawa Heart Institute at a Sodium Reception in Ottawa.
There is some concern that bill C-460, calling for national sodium reduction strategy, is problematic. In this blog, I will explain the bill, what brought it about, and tell you why all the excuses for not supporting it are myths.
Here are the 7:
1. The current approach is working
2. scientists are fine with the current program
3. The bill is bureaucratic nightmare
4. It’s a burden on industry
5. Canadians can self-regulate
6. Canadians don’t support this bill
7. It’s too expensive.
All of these are myths. I’ll tell you why in a momment. First, understand the context of this bill to reduce sodium intake nationally.
What is Bill C-460?
Bill C-460 is a private members bill before parliament that calls for a comprehensive sodium reduction strategy. The strategy, based on the 2010 Sodium Working Group recommendations, calls on the federal government to closely monitor the food supply and to have warning labels on food that are above acceptable levels. Education of the public, already well underway, is also a component of the program.
A “best buy” program
Effective sodium reduction program in the United Kingdom cost up to 15 million dollars a year to run but in Canada, a highly effective fully implemented sodium reduction program is estimated to save approximately 2 billion dollars a year in health costs and more in indirect societal costs. Effective sodium reduction programs are called a “best buy” according to the World Health Organization. In Canada more than 10,000 people are estimated to die annually and over 40,000 hospitalized because of high dietary sodium. Further, an estimated 2 million Canadian have hypertension caused by excess sodium. Unhealthy diets are estimated to be the leading risk for death, disability and life years lost in Canada according to a global Burden of Disease report released this year.
The 7 Myths Canadian Members of Parliament need to understand
The Federal government has primary responsibility for the health and safety of Canada’s food supply. A critical requirement of a productive country and economy is a healthy population. With such a clear public health and societal benefit it is startling that politicians are developing rationale and artificial concerns for not supporting Bill C-460. Several of the stated concerns that have been raised about bill C-460, by federal politicians are addressed below.
Here is what politicians are saying, and why none of it makes any sense.
These are the 7 myths that need to be dispelled:
The CURRENT APPROACH IS WORKING
“There is no need for a new bill on sodium reduction because the current government sodium reduction approach is working.”
The current government program does not include checking to see how much salt Canadians are eating, monitoring the amount of sodium in foods, checking to see if companies are accurately reporting sodium in the foods they produce or providing guidance to restaurants on how much they should reduce sodium additives to foods.
The structure of the current government approach of education and providing loose, voluntary guidance to industry without monitoring are ineffective in many policy areas and have been heavily, repeatedly and publicly critiqued by the Canadian health and scientific community. An extensive report on reducing dietary sodium commissioned by the United States Government indicated these types of voluntary programs have a long history of being ineffective and such approaches were recommended not to be used. Another recent review in the prestigious journal ’Lancet’ concluded voluntary food industry programs have not been shown to be safe, are untested and called for ‘proven’ regulatory approaches as did the report from the United States .
The Canadian government requested the food industry to reduce salt additives in the 1990s without effect. A very similar voluntary approach to that used in Canada has been used in Australia and was recently found to result in higher (not lower) levels of sodium in foods. In Australia, similar to Canada, the industry claimed prior to the report to have been successfully lowering sodium in food by reporting selective data. To my knowledge, only the voluntary programs that have had close government monitoring and oversight have been successful and even these enhanced voluntary programs are less effective than regulations.
Restaurants in Canada have very high levels of salt added to foods and represent a significant and growing proportion of the food Canadians eat. Before it stopped monitoring the accuracy of nutrient labeling, the federal government has documented serious inaccuracies in reporting sodium levels in packed foods. There is also a long history of food companies selectively reporting only the positive changes they make thereby misrepresenting the overall impact.
The current government program for reducing dietary sodium is a primary example of a window dressing program to provide an illusion of action while not addressing the issue at hand but ineffectually wasting Canadians hard-earned tax dollars.
SCIENTISTS ARE FINE WITH THE CURRENT PROGRAM
“Scientists and health care professions support the current government program to reduce dietary sodium.”
The Presidents of national organizations representing nurses, pharmacists, dietitians, family doctors, medical specialists, cardiologists and cardiovascular scientists, kidney specialists, stroke specialists and the Heart and Stroke Foundation have repeatedly called on the government to take comprehensive action to reduce dietary sodium and have expressed concern that the current government approach is ineffective. To my knowledge no scientific health or scientific group has indicated support for the current government program although many have indicated they will assist the government in education programs on dietary sodium. The Sodium Working Group report was unanimously supported by government, industry and health organizations and called for a comprehensive sodium reduction program similar to Bill C-460. Government scientists who strongly supported the sodium working group report have been told to not express their own opinions publicly.
