Cost effectiveness of salt reduction interventions in Pacific Islands

Background

There is broad consensus that diets high in salt are bad for health and reducing salt intake is a cost effective strategy for reducing the burden of diseases such as high blood pressure. Available data indicates that salt intake in the Pacific Islands is too high and that the World Health Organisation has been promoting the development of salt reduction strategies in Pacific Island Countries. Consultations to develop strategies have been initiated in several countries. However, accurate assessments of sodium consumption patterns upon which such strategies can be based on and subsequently monitored are missing.

Aims

The aim of the project was to evaluate the impact and cost-effectiveness of multi-faceted intervention strategies to reduce salt in the Pacific Islands.

Project plan

The project methodology drew heavily upon the techniques employed in Australia and in Fiji and used in prior successful population surveys done in Samoa.

Phase I- Baseline assessments

Estimate the baseline mean daily sodium consumption directly through the collection of 24hr urine samples and understand sodium consumption patterns through repeat 24hr dietary recall and questions on consumer knowledge, attitudes and behaviour.
Assess the sodium content of foods and meals which contribute the most sodium to diets and establish a database to record and monitor over time.

Phase II – Policy development and intervention

Identify the most effective approaches for influencing government, the food industry and consumer behavior through focus groups.
Use the information from a, b and c above to develop a comprehensive policy response and industry action plan. This should include a diverse range of interventions targeted at (i) stores (ii) caterers and bakers (iii) food manufacturers (iv) consumers through health workers, media, community leaders and schools.

Phase III – Monitoring of impact

Quantify the effectiveness of the national sodium reduction efforts by repeating the measurements done in 1a and 1b, and undertaking a process evaluation.
Assess the cost-effectiveness of the overall strategy in both Fiji and Samoa.
Use the findings of (e) and (f) as the basis for an iterative cycle of policy review and strategy re-development in Fiji and Samoa and to inform recommendations for other countries in the region.

All phases of the project were implemented by a local professional research person supported by a technical assistant in each country as well as 3-4 research assistants required to undertake the survey during baseline and follow-up. Training in dietary assessment and monitoring activities was carried out to the initial baseline assessment in addition to further on-going training and support during the intervention stage.

Impact

The project has resulted in significant policy changes. The project team worked with the Government in Samoa to amend the Food Act, introducing labelling of salt content and mandatory limits for salt content. In Fiji, salt reduction efforts were mainstreamed into government policies, including through voluntary salt targets and salt education as part of national NCD or nutrition strategies.

Publications and output

GACD have published an end-of-programme report, providing a comprehensive summary of the programme and outcomes.

This project has a related case study Salt reduction interventions in Pacific Island countries.