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In October of 2007, then-federal-health-minister Tony Clement declared war on salt. The “silent invader of our food supply,” he said, was a bigger threat to the health of Canadians than artery-clogging trans fats.

The minister announced the creation of a Sodium Working Group to draft an action plan and promised to move quickly. Twenty months later, there is still no plan and no deadline for coming up with one.

Meanwhile, Canadians remain among the top consumers of salt in the world, gobbling an average of 3,100 milligrams a day – more than twice the recommended daily amount. Canada is one of the few governments in the Western world that has not tackled salt, a common dietary additive that is contributing to a deadly epidemic of hypertension and cardiovascular disease.

“Sodium is a hidden, silent killer in our food supply. It's contributing to the deaths of tens of thousands of people every year but we are largely disregarding this problem in public policy,” said Norm Campbell, the Canadian Research Chair in Hypertension Prevention and Control and president of Blood Pressure Canada, an advocacy group. “There is an urgent need for action.”

The lack of urgency on the part of government is frustrating, as is the plodding pace of the Sodium Working Group, said Stephen Samis, director of health policy at the Heart and Stroke Foundation of Canada.

“Let's face it, they've been slow,” he said, although he allows that a federal election, a new health minister and personnel changes at Health Canada have all conspired to delay the process.

“But they need to expedite their work. This is an important public-policy issue and we can't wait forever for action.”

In the fall of 2007, just before Mr. Clement's announcement, a coalition of 17 health groups including the Heart and Stroke Foundation, the Canadian Medical Association and the Canadian Nurses Association, issued a National Sodium Policy Statement that detailed exactly what they thought needed to be done.

The document called for sharp reductions in the sodium content of processed foods and fast foods (either voluntary or enforced by regulation), better labelling of packaged foods and education campaigns to persuade Canadians to alter their salty tastes.

They proposed a clear objective and a timetable – cut Canadians' intake of salt by half by 2020.

So, what has the Sodium Working Group been doing all this time?

First, it took Ottawa months to appoint the 24 members, a cross-section of representatives from consumer health groups, health practitioners, academia, industry and government. The group met three times in 2008 and achieved little but hashing out its terms of reference.

In May of this year, the working group managed to “define a process to establish a Canadian approach to dietary sodium reduction, including targets, an education/awareness strategy and a research agenda,” said Stéphane Shank, a spokesman for Health Canada.

Mr. Shank said the department “is happy with the progress of the Sodium Working Group,” and that another meeting is slated for the fall. (Health Canada would agree only to answer written questions and it did so only in broad terms.)

Despite the slow progress, Dr. Campbell still believes the Sodium Working Group will come up with the right recommendations and that the government will implement a much-needed plan. The question is when that will happen.

Excessive salt consumption is causing the premature deaths of 30 Canadians a day, according to research published in the Canadian Journal of Cardiology. Cardiovascular disease kills more Canadians each year than anything but cancer and it is estimated that one in every eight cardiac events (such as heart attacks and strokes) is caused by excess sodium. Salt consumption is one of the most obvious modifiable risk factors for heart disease, since cutting salt has an almost immediate impact on blood pressure.

Frans Leenen, director of the hypertension unit at the University of Ottawa Heart Institute, said it is frustrating to know that other countries have made tremendous progress reducing salt consumption while Canada has yet to take the issue seriously.

“Finland started 15 years ago. What are we waiting for exactly?” he said. As part of its public health goals to reduce heart disease, the Finnish government launched a high-profile media campaign to warn citizens about the dangers of too much salt, adopted a strict labelling law requiring warning labels on processed foods that read “high salt content” and persuaded food companies to replace salt with a low-sodium substitute called Pansalt. The result has been a 25-per-cent drop in consumption.

Dr. Leenen also pointed to Britain, which is often cited as the model for sodium policy. There, the government established a Food Standards Agency which, among other things, took on the task of reducing the salt content of food. In 2002, it set an ambitious goal of reducing average salt consumption by 40 per cent over a decade and it is well on its way to meeting that target.

Britain has strict labelling laws that include a traffic-light system for salt that shows a red light for high-sodium foods and a green light for low-sodium products.

Above all, Dr. Leenen said, Britain had a champion for the cause.

Graham MacGregor, a professor of cardiovascular medicine at St. George's University in London and chairman of the non-profit group World Action on Salt and Health, has been tireless in his advocacy for reducing salt in the diet and unrelenting in his criticism of industry.

In a recent article in the Journal of Human Hypertension, Prof. MacGregor said, “The reasons that the food industry adds large amount of salt to processed foods is mainly because it makes cheap, unpalatable food edible at no cost.”

Dr. Leenen said that even when all the required elements are there – a government keen to act, good legislation, strong advocates and an informed public – it is still difficult to bring about dietary change.

“You don't resolve dramatic problems like this overnight. It takes time, it takes money and it takes a plan,” he said. “This is a challenge: By comparison, reducing smoking was easy.”

Salt is an acquired taste, and people have come to expect it in their food. (Unlike sugar, there are few alternatives. Those that do exist contain a lot of potassium, which can interfere with blood pressure medications.)

Dr. Campbell said public policies on sodium reduction should not be Draconian but aim to wean Canadians off salt.

“Industry is not interested in a sudden drastic reduction in sodium and, frankly, neither is the public,” he said. “But if reduction of sodium is gradual, it will go unnoticed.”

While some companies, such as Campbell Co. of Canada, are voluntarily reducing the sodium content in their products (in recent years Campbell's has brought sodium levels in its products down by 10 to 25 per cent), Dr. Leenen said that regardless of how enthusiastic some companies are, how good labelling is and how much public education there is, some regulation is going to be required.

“This is not a problem that is going to be resolved strictly with voluntary measures,” he said.

One need look no further than the trans-fats issue to understand why. After a public outcry about the level of heart-damaging trans fats in processed foods, the federal government gave industry two years to phase out their use voluntarily, under the threat of a total ban. While some companies eliminated trans fats, most have simply not bothered and there are now renewed calls for legislation.

Salt is far more ubiquitous and damaging than trans fats.

Maria Ricupero, a dietician in the cardiac program at Toronto Rehabilitation Institute, said one of the most difficult changes for patients to make after a cardiac event is adopting a healthier diet, in particular reducing sodium consumption.

Ms. Ricupero teaches patients to read labels and urges them to “work within a budget” of 1,500 milligrams a day of sodium when choosing their foods.

But Ms. Ricupero believes this is a problem that should be addressed at the source, not in individual kitchens.

“Not having all this sodium in food in the first place would make my job a lot easier,” she said. “And it would make food a lot healthier.”