In Canada several Federal Government organizations have played important roles in the effort to reduce dietary sodium. Health Canada is the Federal Government department responsible for food safety and some aspects of public health, the Public Health Agency of Canada (PHAC) is the Federal Government agency responsible for most public health issues, Statistics Canada is the Federal Government agency responsible for many health surveys and statistics and the Canadian Institute for Health Research (CIHR) is funded by the Federal Governmental to lead and coordinate health related research.
In 2004 Statistics Canada conducted a nutrition “24 h dietary recall” survey in Canada and in 2007, in response to Canadians interest in dietary sodium, analyzed the sodium intakes (). A subsequent media release from Statistics Canada focused on the High Levels of Sodium Intake at All Ages
]. The survey results were used in extensive modeling exercises to determine the major dietary sources of sodium and how to reduce dietary sodium additives in foods to achieve various dietary sodium intake targets.
The collective efforts of the SWG lead by Health Canada resulted in the publication of the report “Sodium Reduction Strategy for Canada, Recommendations of the Sodium Working Group” in July 2010 [21
]. In this report the SWG called for a reduction in population sodium intakes from the current 3400 mg/day to an average of 2300 mg/day by 2016, with an eventual goal of having most Canadians (95%) below 2300 mg/day. To meet the interim targets, the SWG called for a number of actions including (1) structured voluntary sodium reductions in the food supply; (2) public educational campaigns; (3) food science and health research related to sodium; and (4) planned, periodic monitoring and reporting of sodium intake levels and sodium program evaluation. This work has been extended by Health Canada’s publication early in 2011 of draft sodium reduction targets for a number of food product categories with targets set for 2016 and interim milestones for 2012 and 2014. These targets will provide a foundation for evaluating the success of the Canadian Sodium Reduction Strategy and determining if modifications are required in order to achieve maximum health benefits for all segments of the population. The Federal and Provincial Health Ministers also agreed that regulation to limit the sodium content of foods remains an option in case the voluntary approach lacks substantive and timely progress. On the eve of 2011, Prime Minister Harper indicated that the initiation of the sodium reduction program had been one of two health-related priorities in 2010 of the Federal Government, the other being child obesity. The CIHR hosted a meeting to define research needs related to dietary sodium followed by three priority calls with funding for sodium based research [29
]; and also a media awareness meeting on dietary sodium. CIHR partially funds the Canadian Chair in Hypertension Prevention and Control. PHAC has conducted surveys of Canadian’s knowledge, attitudes and behaviours relating to dietary sodium [30
] and funded a population survey of 24 h urinary excretion of sodium (results pending). In addition the PHAC and Statistics Canada in collaboration with NGOs have developed and conducted a national population survey of hypertensive Canadians that included attitudes and behaviours relating to dietary sodium (results pending). The PHAC has also contributed funding to the creation and dissemination of educational resources on dietary sodium to health care professional and the public through Blood Pressure Canada.
Salt intake of Canadians from a 24 h dietary recall study *.
|Age category||Gender||Average intake||% Above upper limit (UL)||Upper limit|
|1 to 3||1918||77.1||1500|
|4 to 8||2677||92.7||1900|
|9 to 13||Male||3513||96.9||2200|
|14 to 18||Male||4130||97.1||2300|
|19 to 30||Male||4066||98.8||2300|
|31 to 50||Male||3607||91.7||2300|
|51 to 70||Male||3334||85.7||2300|
|Over age 70||Male||2882||76.9||2300|
In Canada, provision of health services is a provincial responsibility and hence provinces are very interested in initiatives and interventions that would improve the health of their populations, reduce the incidence of chronic diseases, improve their management and decrease health care utilization. In 2010 the Federal/Provincial/Territorial (F/P/T) Ministers of Health supported the population goal recommended by the Sodium Working Group of 2300 mg/day as an average daily sodium consumption. There was also a commitment to develop a monitoring system for sodium levels in food to evaluate the effectiveness of voluntary industry measures.
Under the direction of the Deputy Ministers of Health, F/P/T senior officials have formed a Sodium Task Group to review the recommendations of the SWG. Beyond voluntary targets and monitoring, these elements include identification of potential federal and provincial/territorial regulatory mechanisms that may be necessary. A full report of the targets and timelines for foods, the monitoring and evaluation program, and the social marketing program is expected in the fall of 2011.
The SWG made many recommendations including consistency of serving sizes in Nutrition Fact Tables and onsite disclosure of nutrition information/menu labeling, food and nutrition policies for publicly funded institutions (e.g., schools and universities, daycares, health care facilities, recreation facilities), increased public awareness and education, reducing marketing of foods high in sodium to children, and research. Many of these elements are linked to or imbedded in broader healthy eating initiatives at the federal and provincial/territorial level and are already at varying levels of discussion and/or implementation across provinces and territories. To further support the effort a separate Federal Government committee (the Food Regulatory Advisory Committee) has also been charged with aiding the sodium reduction effort. The terms of reference for this committee with regard to sodium are currently being developed.
The Canadian government has also played a role in international efforts to reduce dietary sodium. Members from the Canadian government are members of the Pan American Health Organization (PAHO) Expert Group on Sodium Reduction, the government has helped support some of the PAHO Expert Group meetings and co-hosted one of the World Health Organization Platforms on Dietary sodium [31