SODIUM REDUCTION RESOURCE LIBRARY

Find case studies, fact sheets, advocacy tools and more on sodium reduction interventions

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Lindsay S. Taillie, et al.

New study co-authored by the RTSL nutrition team uses focus groups of consumers in Bangladesh to better understand purchasing decisions and effectiveness of nutrition labels. Chief food purchase concerns include that a food has sufficient beneficial nutrients, is free from germs or toxins, and does not contain high levels of nutrients of concern. Results suggest that front-of-package labels would help consumers more easily identify unhealthy foods and that warning labels were perceived as more effective than color-coded labels.

Abstract:

Background/Objectives: Front-of-package labeling (FOPL) policies are a useful strategy to inform consumers about foods high in nutrients of concern, but little is known about what type of label works best in Bangladesh, a country with increasing levels of unhealthy food intake and diet-related diseases. Methods: We conducted 10 focus groups with men and women in rural and urban Bangladesh (n = 76). Using a semi-structured discussion guide, we asked consumers for their perceptions of the healthfulness of nutrients and foods, two common FOPLs (a color-coded guideline daily allowance [GDA] label and a warning label), and different visual elements of the warning label (e.g., shape, icon, text). Results: Participants understood the health harms of sugar and salt consumption but were less clear on saturated fat. Both FOPLs were perceived as helpful for identifying unhealthy foods, but the warning labels were perceived as easier to understand and more likely to influence behaviors than the GDA. Regarding the design of warning labels, participants perceived warning devices, holding straps, and octagonal shapes as effective but had mixed reactions to which icons or textual statements were most effective. Conclusions: FOPLs are likely to facilitate Bangladeshi consumers’ ability to identify unhealthy products. Further research is needed to understand the impact on food choices as well as the most effective design in this population.
Ummay Afroza, et al.

Clear and accurate nutrition labeling on food products is an important way for consumers to understand what’s in the foods they buy. This new comprehensive review in Frontiers led by partners at the National Heart Foundation of Bangladesh and co-authored by Resolve to Save Lives shows that governments are scaling up action to help consumers make informed food choices especially through front-of-package labels (FOPL). Research in the field shows that the most effective FOPL is mandatory; uses a black and white warning label design to flag products high in sodium, sugar, and saturated fat; and is developed free from any conflicts of interest.

Learn more about RTSL’s work to create healthier food environments here, or browse our library of key resources.

Vital Strategies

A resource outlining Vital Strategies’ Breakthrough model for planning strategic communication campaigns to achieve measurable public health outcomes.

Resolve to Save Lives

A case study on Singapore’s national strategy to reduce sodium intake through the promotion of lower-sodium alternatives

NCD Alliance

NCD report highlighting common best practice fiscal policies consistent with NCD prevention as well as measures that are recommended as highly effective in reducing the enormous strain of NCDs.

Imperial College Business School

A preliminary report by the Centre for Health Economics and Policy Innovation advocating for a broader approach to food taxes by applying nutrient profile models to define tax bases, rates, or tiers, aligning taxation with the nutritional quality and health impact of foods.

World Health Organization

A WHO guideline offering Member States recommendations on implementing fiscal policies, such as taxes and subsidies, to promote healthy diets by influencing consumer behavior through price adjustments at the retail level.

 

World Health Organization

This guideline builds on the 2010 WHO Set of recommendations on the marketing of foods and non-alcoholic beverages to children, and takes into consideration more recent evidence specific to children and to the context of food marketing.

World Health Organization

A policy brief providing guidance for policymakers, program managers, and advocates on implementing comprehensive strategies to protect children from the harmful impact of food marketing by reducing both their exposure to and the influence of such marketing practices.

NCD Alliance

A guide on how to counter harmful commercial marketing towards children and young people across risk factors for noncommunicable diseases.  

World Health Organization South-East Asia Regional Office

A document that tailors the 2021 global sodium benchmarks for packaged food categories to the South-East Asia Region, incorporating regional food sources and sodium levels to support countries in setting feasible reformulation targets and advancing sodium reduction efforts.

University of Washington, Resolve to Save Lives

Models how many lives could be saved in countries around the world by scaling up hypertension control and reducing salt consumption by the year 2040

Global Health Advocacy Incubator

Overview of front-of-package warning labelling policies around the world developed by GHAI

Pan American Health Organization

The WHO/PAHO Protocol for Population Level Sodium Determination in 24-hour Urine Samples guides countries in conducting surveys to estimate dietary salt intake, offering support for planning, staff training, data collection, and result dissemination to advance salt reduction initiatives

Global Health Advocacy Incubator

Centralized location for industry alerts, policy briefs, and reports to help organizations stay up-to-date on the ultra-processed food and beverage industry.

