Lessons for Moving Upstream: Strategies for Community Efforts to Affect Policy and Environmental Change to Reduce Consumption of Sodium

Introduction.  This presentation describes lessons learned from a cross-site evaluation of community-based approaches to reduce sodium and describes how public health practitioners focused on more upstream voluntary policy, systems, and environmental changes.

American’s consume an average of 3,300 mg/day compared to recommendations of 2,300 mg/day for adults, and 1,500 mg/day for older adults and people with hypertension. This gap poses a serious public health risk because high sodium intake contributes to hypertension and risk of cardiovascular disease.

Until recently, public health interventions to reduce sodium intake focused primarily on public education and changing individual behavior, such as sodium messages in the Dietary Guidelines for Americans, product labeling, and consumer awareness campaigns recommending individuals to limit sodium intake.  Yet, the majority of sodium content occurs in already packaged and prepared food.  Consequently, program staff in funded communities focused on community-based approaches in combination with public education to sodium reduction. 

Methods. This paper reports on a comparative case study evaluation of six communities around the country.  These communities received Sodium Reduction in Communities funding from the Centers for Disease Control and Prevention to implement sodium reduction strategies in diverse venues, including schools, restaurants, hospitals, congregate meal centers, grocery/convenience stores, and government and private worksites.   The evaluation examined the implementation processes of the communities’ efforts to promote changes to reduce sodium consumption.

Results. The communities moved beyond demonstrations of foods to individual consumers to finding ways to change the food environment.  To reduce sodium in restaurant meals, program staff in two communities worked with independent restaurant owners to develop lower sodium meals; three communities collaborated with school food service staff to identify sources of and improve access to lower sodium ingredients and foods and to integrate sodium reduction into wellness policies.  In three communities, program staff worked with government agencies to develop voluntary policies and guidelines for RFPs that included nutrition standards.  

The study identified the value of strategies that (1) incorporated sodium reduction efforts and messaging into other nutrition efforts, (2) built relationships with nontraditional partners and understood their perspectives regarding sodium reduction, (3) found alternate strategies to account for cost of lower sodium products, (4) reduced sodium gradually to take into account taste transitions, and (5) engaged consumers to facilitate change.

Conclusions. These community-based approaches help to create a supportive environment for individual choices, provide models for other communities, and create the demand for distributors to consider accommodating sodium reduction.