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The Globe and Mail

Ottawa must act on salt crisis, doctors say

Developing a campaign to reduce the population's dangerously high sodium consumption is one of the most pressing public health matters facing Canada, a new article published Monday in the Canadian Medical Association Journal charges.

The article, written by two of Canada's leading experts on the health effects of sodium, comes as a federal task force charged with creating potential solutions faces a change in leadership and significant delays in progress.

The delays have caused mounting frustration among a growing network of medical experts who say urgent action on sodium is needed, but that the federal government is dragging its feet, using the wrong approach and consequently putting lives at risk by failing to make sodium reduction a national priority.

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The serious dangers posed by the country's excessive salt intake, including the toll it's taking on the health of children and teens, was the subject of a major series published by The Globe and Mail earlier this year.

"I think a lot of people in the health community would like to see more action and a more rapid response to the sodium issue," said Kevin Willis, director of partnerships at the Canadian Stroke Network and one of the authors of the CMAJ article . Dr. Willis is also a member of the sodium working group, a federally appointed task force that's supposed to devise strategies and solutions for dealing with the problem.

The task force was created two years ago, but little progress has been made and its goals appear as far away as ever. A Health Canada spokeswoman revealed that the department doesn't expect to see a national action plan unveiled until the end of next year - a major delay that's fuelling discontent among medical professionals.

In comparison, a similar Health Canada task force set up to deal with artery-clogging trans fats had completed its work and received commitment to action from the federal government within two years.

The federal government's sodium working group was further stalled after its chairwoman, Mary L'Abbé, left Health Canada for a position at the University of Toronto in early July. The department is now proposing to replace her with Hasan Hutchinson, director general of the office of nutrition policy and promotion at Health Canada, according to Dr. L'Abbé, who said she expects to continue as vice-chair.

But the shift in leadership is a snag that threatens to further delay what many see as a process that's already taken far too long.

"[Sodium]requires urgent action," said Martin Bitzan, director of the pediatric nephrology division at Montreal Children's Hospital. "It's not something that requires tremendous resources to be done."

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Members of the sodium task force are scheduled to meet this fall to start talking about how to go about setting sodium reduction targets for various food categories, a key component of any successful sodium reduction campaign.

But medical experts say Canada needs solutions now. Sodium is a major risk factor for the development of high blood pressure, an affliction that affects about 20 per cent of Canada's population. High blood pressure can lead to heart attack, stroke and other cardiovascular diseases, major causes of death in this country.

The average Canadian consumes 3,092 milligrams of sodium a day, more than double the recommended amount for any age group, and statistics show that nearly all toddlers and children consume enough sodium to elevate their risk of health problems. Hypertension experts predict a growing number of young Canadians will suffer heart attacks and other serious health problems if measures aren't taken to combat excessive salt intake.

"We've raised this alarm in terms of sodium for 10, 15 years," said Ross Feldman, past chair of the Canadian Hypertension Education Program and R.W. Gunton professor of therapeutics at the University of Western Ontario's Schulich School of Medicine and Dentistry. "It's on the radar screen now, but I think it's a long way from implementation."

Even if Canada's sodium task force develops a plan to cut salt intake, many doubt it will be completely effective. In order for any plan to work, food companies must commit to reducing the amount of salt they use because up to 80 per cent of the sodium Canadians consume comes from packaged or processed goods, including bread, cereal, dressings, sauces and canned food.

But regardless of what the task force recommends, any action taken by industry will be voluntary. While some food makers have expressed interest in lowering the sodium content of their products, members of the medical community say a voluntary approach offers no incentive for industry and will allow companies to do as little as possible, with no repercussions.

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"I don't think that the volunteer initiatives are going to work on the regulatory side of getting salt out of the processed food system," said Dr. Feldman, who is also funded by the Heart and Stroke Foundation.

Another problem is that many companies may be hesitant to be the first to adopt a broad sodium reduction program for fear of losing customers. It's a fundamental flaw that threatens to hold up changes to Canada's food supply indefinitely.

"Where's the incentive?" asked Peter Magner, head of nephrology at the University of Ottawa and associate editor at the CMAJ, who has years of experience treating high blood pressure. "I'm myself not all that much of an optimist about voluntary reductions."

Serious concern about the effects of high salt intake is mounting around the world. The Pan American Health Organization announced last week the creation of a new expert panel to develop recommendations for potential sodium-reduction policies throughout the Americas. Norm Campbell, co-author of the new study and Canadian Chair in Hypertension Prevention and Control, has been appointed as chairman of the Pan Am panel.

At the same time, a U.S. study has found that reducing that country's sodium intake to the recommended amount could lower health-care costs by as much as $18-billion (U.S.) a year. The study, conducted by the RAND Corporation, will be published in the September/October edition of the Journal of Health Promotion.

Britain is held up by many countries as a model for an effective salt reduction strategy. Although Britain is also using a voluntary approach to appeal to food manufacturers, the aggressive and visible nature of its campaign has put salt on the public radar, providing an incentive to help push food companies into action. Its Food Standards Agency launched the first phase of the salt reduction campaign months after its first stakeholder meeting on the issue in 2003. Sodium reduction targets aimed at the food industry, as well as a comprehensive website and television commercials, had all been rolled out within three years.

Dr. L'Abbé said she expects the working group to start focusing more closely this fall on setting reduction targets for a variety of food categories.

"We've seen progress start and I expect over the next while, [the]next year, for example, we will continue to see progress," she said.

But for doctors who see firsthand the damaging effects a high-salt diet can have on the health of some people, the progress has been far too slow.

"I think this has to be much more of a front-burner issue for the government," Dr. Feldman said.

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