Eating too much salt kills nearly two million people every year, and without the rapid introduction of global policies to limit sodium content in processed foods, another seven million preventable deaths will occur by 2030, the World Health Organization (WHO) said in a new report.

Unhealthy diets are a major global health challenge, and sodium’s link to high blood pressure and cardiovascular diseases makes it one of the major contributors to nutrition-related deaths.

The average sodium intake globally is more than double the recommended 5-gram, or one teaspoon, daily limit, according to the report.

“That leaves people at risk for heart attack and stroke,” said Dr Tom Frieden, Director of Resolve to Save Lives, a non-profit organization that works to prevent deaths from cardiovascular diseases. “The world needs action, and now, or many more people will experience disabling or deadly, but preventable heart attacks and strokes.”

@ResolveTSL Dr Tom Frieden explains that despite global consensus on the need to⬇️salt intake, action has been limited. Self-regulation by the food industry has repeatedly been show to be ineffective – government regulation is needed to create a level playing field @actiononsalt pic.twitter.com/QTQJYNgNdo

— WASSH (@WASHSALT) March 9, 2023

All 194 WHO member states have committed to the goal of reducing national sodium intake by 30% by 2025, and the science is clear: sodium is an essential nutrient but increases the risk of heart disease, stroke, and premature death when overconsumed.

At a press conference accompanying the launch of the report, WHO Director-General Dr Tedros Adhanom Ghebreyesus was blunt about the chances of reaching the 2025 target: “The world is off-track,” he said.

Only nine countries have fully implemented best-practice policies, leaving more than two-thirds of the world unprotected by policies limiting sodium content in food products. The lack of progress by governments in passing basic policies to regulate sodium levels has frustrated WHO officials.

“We cannot fail this completely achievable and affordable public health goal,” said Dr Francesco Branca, Director of Nutrition for Health Development at WHO. “Reducing sodium intake is one of the most cost-effective ways to improve health. It can avert millions of deaths every year at very low total programme costs.”

Governments must push industry

The report sets out a series of so-called “best buy” policies, which it describes as easy to implement and highly cost-effective measures to reduce sodium intake. These recommendations, however, are not new. These were first endorsed by member states in 2017, yet many have yet to implement any of them.

“Best buy” policies include steps like reformulating foods to contain less salt, establishing public procurement policies to regulate sodium levels in foods purchased by institutions such as hospitals, schools and workplaces, and clear package labelling to help consumers avoid sodium-rich foods.

But these are no replacement for governments setting maximum limits for sodium in processed foods, WHO said. “Best buy” practices, while helpful, do not prohibit manufacturers from producing high-sodium foods and continue to place a significant burden of responsibility on consumers.

“Government-led mandatory maximum limits for sodium in processed foods promote industry-wide reformulation [by creating] a marketplace that restricts the less healthy food options regardless,” Branca said. “This type of policy requires no consumer action and places the burden of avoiding manufacturing less healthy products on the food industry.”

Top down limits on sodium content also safeguard against industry prioritizing short-term commercial interests while leveling the playing field for food manufacturers, preventing competition from developing based on sodium content.

“We know that unfortunately, self-regulation by the food manufacturing industry has repeatedly proven to be ineffective,” Frieden said. “The mandatory approach safeguards against commercial interests which may delay, weaken, distort or impede the development of healthy food and nutrition policies and programmes.”

By October 2022, just 5% of member states had implemented the recommended two mandatory sodium reduction policies. Another 22% had implemented their first mandatory policy. The remaining 73% have no hard restrictions on sodium content.

“We all have a role to play. WHO, governments, the private sector and consumers,” Tedros said. “Together we can make sure that food is a source of health, not a cause of death.”