Context

• In recent years, the discourse on nutrition and health in India has largely revolved around the harmful effects of sugar and excessive oil consumption.
• This is unsurprising given the growing prevalence of non-communicable diseases (NCDs), particularly obesity, across all age groups.
• However, amidst this focus, one equally significant dietary concern remains underappreciated: the high consumption of salt among India’s population.
• Despite being deeply ingrained in India’s food culture, excess salt intake has profound health consequences, making it imperative for public health policies to address this issue with the same urgency as sugar and fat consumption.

The Extent of the Problem

• Scientific data reveal that Indian adults consume between eight to eleven grams of salt daily, nearly double the World Health Organization’s (WHO) recommended limit of five to six grams.
• Unlike sugar and fat, where a substantial portion comes from processed foods, nearly three-fourths of India’s salt intake originates from home-cooked meals.
• Staples such as pickles, papad, and other traditional items contribute to this problem.
• Furthermore, the cultural habit of keeping salt shakers on dining tables and the rise in eating out, where restaurants enhance flavours with more oil, butter, and salt, only exacerbate the issue.
• Salt is not always visible. It exists in hidden forms in bread, cookies, sauces, and even sweet items like cakes.
• Packaged and ultra-processed foods, often categorised under the high-fat, salt, and sugar (HFSS) label, saturate the market.
• While their harmful effects are recognised, salt reduction seldom receives the same advocacy as sugar or oil reduction.
• This neglect persists despite the fact that hypertension, a condition strongly linked to excess salt intake, affects 28.1% of Indian adults and significantly increases the risk of cardiovascular disease.

Misconceptions and Myths

• Public understanding of salt consumption is further complicated by widespread myths.
• Many Indians believe alternatives such as rock salt, black salt, or Himalayan pink salt are healthier options.
• In reality, all salts contain sodium, and their excessive consumption leads to the same harmful effects.
• In some cases, these alternatives are consumed in greater amounts due to their milder taste, compounding the problem.
• Moreover, they are often not iodised, which can lead to iodine deficiency, a condition India has long battled.

The Multi-Pronged Approach

• Expanding Nutritional Boards
  • Current initiatives such as sugar and oil boards should evolve into HFSS boards that encompass salt as well.
  • This would highlight the collective risks of ultra-processed foods high in sugar, fat, and salt.
• Behavioural Change Campaigns
  • Public campaigns must encourage gradual salt reduction during cooking, flavouring food with herbs and spices, and using low-sodium substitutes when medically appropriate.
  • Crucially, these substitutes should be consumed under medical advice, as high-potassium alternatives can be risky for individuals with kidney disease.
• Early Intervention in Children
  • Since salt preference is an acquired taste, efforts must begin in early childhood.
  • Infants and toddlers should not be given added salt, while older children should consume the same minimally salted food as adults.
  • Establishing healthy taste preferences early can help reduce long-term salt dependency.
• Reforming Public Food Programmes
  • Millions of vulnerable Indians, including children in schools, pregnant women at Anganwadi centres, and patients in hospitals, depend on government meals.
  • These programmes should introduce salt regulations, train cooks, and implement procurement standards to safeguard public health.
• Front-of-Pack Labelling
  • India should adopt mandatory warning labels for high-salt foods, drawing inspiration from countries such as Chile, which have pioneered such measures.
  • Labelling, salt ceilings in processed foods, and restrictions on marketing unhealthy foods to children are crucial regulatory steps.
• Community and Family-Level Interventions
  • Practical measures like removing salt shakers from restaurant tables, families auditing weekly purchases of HFSS items, and discouraging repeat purchases can curb consumption.
  • Local innovations at the household and community levels will also prove vital.
• Integration with National Health Programmes
  • Salt reduction is already part of India’s National Multisectoral Action Plan (2017–22) for NCD prevention.
  • However, stronger cross-ministerial collaboration and integration into broader health programmes are necessary.
  • As the government formulates a new multi-sectoral plan, salt reduction should be embedded as a central objective.

The Case for Stronger Regulation

• The WHO describes salt reduction as a best buy public health intervention, yielding twelve dollars of return for every dollar invested.
• Such evidence underscores the cost-effectiveness of salt reduction initiatives. Yet, isolated awareness efforts are insufficient.
• A mix of regulatory measures, such as mandatory labelling, procurement reforms, and marketing restrictions, must combine with grassroots-level interventions to yield meaningful results.

Conclusion

• Salt, an invisible but equally harmful component of modern and traditional diets alike, demands urgent attention.
• Excessive consumption is fuelling the country’s rising burden of hypertension and cardiovascular diseases, which strain both families and the healthcare system.
• By debunking myths, reforming food systems, and promoting behavioural change, India can take bold steps toward reducing salt intake.
• Ultimately, an integrated and multi-pronged strategy that balances regulation, awareness, and community participation is essential to safeguard public health and reduce the burden of NCDs for future generations.