World Hypertension Day is May 17th, an important day for hypertension prevention awareness globally. Here’s why.
Hypertension has become such an important non-communicable disease around the world, that last year for World Health Day, the World Health Organization (WHO) focused in on Hypertension and released a fact sheet demonstrating the extent of this global health problem, now understood to be the world’s number one killer.
Efforts to tackle the challenge of non-communicable diseases globally including hypertension prevention have been increasing since the 2011 United Nations Political Declaration on the prevention and control of non-communicable diseases, including a Global Plan of Action and roadmap.
The fact is, there is still a serious lack of understanding around the world about the seriousness of raised blood pressure as a warning sign, and the significant lifestyle changes needed to lower BP before it is too late.
As a global effort, the WHO recommends hypertension prevention efforts. “Countries need systems and services in place to promote universal health coverage and support healthy lifestyles: eating a balanced diet, reducing salt intake, avoiding harmful use of alcohol, getting regular exercise and shunning tobacco.”
We’ve been watching to see what countries are taking vital steps to deal with this issue, especially in the area of improved diet and more specifically whole population sodium reduction and food policy.
Prevention and control of hypertension is complex, and demands multi-stakeholder collaboration, including governments, civil society, academia and the food and beverage industry.
Only a handful of countries have indeed put forth initiatives to combat the problem. Here, we highlight some of the notable policy changes around the world:
The UK’s Food Standards Agency committed to a national salt reduction strategy in 2002. Since then, the government has taken steps to set salt reduction targets for the food industry (see the timeline of events here).
In April 2014, a paper published in the online medical journal BMJ Open offered conclusive evidence that the UK salt reduction strategy has had direct correlation to improvements in public health. Measuring data from 2003-2011, the study showed that during this period, while salt intake in the population fell by 15%, stroke and heart disease deaths fell by 40%. Read more about the study, including the original paper, here. “In our view it would now be a gross breach of ethical and corporate responsibility for companies not to reduce salt as the benefits of salt reduction are now so clear,” said Claire Ferrand of WASH in response to the study.
Finland is a leader in salt reduction, with an awareness campaign in place since 1970. In 2008, the country’s National Health Institute proposed a mandatory labelling law for products with high sodium content. Despite the lack of such a law to date, figures show that the country’s population has seen a 40% decline in salt consumption, along with an 80% drop in death from stroke.
With a population consuming more than twice the daily salt intake recommended by the WHO, Korea faces a serious threat to public health. In 2012, the government launched the Korea Center for Less Sodium Campaign, a cross-platform effort in collaboration with consumer advocate groups, the medical community and the food industry. Initiatives are slowly rolling out. For example, on March 13th, 2013 every 3rd Wednesday of the month became ‘No Soup Day’. It turns out that soup accounts for 30.7% daily sodium consumption in Korea. While recommending a daily intake of sodium is 2000mg, Koreans take in almost half of that amount in just one soup meal.
In March 2013, South Africa’s Minister of Health signed legislation which made it mandatory for the food industry to meet salt reduction targets, aiming for daily consumption of salt to be less than 5 grams per day.
Graham Macgregor, chairman of the World Action on Salt and Health (WASH) described South Africa as taking a “pioneering” role in salt reduction programmes. “Achieving a long and healthy life, free from disease, is a right not just for South Africans but for everybody in the world. It is time that Western governments stopped being pressured by their tobacco and food industry and follow South Africa’s example by setting specific targets for reducing non-communicable diseases (NCDs), including salt reduction to less than 5g a day, particularly in developing countries where the major burden of NCDs lies.” See more on South Africa salt regulation.
Going further than countries that make these targets voluntary, this step was taken after extensive consultation with the industry as well as scientists, and in the face of much media criticism.
Though setting mandatory reduction targets presents considerable challenges, the South African experience shows that it can be done when governments have a firm commitment to public health. As doctors Karen J. Hofman and Stephen M. Tollman succinctly put it in a comment on the South African laws, published in medical journal The Lancet, “Restricting salt in processed food is an example of why using regulation is inherently more equitable, because it provides an opportunity for an entire population to attain their full health potential rather than individual use of overextended health services.”
Following the recommendations of a Sodium Working Group in Canada, in 2006, the first Chair in Hypertension Prevention and Control was appointed. The chair, with support from health-related and science organizations, worked to lobby the government to implement policies aimed at reducing the addition of salt to food. A year later, the Minister of Health established a working group tasked with developing and implementing a strategy for reducing sodium intake among Canadians.
Canada had the potential to become a leader in sodium reduction policies. But in May 2013, Bill C-460 – the Sodium Reduction Strategy for Canada Act – was narrowly defeated, by a vote of 147-122, in the House of Commons (For more about the bill, see Bill C-460 Struck Down and previous blog by Hypertension Chair Norm Campbell 7 Myths About Bill C-460, a National Sodium Reduction Strategy.) Similar to matters regarding environmental policy, Canada is now in the embarrassing position of being globally viewed as moving backwards where other countries are moving forwards. With the scientific evidence from the UK study showing the clear health benefits of sodium reduction, and the South African experience showing that legislation is possible, Canada is missing only the political will.