How three countries in the Americas are fortifying dietary salt reduction: a north and south perspective.

A chronic disease/risk factor prevention framework with three policy environments--communications, physical and economic--was used to organize population level interventions that address the "over consumption of dietary salt", a key risk factor for cardiovascular diseases. The framework was then used to map the population based strategies to reduce dietary salt consumption being applied in three countries in the Americas--Argentina, Canada and Chile--each with a history of multi-sector approaches to deal with the risk factors for chronic disease, offering a north versus south perspective. Results show that in all three countries policy instruments are concentrated in the communications environment, e.g., media and education campaigns and/or regulations for standardized information on the salt or sodium content of packaged food products. Notable gaps are the requirement for nutrient information on meals and food items prepared by food establishments and restrictions on advertising and marketing of foods to children. In the physical environment, referring to the sodium levels in commercially prepared foods and meals available on the market, voluntary reformulation of food products is underway at this time in the three countries. Argentina and Chile began with bread and have gradually added other food categories; Canada at the outset is addressing all food categories where products have added salt. Argentina alone is at this point actively approaching regulations to limit the salt content of food, preferring this over ongoing monitoring of voluntary targets. No government in the three counties has yet considered action in the economic environment, a complex area where the research on and initiatives to limit or disadvantage energy-dense food products to address obesity may also capture foods that are highly salted. In the meantime, with recent research estimating substantially higher gains in population health from government legislation to limit salt in foods compared to voluntary approaches, decision makers in countries, whether in the north or south, committed to reducing dietary salt can take Argentina's example to strengthen their interventions in the physical environment with regulatory instruments. This will sustain reformulations made to date, "level the playing field" industry-wide and broadly and equitably distribute the health benefits of low salt foods.