China

Salt Action Summary

September 2011

In China, salt reduction is a primary theme for the next two years in the ‘Government-led National Initiative of Healthy Lifestyle for All’ program, which is a government initiated program being implemented through China Centre for Disease Control network country wide. This program started in 2007 with the aim of promoting healthy lifestyles among the Chinese population. The relevant health promotion activities are implemented in most of the provinces in China.
Shandong Province remains the most outstanding province having a coordinated salt reduction program in place with the support from the provincial government. Beijing has been doing a great job as well with strong support from the vice mayor Mr Ding Xiangyang. Low sodium salt is available for purchase in almost 100% of supermarkets in Beijing now with some supermarkets having removed all usual salt from their shelves.
The China Action on Salt Reduction Network (the idea is similar to the China Salt Reduction Initiative) was launched early this month with the secretariat being based at ThinkTank and Beijing Hypertension League. Currently there are over 30 individuals each representing a stakeholder institution included in this network. Dr Wu is a member of this network representing The George Institute, China. There are representatives from MOH, China CDC, Salt Industry, Food Industry, and Military Health System included in this network.
The George Institute China is also co-ordinating a community intervention as part of the China Rural Health Initiative with salt reduction interventions, including the use of a subsidised salt substitute now underway in 60 communities as part of a controlled study.
For more information contact Nicole Li nli@thegeorgeinstitute.org.cn.

September 2008

New guidelines for nutrition labelling on packaged foods for industry self-regulation have been introduced in China.  These voluntary guidelines will standardise presentation of information on products that already state nutrient levels.

The new guidelines will have to detail levels of sodium per 100g, per 100ml or per serving, as well as labelling nutrient content as a percentage of the nutrient reference value.  This is a major step for China which has WASH's support.

May 2008

China has introduced new voluntary guidelines for nutrition labelling on packaged foods, in a bid to prevent the government imposing stringent regulations in the future.  All foods carrying nutrition labels will have to convey levels of sodium per 100g or per serving, and as a percentage of the nutrient reference value (NRV).

Raised blood pressure is by far the commonest cause of death and disability in China, and despite the compelling evidence of the benefits of reducing salt intake, particularly in Northern China where stroke and cancer of the stomach are almost pandemic, the long term restriction of salt consumption has proven difficult.  China represents some unique challenges and The George Institute for International Health, Sydney, Australia (The George), Fuwai Hospital and Cardiovascular Institute, Beijing along with the China (Fuwai) and the Clinical Trial Research Unit, Auckland, New Zealand (CTRU) have in collaboration been very active in seeking to identify practical new ways of tackling the serious problem of hypertension in China.

They have recently carried out a large double-blind randomised cross over trial of the effect of a lower sodium, higher potassium salt substitute in 600 individuals in Northern China.  The results showed that replacing salt with a salt substitute reduced blood pressure almost to the same extent as single drug therapy. Importantly, these effects were achieved at a low cost and appeared to increase over the time as the salt substitute was incorporated progressively into the daily diet.  This study should achieve major publicity when it is published.  Already the results have formed the basis for new initiatives to try to persuade Chinese policy makers to increase the use and availability of salt substitutes.  Most of the salt sold in China is through a state monopoly.

Commissioning of a larger research project looking at the effects on cardiovascular mortality and morbidity with the use for a salt substitute is already in progress.  This is not an easy study to conduct but no doubt if it showed positive results it would hugely influence the use of salt substitutes.  At the same time, an application has been made to the Ministry of Science and Technology for funding to initiate a salt replacement programme in more remote rural countries.  A scientific symposium was also held in Beijing and was attended by key opinion leaders, policy makers, representatives from the China National Salt Corporation, Ministry of Health and the National Development and Reform Committee.  Feedback from the attendees surprisingly suggested that even more strong research evidence was needed from large scale studies until there is an extensive change in salt policy in China.

A spoonful of salt will help the sickness rate go down
From The Times
4 May 2007

Five million small, blue, plastic spoons are being distributed to households in Beijing in an attempt to encourage healthier eating. The plan is to get every family to limit its salt intake to only one spoonful a day.

Zhao Chunhui, deputy director of the Beijing Municipal Health Bureau, said: “Diseases resulting from unhealthy dietary habits, such as obesity, hypertension and diabetes, are spreading fast in Beijing. Every family will get a free spoon for their kitchen in the ‘Salt Containment Campaign’.” His drive to limit the salt intake of the city’s 15 million people is the result of rapidly rising affluence that has had a dramatic impact on the diet, shape and health of the Chinese.

Less than two decades ago most people in Beijing chose the bicycle as the most convenient means of transport. The average family counted itself lucky to be able to afford meat once every few days, and almost everyone except the highest officials had to use ration coupons for rice and vegetable oil. Now supermarkets and vegetable markets abound.

About 35 per cent of adults in Beijing are overweight, compared with a national average of 22.8 per cent, and 17 per cent rank as obese. These figures have alerted health authorities.

Shen Hongfei, a food critic, told The Times that the vogue for spicy cuisine from southwestern Sichuan province and the rich Shanghai-style food was resulting in people using more salt in their cooking. “Spicy food relies on salt to adjust the taste. The more salt you use, the hotter the dish.

Guangdong cuisine is more lightly flavoured and healthier but it is no longer as popular.” Statistics indicate that the daily intake of salt of a Beijing resident is 16 grams (½oz) a day – nearly three times the six-gram level recommended by the World Health Organisation. The overuse of salt is blamed for an increase in many diseases, including high blood pressure and diabetes. The spoons hold two grams of salt.

Diabetes is increasing rapidly among young Chinese. Traditionally in China, only a plump baby is a healthy baby. The proportion of children between 7 and 18 years who are obese or overweight soared 28-fold between 1985 and 2000.

Pan Beilei, an official of the state food and nutrition consultant committee, said: “An increasing number of Chinese are eating more fat and junk food and less grains and vegetables.” Because of poor eating habits, 160 million Chinese had high blood pressure last year, up from 90 million in 1991, and 20 million had diabetes.

And so Mr Zhao hopes that his little plastic spoon will result in a healthier diet among Beijing residents.