Reducing Sodium Intake

A global health priority, making a difference in Shandong, China and Philadelphia

By Andrea Neiman, PhD, MPH, CDC

The global burden of deaths due to cardiovascular diseases (CVDs) such as heart disease and stroke has become a global public health crisis. CVD is among the top three causes of mortality and morbidity worldwide. High sodium intake is a leading contributor to hypertension, which accounts for nearly 50% of CVD globally.  Reducing sodium intake is therefore both a domestic and global public health priority.

In China, as in the US, average sodium consumption exceeds WHO recommendations, and the primary source of this excess is salt added during cooking; in the US, the primary source of excess salt intake is processed and restaurant foods.

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In Shandong Province, the second most populous province in China, hypertension rates and salt intake in adults are significantly higher than the national average.  In 2011, to address the challenges presented by these high hypertension rates, China’s National Health and Family Planning Commission (formerly Ministry of Health) and Shandong provincial government, with technical assistance and guidance provided by US CDC, launched the first comprehensive salt reduction project in China through multisectoral approaches: the Shandong Province and Ministry of Health Action on Salt and Hypertension (SMASH). The goal of SMASH is to reduce daily salt intake to 10 g/d by 2015 from the 12.5g/d at the baseline and increase awareness and control of hypertension.

Among many strategies, the SMASH initiative works through restaurants to develop sodium use standards for Shandong cuisine, as well as develop complementary communication activities to increase consumer knowledge and awareness. Restaurants following the lower salt requirement are labeled as Distinguished Restaurants.

The partnership between China’s SMASH and the United States’ own sodium reduction efforts has been mutually beneficial. SMASH officials have been working with Philadelphia’s Healthy Chinese Take-Out Initiative to share information about China’s respective sodium reduction initiatives. The Philadelphia initiative aims to reduce the sodium content in Chinese take-out dishes by 10–15% moving forward.

Shandong provided Philadelphia with CDC sodium fact sheets translated to Chinese, which has assisted the Philadelphia Initiative in communicating health information more effectively with participating restaurant operators who do not speak English. Shandong province officials also visited Philadelphia in 2014, further boosting this important collaboration.

The United States is making substantial progress in reaching its CVD goals, and active engagement with global partners provides the unique opportunity to share CDC’s expertise and knowledge. These partnerships also maximize existing global efforts to enhance learning capacity and improve domestic approaches. SMASH and Philadelphia’s Healthy Chinese Take-out Initiative, like many of CDC’s many other collaborative efforts help to leverage resources and experiences that enhance sodium reduction efforts for everyone involved.