Global Health Advocacy Incubator

Collection of advocacy resources on various health food policies such as Front-of-Package Warning Labels, Marketing Restrictions, Sugar-Sweetened Beverage Taxes, and Trans fatty Acids Eliminations.

Global health Advocacy Incubator

Guide developed by the Global Health Advocacy Incubator (GHAI) to provide public health advocates with strategies, case studies, and lessons from over 40 countries to plan, organize, and implement effective advocacy for health policy outcomes.

World Cancer Research Fund

The NOURISHING database, built on the NOURISHING policy framework, offers a comprehensive set of policies to guide policymakers, researchers, and civil society in promoting healthy diets and combating obesity and NCDs across ten key action areas.

Key Resource

Pan American Health Organization

Virtual course developed by PAHO aiming to strengthen capacity to design and advance effective regulatory policies that reduce the demand for and offer of ultra-processed and processed products to prevent obesity and diet-related NCDs in the Region of the Americas.

World Health Organization

WHO’s updated list of “best buys” and recommended interventions for addressing NCDs, aligned with the extended Global Action Plan (2013–2030) to help countries achieve the nine voluntary NCD targets and advance SDG 3 on good health and well-being.

Key Resource

World Health Organization

This guideline offers evidence-based recommendations for reducing sodium intake to prevent NCDs, supporting policymakers and program planners in assessing intake levels, developing interventions, and aligning efforts with global health targets.

Key Resource

World Health Organization

WHO report assessing global progress in implementing sodium reduction policies, providing insights by country, region, and income group to guide future actions for reducing sodium intake and improving cardiovascular health.

Resolve to Save Lives

Provides centralized access to category level nutrient data for packaged foods sold around the world

Resolve to Save LIves

Sodium reduction is the single most important dietary intervention for improving heart health and saving lives in India. Learn more in this resource developed by Resolve to Save Lives.

Learn more about Resolve to Save Lives’ comprehensive, cost-effective interventions to promote healthier diets and save lives in India.

Resolve to Save Lives

Learn more about how Resolve to Save Lives is working to end preventable deaths from cardiovascular disease in India.

Key Resource

Resolve to Save Lives

Nutrition standards guide developed by Resolve to Save Lives that governments can use to ensure food and beverages purchased, served and/or sold in government settings such as schools, public hospitals, childcare or child development facilities, correctional facilities and government workplaces are healthy and low in sodium.

Key Resource

Resolve to Save Lives

Sodium reduction is the single most important dietary intervention for improving heart health and saving lives. Learn more in this resource developed by Resolve to Save Lives.

RESOLVE TO SAVE LIVES

A six-step guide developed by Resolve to Save Lives that governments can follow to help reduce sodium consumption at the national level.

RESOLVE TO SAVE LIVES

Fact sheet highlighting the addition of low-sodium salt to one’s diet to reduce blood pressure and associated risk of heart attack or stroke.

Global Health Advocacy Incubator

Position paper from GHAI, Resolve to Save Lives and other partners presenting best practices for defining, selecting and using effective NPMs.

Global Health Advocacy Incubator

This report by GHAI’s Food Policy program reveals how the ultra-processed food industry has aggressively fought against front-of-package labels globally.

Pan American Health Organization

From WHO/PAHO Regional Expert Group for Cardiovascular Disease Prevention through Population-wide Dietary Salt Reduction

Key Resource

Resolve to Save Lives

This framework summarizes the recommended components of a comprehensive dietary sodium reduction program, and provides links to existing implementation tools, examples of successful programs and other resources.

Resolve to Save Lives

Resource on the benefits of healthy public food procurement and service policies.

Key Resource

World Health Organization

A document that updates the global sodium benchmarks developed in 2021 for different food categories to help reduce salt intake using country experiences (updated in 2024)

World Health Organization

WHO’s monitoring tool that tracks countries’ progress in implementing policies and programs on population sodium reduction. For other relevant score cards see:

Key Resource

Vital Strategies

Step-by-step guide to developing front-of-package labels

Pan American Health Organization

Sodium targets for the PAHO region (published 2021).

 

Resolve to Save Lives

A fact sheet about tips on reducing dietary salt intake for Americans

World Health Organization

A support package to help countries in the European region to initiate or accelerate efforts towards population sodium reduction

Jingmin Ding et al

An article that provides an overview of global salt reduction policies in restaurants in many countries

Resolve to Save Lives

Short guide on potential use of health warning messages on low-sodium salt packaging

Resolve to Save Lives

Series of videos launched to increase awareness that excess daily salt intake leads to cardiovascular disease. See in the various projects below:

A communication guide for patients, nurses, and school staff that features steps and approaches to reduce dietary salt intake.

