title: Progress on salt reduction in the Pacific Islands: from strategies to action.
abstract: BACKGROUND
  Most populations are consuming too much salt which is the main contributor of high blood pressure, a leading risk factor of cardiovascular disease and stroke. The South Pacific Office of the World Health Organization has been facilitating the development of salt reduction strategies in Pacific Island Countries and areas (PICs). The objective of this analysis was to review progress to date and identify regional actions needed to support PICs and ensure they achieve the global target to reduce population salt intake by 30% by 2025.
  
  
  METHODS
  Relevant available national food, health and non-communicable disease (NCD) plans from all 22 PICs were reviewed. NCD co-ordinators provided updates and relayed experiences through semi-structured interviews. All activities were systematically categorised according to an existing salt reduction framework for the development of salt reduction strategies.
  
  
  RESULTS
  Salt reduction consultations had been held in 14 countries and final strategies or action plans developed in nine of these, with drafts available in a further three. Three other countries had integrated salt reduction into NCD strategic plans. Baseline monitoring of salt intake had been undertaken in three countries, salt levels in foods in nine countries and salt knowledge, attitude and behaviour surveys in four countries. Most countries were at early stages of implementation and identified limited resources as a barrier to action. Planned salt reduction strategies included work with food industry or importers, implementing regional salt reduction targets, reducing salt levels in school and hospital meals, behaviour change campaigns, and monitoring and evaluation.
  
  
  CONCLUSIONS
  There had been good progress on salt reduction planning in PICs. The need for increased capacity to effectively implement agreed activities, supported by regional standards and the establishment of improved monitoring systems, were identified as important steps to ensure the potential cardiovascular health benefits of salt reduction could be fully realised in the region.
authors.affiliation: Food Policy Division, The George Institute for Global Health, The University of Sydney, Camperdown, New South Wales, Australia. Electronic address: achristoforou@georgeinstitute.org.au.
authors.forename: Anthea
authors.initials: A
authors.lastname: Christoforou
authors.affiliation: Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, Suva, Fiji. Electronic address: wendy.snowdon@deakin.edu.au.
authors.forename: Wendy
authors.initials: W
authors.lastname: Snowdon
authors.affiliation: Ministry of Health, Honiara, The Solomon Islands. Electronic address: nlaesango@moh.gov.sb.
authors.forename: Nevalyn
authors.initials: N
authors.lastname: Laesango
authors.affiliation: Nauru Public Health Centre, Nauru. Electronic address: setareki.vatucawaqa@nauru.gov.nr.
authors.forename: Seta
authors.initials: S
authors.lastname: Vatucawaqa
authors.affiliation: Commonwealth Healthcare Corporation, Northern Mariana Islands. Electronic address: danielclamar@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lamar
authors.affiliation: Guam Department of Public Health and Social Services, Mangilao, Guam. Electronic address: lawrence.alam@dphss.guam.gov.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Alam
authors.affiliation: FSM Health, Pohnpei State, Federated States of Micronesia. Electronic address: klippwe@fsmhealth.fm.
authors.forename: Kippier
authors.initials: K
authors.lastname: Lippwe
authors.affiliation: Tonga Health, Nuku'alofa, Tonga. Electronic address: iemaimah@tongahealth.org.to.
authors.forename: Iemaima Lise
authors.initials: IL
authors.lastname: Havea
authors.affiliation: Ministry of Health, Rarotonga Cook Islands. Electronic address: k.tairea@health.gov.ck.
authors.forename: Karen
authors.initials: K
authors.lastname: Tairea
authors.affiliation: World Health Organization South Pacific Office, Suva, Fiji. Electronic address: Hoejskovp@wpro.who.int.
authors.forename: Peter
authors.initials: P
authors.lastname: Hoejskov
authors.affiliation: World Health Organization, Geneva, Switzerland. Electronic address: WaqanivaluT@wpro.who.int.
authors.forename: Temo
authors.initials: T
authors.lastname: Waqanivalu
authors.affiliation: Food Policy Division, The George Institute for Global Health, The University of Sydney, Camperdown, New South Wales, Australia. Electronic address: jwebster@georgeinstitute.org.au.
authors.forename: Jacqui
authors.initials: J
authors.lastname: Webster
mesh_terms: D004039:Diet, Sodium-Restricted; D005260:Female; D006801:Humans; D008297:Male; D010139:Pacific Islands / Q000453:epidemiology; D012307:Risk Factors; D017673:Sodium Chloride, Dietary; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D017673:Sodium Chloride, Dietary
keywords: Cardiovascular disease; Intervention; Non-communicable diseases; Pacific Islands; Salt; Sodium