George Cheriyan, Consumer activist and an expert on Food Safety
The Sustainable Development Goal (SDG) 3 is to ensure health and promote well-being for everyone. SDG 3 focuses on good health and well-being as essential for individuals, communities, and nations to enable everyone to thrive and achieve their potential. The idea behind SDG 3 is that good health is a fundamental human right and a prerequisite for sustainable development. Therefore, investing in health and well-being will achieve increased productivity, economic growth, and social stability. This in turn will help to reduce poverty reduction and promote an equitable society.
SDG 3 is particularly important for India, given the challenges faced by its large and diverse population. India has made significant improvements in the health outcomes of its people. However, progress is uneven across states. And demographic and epidemiological changes mean, the country faces a double burden of disease and an ageing population.
Despite significant economic progress, India has faced challenges of equity and lack of access to quality health services, particularly in rural areas. With a rise in non-communicable diseases (NCDs) such as heart disease, cancer, diabetes and hypertension, the need to address health as a determinant of progress is strongly felt.
Risk of High Salt Intake
Indians consider salt as a symbol of their freedom struggle, with reference to the Dandi March of Mahatma Gandhi to challenge the tax laws of the colonial rulers, and through the years, have developed an affection towards salt.
Indians, on an average, consume almost 10-11 grams of salt per day, which is double the World Health Organization (WHO)’s recommendation of a maximum 5 grams or one teaspoon a day, to reduce the burden of NCDs caused by consuming excessive sodium.
India is the third largest salt producer in the world after the US and China. About 30 million tonnes of salt are produced in India every year. India exports around 10 million tonnes of salt while 12.5 million tonnes of salt is used in industries. The rest of the salt is consumed by domestic customers. India exports salt to more than 55 countries.
Most dietary sodium (over 70 per cent comes from eating packaged and prepared foods, not from table salt. Although the sodium content in Indian food varies depending on the dish, it is generally high in sodium. This is due to the use of salt and other high sodium ingredients, such as soy sauce, in many Indian dishes. Most of the snacks like bhujiya, namkins or banana chips contain salt and fat. Even summer beverages like jaljeera, nimbu pani, and chaach have salt, and food accompaniments like pickle or chutney contain high levels of salt and fat.
Hypertension
Hypertension is a common but dangerous condition that affects the force of blood against the artery walls. It is a major cause of premature death worldwide. According to the WHO, an estimated 1.28 billion adults aged 30–79 years worldwide have hypertension, with two-thirds of them living in low, and middle-income countries. Shockingly, approximately 46 per cent of adults with hypertension are unaware that they have the condition.
A comprehensive global analysis of trends in hypertension prevalence, detection, treatment, and control, led by Imperial College London and WHO, and published in The Lancet (2021), reveals that the number of adults aged 30–79 years with hypertension has increased from 650 million to 1.28 billion in the last thirty years.
In India, the prevalence of hypertension is estimated to be around 29.8 per cent, with urban areas having a higher rate of 33.8 per cent and rural areas at 27.6 per cent. It is estimated that at least one in four adults in India has hypertension. In response, India has set a target of a 25 per cent relative reduction in the prevalence of hypertension (raised blood pressure) by 2025. It is well established that high-salt intake is the major cause of raised blood pressure and subsequent cardiovascular diseases.
Limiting salt intake to the recommended level of less than 5 grams per day for adults can help reduce blood pressure and the risk of cardiovascular disease, stroke and coronary heart attack. Lowering salt intake has the key benefit of reducing high blood pressure, and has been identified as one of the most cost-effective measures countries can take to improve population health outcomes. An estimated 2.5 million deaths could be prevented annually, if global salt consumption is reduced to the recommended level.
Increasing NCDs, a Major Challenge
The 2030 Agenda for SDG recognises NCDs as a major challenge for sustainable development. As part of the agenda, heads of state and government committed to developing ambitious national responses, by 2030, to reduce premature mortality from NCDs by one third through prevention and treatment (SDG target 3.4). WHO plays a key leadership role in the coordination and promotion of the global fight against NCDs and the achievement of SDG target 3.4.
In 2019, the World Health Assembly extended the WHO Global action plan for the prevention and control of NCDs 2013–2020 to 2030 and called for the development of an Implementation Roadmap 2023 to 2030 to accelerate progress on preventing and controlling NCDs. The Roadmap supports actions to achieve a set of nine global targets with the greatest impact towards prevention and management of NCDs.
The NCDs kill 41 million people each year, equivalent to 74 per cent of all deaths globally. The contribution of NCDs, as top causes of death in India, has risen to a staggering 64.9 per cent, according to a study released by the Apollo Hospitals Group in April 2021. One of the global targets for NCDs is to reduce the prevalence of hypertension by 33 per cent between 2010 and 2030.
The economic cost of NCDs also has a significant macroeconomic effect on the Indian economy. NCDs reduce the productivity of the workforce, resulting in the reduction of overall economic output. It is estimated that every 10 per cent increase in NCD mortality results in a 0.5 per cent reduction in annual economic growth.
The Way forward
India has set a target of 25 per cent relative reduction in the prevalence of hypertension (raised blood pressure) by 2025. To achieve this, it is important to reduce the salt intake and fast-track access to treatment services by strengthening interventions such as the India Hypertension Control Initiative (IHCI). Recognising that hypertension is a serious, and growing, health issue in India, IHCI is a joint five-year initiative of the Union Ministry of Health, Indian Council of Medical Research (ICMR) and WHO-India, to monitor and treat hypertension.
Generating awareness among the consumers to reduce salt intake, and urging the Food Regulator to introduce front-of-the-pack warning labels to alert consumers about unhealthy ingredients such as salt, sugar and saturated fat, are important immediate actions to be taken. Front-of-the-Pack-labelling (FoPL), proposed by WHO, is a cost-effective messaging strategy and a simple, inexpensive, practical, and effective tool to help consumers make informed and healthier choices, that is long over due to be implemented in India.