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School of Nursing
Diego Silang Bldg, A. Bonifacio St., Baguio City
Submitted by:
LARA, Kit
ROSARIO, Ryle
REALUBIN, Dianne
USON, Emmarie
THIAM, Joybee
BSN IV-D3
Submitted to:
Cherylina Dalilis, RN
Hypertension causes 7 million deaths every year while 1.5 billion people suffer
from its complications according to WHO; hence, hypertension is considered a
detrimental factor for deaths worldwide. As stated by Dr. Dante Morales,
President of the Philippine Society of Hypertension (PSH) during the National
Hypertension Awareness celebration conducted at the Universidad De Manila
on 19 May 2012, “21 percent of Filipino adults are hypertensive.”
It’s well-established that consuming too much salt can lead to high blood
pressure and other risk factors for heart disease and heart failure. According to
national surveys, adults 51 years and older consume 3,100 mg of sodium per day
on average and fewer than 2% of adults in that age range meet current sodium
recommendations. The 2010 Dietary Guidelines for Americans recommend that
adults over 51 should reduce sodium intake to 1,500 mg daily.
According to the Food and Nutrition Research Institute, salt and soy sauce were
among the top 10 widely used miscellaneous food items used by Filipinos.
Excessive intake of salt and soy sauce can result to high blood pressure
especially to salt-sensitive individuals. Persistent high blood pressure can result to
cardiovascular diseases.
That being said, living a healthy lifestyle plays a significant role in treating
hypertension. One of which is to minimize or reduce salt intake. Decreasing
dietary salt intake will reduce coronary heart disease deaths in the four
countries. A comprehensive strategy of health education and food industry
actions to label and reduce salt content would save both money and lives.
The reduction in population levels of salt intake has been associated with the
implementation of national salt reduction strategy in the United Kingdom. This
national salt reduction strategy introduced in 2003 voluntary agreements with
food industry to reduce salt content in foods and public awareness campaigns
to change personal behavior like reducing salt added during cooking.
As of now, a house bill had made its way to the House of Representatives last
2016. It seeks “to impose mandatory warning labels on food products or
processed food products containing sodium and to subject all processed foods
for review on their sodium levels.” On another note, it was also stated in the bill
that “Despite indicating that the leading cause of health-related diseases are
cardiovascular diseases, the DOH has not campaigned or lobbied for food
producers to inform the public about the deadly levels of sodium in their
products.” Hence, the need of a policy to reduce sodium intake in the country
becomes a greater necessity.
Since the people in the Philippines has been reported many cases of high blood
pressure and CVD among older adults, a no salt policy may be implemented to
help reduce these diseases. Following strategies that may help implement this
policy in the Philippines are strategy which involves making reductions in salt in
cheaper food products which are consumed by poorer households, a public
awareness campaign of the risk of high salt intake in older adults especially
when they have high blood pressure and who are at risk of having CVD, and
possible regulation and ongoing monitoring of salt intake levels among older
adults by barangay health care centers.
Implementation
A diet high in sodium is a major risk factor for non-communicable diseases like
cardiovascular disease. Sodium reduction is considered a public health priority
globally.
Strategy 1: Mandatory 25% reduction in sodium levels in three groups of
processed foods: bread, processed meats, and sauces
MEDIA:
Strategy 3: A salt tax*: an excise tax applied and increased up to the point
where the recommended level of sodium intake is achieved (2300
mg/day)
Three public health legal tools often used to deal with products
associated with negative public health impacts include 1) taxes (to
decrease consumer use and raise public health revenues), 2) spending
incentives (to directly influence industry or consumer choices through
financial rewards), and 3) bans (to remove a product from the market or
limit specific consumers’ access). In small amounts, salt is not only safe but
essential. Salt makes food taste better and last longer with no added
calories. Taxing or banning salt or other sodium products may seem
unjustified but it only applies to salty snacks. In 2015, the Navajo Nation
imposed a 2% tax on all junk food sold on its reservation, including an
array of high sodium products of “minimal-to-no nutritional value.”