Based on advice from the scientists in the provincial and territorial governments, the Ministers of Health and Premiers of the provinces and Territories have also called for federal government leadership in this area of federal constitutional responsibility for a healthy food supply.
IT’S A BUREAUCRATIC NIGHTMARE
“The proposed program to monitor sodium in food will be a bureaucratic nightmare.”
The monitoring of food can be simply done by requesting the sodium, and other important nutrition information currently listed on the food label, to be sent to an automated database that tracks the foods and indicates which foods require warning labels. Several such databases are already in use around the world run by scientists with relatively little funding and cooperation from industry (e.g. the George Institute has a data base sodium in foods from many countries). Even low to middle-income countries with very few resources are developing and updating such data bases, which are very important to determine how much dietary sodium is being consumed and which foods the sodium is coming from. Lastly the database is simply industry reporting what they are putting in food as was recommended in a World Health Organization report on monitoring salt reduction programs that was funded by and in part supported by the Government of Canada.
IT’S A BURDEN ON INDUSTRY
“The reporting of sodium is too much burden on industry.”
Most large food companies already track and report on websites and the nutrition facts panels the sodium content of their foods. For small companies there are several inexpensive easy to use applications that determine how much sodium is in foods based on the ingredients they put in. To be clear, Canadians consider the burden related to sodium additives to foods to be the millions of Canadians with sodium induced hypertension, heart disease and stroke and premature death.
CANADIANS CAN BE EDUCATED TO SELF-REGULATE SALT INTAKE
“Canadians need to do more to reduce dietary sodium and we will provide education.”
Much more extensive education than the government plans to provide has been shown to have a relatively small effect that lasts a short time. It has also been observed that education programs are relatively expensive. Extensive education on obesity has not impacted increasing obesity rates. National surveys indicate that most Canadians are trying to eat healthier and to reduce how much sodium they eat. Further, while most Canadians are already aware that they eat too much salt, they are personally unaware of their high salt intake. In others words, it’s not ‘my problem’. This is likely in part because our foods are very poorly labeled such that people cannot tell if the food they eat is high in salt or not, or even healthy or not. The current label in the nutrition facts panel is even misleading guiding the few Canadians who can accurately read the label to eat more sodium that the government indicates is the upper limit for health (the 100% daily value being based on 2400mg/day while the upper limit for health is 2300 mg/day and the recommended daily intake is 1500 mg/day for a middle-aged adult). The best and most accurate education would include warning labels on foods as proposed in Bill C-460 so Canadians would know if they are eating high sodium foods as well as changes to the nutrition facts panel that does not mislead Canadians to eat too much sodium.
CANADIANS DON’T SUPPORT THIS BILL
“Canadians do not support regulations for sodium reduction.”
Three recent studies found a very high level of support from Canadians (75-85%) for warning labels on foods high in sodium as well as for the federal government to play an important role in a sodium reduction strategy. The most recent survey, conducted by Mary L’Abbe, Head of Nutrition at the University of Toronto, was consistent with a similar national survey sponsored by Heath Canada. A third survey conducted by the Pan American Health Organization –World Health Organization found Canadians to have a high level of support for regulations including warning labels and to be more supportive than the people of other countries in the Americas whose governments are taking much more proactive and effective measures.
The food industry has responded by sponsoring a survey asking two questions on dietary sodium. The questions posed did not ask Canadians their opinion but asked them to select between two choices that they may or may not have agreed with. The company paid to conduct the survey concluded that Canadians don’t want government in their kitchens or government regulations. There never has been any proposal at any time that would involve government in anyone’s homes or kitchens. All proposals are for reductions in industrial addition of sodium to food and improved labeling of foods so Canadians can make more informed choices. Although the food industries 2 questions did not directly relate to Bill C-460, the questions were framed to suggest Canadians are not supportive of the bill.
“The sodium reduction bill is too expensive.”
What is at stake is the premature deaths and disability of tens of thousands of Canadians annually, the millions of Canadians who have hypertension caused by high dietary salt and the billions of dollars in health care costs that our health systems cannot afford. Comprehensive programs to reduce dietary sodium while saving billions of dollars and preventing much illness have cost up to 15 million dollars a year in the United Kingdom.