Editorial

Human rights in China

On May 14, the Information Oce of the State Council Chinas cabinetpublished Progress in Chinas Human Rights in 2012. The cabinets white paper assesses human rights achievements through the lens of development: Development is the key to solving all existing problems and facilitating progress of human rights in China. The report reviews economic and social achievements as progress in human rights. It also lists improvements in living standards, stresses the achievements of lifting millions of Chinese out of poverty, raising annual incomes, improving education, housing, health insurance coverage, and access to health, and decreasing mortality of children younger than 5 years ahead of the Millennium Development Goals deadline. Acknowledging the scale of the threat to peoples right to live in a clean and sustainable environment, the report devotes an entire section to ecological quality. Although the abolition of the death penalty is not discussed, there is a substantial reduction in the number of situations in which a defendant could face such a penalty. Physical and mental health are mentioned in the white paper, providing an opportunity for health professionals in China to improve human rights in many important ways. First, by making health and high-quality care a human right. Second, by seeking protection of their own rights, which too often have been violated by dissatised patients and their families. Third, by defending the rights of their patients, including sex workers, who allegedly face coercive testing for HIV according to another report, Swept Away: Abuses against Sex Workers in China, published by Human Rights Watch on May 14. Progress on human rights depends on openness, which makes Chinas white paper welcome and marks an important stage in the evolution of rights for its people. China has made colossal progress to improve economic and health standards. Further advances, like those announced by the cabinet for human rights, are encouragedparticularly for groups for whom progress in development alone might not be important enough. The Lancet

Corbis

For Progress in Chinas Human Rights in 2012 see http://news. xinhuanet.com/english/ china/2013-05/14/ c_132380706.htm For the Human Rights Watch report see http://www.hrw.org/ reports/2013/05/14/ swept-away-0 For more on human rights in China see Editorial Lancet 2011; 378: 290

Salt: friend or foe?

Dietary guidelines advise against the consumption of too much salt. A high intake of sodium causes raised blood pressurean established risk factor for heart disease, stroke, and kidney disease. But how much salt is too much? And could a very low salt intake also be detrimental? The eects of salt consumption on health are controversial, but reduced salt intake is mostly believed to decrease the risk of cardiovascular disease. The 2010 Dietary Guidelines for Americans recommend a maximum daily consumption of 2300 mg salt for healthy adults and 1500 mg for people at raised risk of heart disease (eg, those older than 51 years, people with diabetes, and black people). The American Heart Association even advises that everyone adheres to the 1500 mg limit, irrespective of age or race. However, most people still eat too much salton average, US adults consume 3400 mg (about 15 teaspoons) daily. In May, 2013, the Institute of Medicine reviewed recent evidence (39 studies) and reported that a very low salt intake might not be as benecial as was previously thought, at least for those at increased risk of heart disease. Less than 2300 mg salt daily could even increase some cardiovascular risk factors, such as blood lipids and insulin resistance, potentially triggering heart problems. Moreover, no evidence suggested a benet of an ultra-low sodium intake (<1500 mg daily) in any population. High study heterogeneity, and the fact that the eects of reduced sodium intake on health outcomes cannot always be distinguished from those of overall diet changes, make accurate conclusions dicult. The report concludes that more trials are needed to address gaps in the data, especially studies of the eects of a 15002300 mg daily salt intake in dierent groups. The report needs cautious interpretationit does not suggest that people use salt freely. The Institute agrees that a link between high salt consumption and increased risk of cardiovascular disease persists, and that average intake needs to be reduced. However, the ndings about very low sodium levels will help to clarify public health messages (eg, updated US dietary guidelines, due in 2015) and hopefully improve health outcomes. The Lancet
www.thelancet.com Vol 381 May 25, 2013

Corbis

For the Institute of Medicine report see http://www.iom.edu/ Reports/2013/Sodium-Intake-inPopulations-Assessment-ofEvidence.aspx

1790