Salt Reduction Guide for Patients (available in Hindi and Telugu upon request)

Sodium Reduction Counselling Guide For Nurses (available in Hindi and Telugu upon request)

 Also adapted use in Ethiopia by nurses, patients, school teachers and students (Available in Amharic and Oromiffa upon request)

Pan America Health Organization

A report on methods, tools, procedures and key recommendations on how to conduct research into front-of-package labeling

Global Health Advocacy Incubator

A how-to guide in planning and conducting an effective media advocacy campaign that aims to strengthen public health policies

Key Resource

Nicole Ide et al

An article identifying high priority strategies that address reduction of sodium intake through home-cooked food, packaged food, food consumed outside the home

Raquel C. Greer et al.

Article presenting the rationale, current evidence on benefits and risks, and implications for using potassium-enriched salt substitutes as a strategy to lower blood pressure

World Cancer Research Fund International

A collection of policies that different countries have in place to reduce children’s exposure to food marketing

Matti Marklund et al.

A study on the benefits of nationwide potassium enriched salt substitution on cardiovascular health in China

Resolve to Save Lives

A comprehensive guide to healthy public food procurement resources featuring policy examples from around the world

Key Resource

Johns Hopkins School of Public Health

A nine-module online course to help policy makers and health advocates design, plan, and implement global sodium reduction interventions at low- and middle-income countries

Pan American Health Organization

A report on key considerations and recommendations to the use of front-of-package labeling as an effective policy tool to reduce demand and support for ultra-processed food products with high sodium, fat, and sugar content

World Health Organization

Outcomes of a narrative review conducted to update an earlier descriptive review published by WHO in 2009 on the extent, nature and effects of food marketing

University of North Carolina

A fact sheet presenting evidence and progress of food labelling policies globally

Key Resource

World Cancer Research Fund International

A report on key recommendations and advice to policymakers who are designing and implementing front-of pack food labelling in nutrition policies

Adefunke Ajenikoko et al.

Proposes a framework for a scalable and sustainable approach of low-sodium salt use in the home and identifies challenges and potential solutions for effectiveness of this strategy

Global Health Advocacy Incubator

A how-to guide in planning and conducting an effective advocacy campaign that aims to strengthen public health policies

Key Resource

World Health Organization

A resource that provides guidance for governments on how to develop, implement, and strengthen a healthy public food procurement or service on a national or sub-national level

Johns Hopkins School of Public Health

An informational video that addresses the role of sodium in one’s diet and its effects on cardiovascular health

Key Resource

Resolve to Save Lives

Summarizes RTSL’s approach to sodium reduction, including two page summaries for key interventions (sodium targets, FOPL, food procurement and service, low sodium salt, policy advocacy and communications)

Key Resource

World Health Organization

A technical package from WHO designed to assist countries with the development, implementation, and monitoring of salt reduction strategies to reduce population salt intake

Jacqui Webster et al.

Article from the Journal of Clinical Hypertension on evidence for salt reduction

Pan American Health Organization

A technical package that offers a rationale and recommendations for a population-based approach to reduce dietary salt intake in adults and children in the Americas

Shauna M. Downs et al.

An article that identifies a five-step approach for setting sodium level targets in foods in LMICs

Key Resource

Resolve to Save Lives

A collection of literature relevant to the science of salt reduction and on sodium reduction interventions

RTSL and Vital Strategies

A paper authored by Resolve to Save Lives and Vital Strategies highlights how the world is not currently on track to reach its SDG 3.4.1 goal to reduce premature death from NCDs, but that it’s possible. Progress will require improvements to access to quality health care and medications and financial protections for health programs in addition to accountability measures for specific, high-impact health outcomes.

 

Abstract

Non-communicable diseases (NCDs) are the world’s leading causes of death and disability, with cardiovascular disease (CVD) accounting for half of NCD deaths. An ambitious global target established by the United Nations Sustainable Development Goals – indicator 3.4.1 – aims to reduce the risk of premature death among people aged 30–69 years from CVD, cancer, diabetes, and chronic lung disease by one third by 2030. This article reviews the science and practice informing what is required to achieve this target, identifying seven interventions that can accelerate progress: 1) tobacco control; 2) treatment to reduce cardiovascular risk; 3) reduction of dietary sodium; 4) reduction of household air pollution; 5) elimination of artificial trans fat; 6) reduction of alcohol use; and 7) prevention, detection, and treatment of cancers. Achieving the target is possible – there has already been progress in some areas, particularly related to CVD reduction – but only if there is faster, more concerted action.

Cardiovascular Health

Trans Fat Elimination