Banning sodium in all processed foods is impossible, but partial bans may
be viable legally. Limiting or banning access to salty products like canned
fruits and instant noodles for older adults is lawful just the same as bans on
selling tobacco, alcohol, or sugar-sweetened beverages. Prohibiting
overuse of sodium as a flavor or preventive in specific products for certain
populations may be legally defensible provided government can
demonstrate legitimate, correlated public health concerns.
Proposal
I. Identifying stakeholders
The coordinating group needs to identify the stakeholders with whom it needs to
collaborate and the methods to achieve this. Potential stakeholders can
include:
Potential barriers
• The producers and distributors of processed foods and meals may have little
awareness of links between salt, health and NCDs, and may be unwilling to
reduce the salt content of their products.
• Stakeholders may not be aware of the dangers of excessive salt intake and
some may view the use of salt in a positive light.
• Many countries do not have identifiable trade and consumer organizations.
• The informal sector is less well defined. Smaller food companies, street vendors
and small caterers may not have representatives and thus are difficult to reach
and get involved.
Countermeasures
• The trust of the food industry can be gained by using an open approach. The
importance of reformulation, the benefits need to be communicated clearly.
Incentives may also be considered.
• Develop a clearly presented document highlighting the evidence base for
action on salt reduction
• Mapping techniques can be used to identify where business interests lie and
how different groups associate, for example some may use the same supplier.
• Respected academics or scientists may use their influence to spread the
message to other academics and NGOs in order to lobby for reformulated food
products.
• International organizations and NGOs can share support and resources with
smaller local organizations
Potential barriers
• The food industry may disengage if profits or market share are affected. It can
also try to influence policy through “umbrella organizations” and paid
consultants.
• Resources may not be sufficient to engage all sectors of the food industry.
• The presence of fast food chains is increasing in many developing countries
where they may be considered the elite food choice.
• The majority of processed foods may be imported from neighboring countries
and there may be limited opportunities to influence changes in these products.
Countermeasures
• The coordinating group can start by identifying progressive companies,
already engaged in reformulation and work with them as champions in their
sectors.
• The coordinating group may refer to food technology experts for technical
advice on reformulation of food products.
• The food sector can be motivated by publicly acknowledging progress. NGOs
can also name and praise, or alternatively, name and shame.
Potential barriers
• Preconceptions held by some journalists regarding salt consumption need to
be overcome. Salt is frequently considered a beneficial product, especially
where it is fortified with iodine, and the implications of excessive salt intake, such
as high blood pressure, are not always recognized.
• Sponsoring of the media by the food industry and other commercial influences
can confuse the public.
Countermeasures
• Good engagement with the media from the initial stages, and taking a
proactive approach - e.g. preparation of myth busters and questions and
answers to help address opposition and avoiding highly technical jargon can
ensure a more positive and balanced campaign.
• The coordinating group can identify spokespeople prepared to respond to
requests made by the media.
References
Mason H, Shoaibi A, Ghandour R, O'Flaherty M, Capewell S, Khatib R, et al.
(2014) A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce
Coronary Heart Disease in Four Eastern Mediterranean Countries. PLoS
ONE 9(1): e84445. doi:10.1371/journal.pone.0084445
http://www.fnri.dost.gov.ph/index.php/publications/writers-pool-
corner/57-food-and-nutrition/204-nutritional-guidelines-for-filipinos-a-
prescription-to-good-nutrition
https://www.cardiosmart.org/News-and-Events/2015/01/Study-Questions-
Strict-Sodium-Guidelines-for-Older-Adults
https://www.foodnavigator.com/Article/2015/01/20/Study-suggesting-salt-
intake-is-less-of-a-risk-for-the-elderly-is-flawed-say-experts
https://sodiumbreakup.heart.org/pass-by-the-salt-sodium-and-older-
adults
Millett, C.,Laverty, A.A., Stylianou, N., Bibbins-Domingo, K., Pape, U.J.
(2012). Impacts of a National Strategy to Reduce Population Salt Intake in
England: Serial Cross Sectional Study. PLoS ONE: 7(1).
Wyness L, Butriss J, Stanner S. (2011) Reducing the population’s sodium
intake: the UK Food Standards Agency’s salt reduction programme. doi:
10.1017/S1368980011000966