Activities and plans at WHO Headquarters Godfrey C Xuereb Team Leader Population-based Prevention Team SPP Unit Department of Chronic Diseases and Health Promotion Population Salt Reduction Strategies

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011 Six objectives: 1. Raising the priority accorded to non-communicable diseases in development work at global and national levels 2. Establishing and strengthening national policies and programmes 3. Reducing and preventing risk factors 4. Prioritizing research on prevention and health care 5. Strengthening partnerships 6. Monitoring NCD trends and assessing progress made at country level Under each of the six objectives, there are sets of actions for member states, WHO Secretariat and international partners MandateMandate 3. Reducing and preventing risk factors

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011 Population Salt Reduction Strategies Creating enabling environment Consumer education Product Reformulation Policy makers Private sector NGOs Academia WHAT HOW WHO London, England 30 June – 1, 2 July 2010 Iodine fortification Reduction of salt intakeFood Composition Data Sodium consumption Calgary, Canada October 2010 Policy makers Private sector NGOs Academia Policy makers NGOs Academia UN Agencies Date and location to be determined 1 Evaluation and monitoring 2 Salt: vehicle for fortification 3

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011 Platform 1& 2 Platform 1 - Organized jointly with UK FSA –Information Exchange Forum with the Private Sector and Nongovernmental Organizations on population-based salt reduction strategies –Technical Meeting on creating an enabling environment for population-based salt reduction strategies Platform 2 - Organized jointly with Government of Canada on Strategies to Monitor and Evaluate Population Sodium Consumption and Sources of Sodium in the Diet –Information Exchange Forum with the Private Sector and Nongovernmental Organizations on Strategies to Monitor and Evaluate Population Sodium Consumption and Sources of Sodium in the Diet Strategies to Monitor and Evaluate Population Sodium Consumption and Sources of Sodium in the Diet –Technical Meeting on Strategies to Monitor and Evaluate Population Sodium Consumption and Sources of Sodium in the Diet

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011 Outcomes of three Platforms Platform 1 – Reducing salt intake: a practical tool for Member States –Practical approach for implementing an education and public awareness campaign –Practical approach for engaging food and meal producers and distributors Platform 2 – Global framework for effective M&E of sodium reduction strategies –Monitoring sodium intakes –Monitoring sources of sodium –Monitoring consumer knowledge and behaviour Platform 3 – Salt Reduction and Iodine Fortification – making the two strategies work together

Nutrition Guidance Expert Advisory Group (NUGAG)

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011 WHO Guidelines on Sodium Consumption for the General Population Current guideline < 2g Na (5g salt) / d to prevent CVD Evidence suggests lower Na intake (1.2 g/day) may confer additional health benefits WHO guideline being reviewed and updated Priority questions for systematic reviews –What is the effect of reducing sodium intake to 1.2 g/d vs. 2.0 g/d on blood pressure and incidence of stroke, coronary heart disease, and cardiovascular disease in hypertensive and non-hypertensive adults? –What is the effect of reducing sodium intake to the equivalent of 2.0 g/d (based on caloric intake) vs. > 2.0 g/d on blood pressure in children? Systematic reviews being undertaken currently Evidence to be considered by NUGAG and recommendations drafted at Nov 2011 meeting

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011 WHO Guidelines on Potassium Consumption for the General Population Currently no WHO guideline on potassium consumption Evidence suggests health benefits WHO guideline to be generated at request of Codex Priority questions for systematic reviews –What is the effect of consuming > 90 mmole/d potassium vs < 90 mmole/d on blood pressure and incidence of stroke, coronary heart disease, and cardiovascular disease in hypertensive and non-hypertensive adults? Systematic reviews being undertaken Evidence to be considered by NUGAG and recommendations drafted at Nov 2011 meeting

Improving public health through the optimal intake of iodine and sodium 31 March – 1 April 2011 WHO Guidelines on Fortification of Salt with Iodine Priority question for systematic review –Is salt iodization safe and effective for reducing IDD? Updating Cochrane systematic review from 2002 Outcomes: goiter, hypothyroidism, iodine intake, cretinism, cognitive function, adverse events Some subgroups of interest to be examined: –Age (<59 months, 5-12 yrs, Women of Reproductive Age, pregnant women) –Population salt consumption ( =15g/d) –Iodine consumption based on urinary iodine excretion –Concentration of iodine in salt ( 40ppm) –Availability of iodized salt source (HH only, processed foods only, USI, unknown) Systematic review near completion To be considered at Nov 2011 NUGAG meeting

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