Burden of Disease
In 2005, 35 million people died from chronic diseases; this represents 60% the total number of deaths (58 million) in that year. Of all deaths from chronic diseases, 30% were due to cardiovascular disease (CVD). Approximately 80% of chronic disease deaths occurred in low- and middle-income countries. Additionally, it is known that 80% of heart disease, stroke, and type 2 diabetes and 40% of cancer can be prevented through inexpensive and cost-effective interventions (WHO, 2005).

In the WHO World Health Report 2002 (WHO, 2002) it is estimated that globally 62% of cerebrovascular disease and 49% of ischaemic heart

disease were attributable to elevated blood pressure (systolic > 115 mmHg). Heart diseases are the leading cause of death for persons over 60 years of age and the second cause of death for persons aged 15–59 years. The report reviews strategies to reduce the risks associated with CVD and states that in all settings population-wide salt reduction strategies were the most cost-effective.

Expert Consultation
A technical report produced by WHO and the Food and Agriculture Organization of the United Nations (FAO) recommended the consumption of less than 5 g sodium chloride (or 2 g sodium) per day as a population nutrient intake goal, while ensuring that the salt is iodized (WHO, 2003). This expert consultation stressed that dietary intake of sodium from all sources influences blood pressure levels in the population and should be limited so as to reduce the risk of coronary heart disease and stroke.

WHO Action
In response to the disease burden of chronic diseases, which is growing at an alarming rate, the Fifty-fifth World Health Assembly in May 2002 called on WHO to develop a global strategy on diet, physical activity and health (WHA55.23). The development of this strategy involved consultations with Member States in all WHO regions, other United Nations organizations, other intergovernmental bodies, and representatives of civil society and the private sector. Advice was also provided by a reference group of independent international experts.

Global Strategy on Diet, Physical Activity and Health (DPAS)
The Global Strategy on Diet, Physical Activity and Health (DPAS), together with the resolution by which it was endorsed (WHA57.17), was formally adopted by the Fifty-seventh World Health Assembly in May 2004 (WHO, 2004). The strategy recognizes the high and growing burden of chronic diseases and addresses two of their main risk factors – diet and physical activity. The overall goal of the strategy is to promote and protect health by guiding the development of an enabling environment for sustainable actions at individual, community, national and global levels which, when taken together, will lead to reduced disease and death rates related to unhealthy dietary patterns and physical inactivity.

DPAS calls upon WHO to provide guidance to Member States on the formulation of guidelines, norms, standards and other policy-related measures that are consistent with DPAS objectives; and to identify and disseminate information on evidence-based interventions, policies and structures that are effective in promoting, among other aspects, healthy diets in countries and communities. Guidance on reduction in salt consumption by the population and individuals is an example.

Forum and Technical Meeting
As part of the implementation of DPAS, WHO organized a Forum and Technical Meeting entitled “Reducing salt intake in populations”. The overall objective was to develop recommendations for Member States and other stakeholders on interventions to reduce population-wide salt intake. The French Ministry of Health and the French Food Safety Agency kindly supported both the Forum and the Technical Meeting. This is the combined report of the WHO Forum and Technical Meeting. It outlines the purpose of the meetings, summarizes the evidence presented

and discussed at the Forum, and details the conclusions and recommendations from the Technical Meeting that followed. The structure of this report follows the structure of the meetings. (For the programme see Annex III).

This report will constitute a tool to be used by WHO, Member States and other stakeholders when developing and implementing policies aimed at the population-wide reduction of salt intake.

Definition
Publications refer to sodium intake as either mass or millimolar amounts of sodium, or mass of sodium chloride (salt). (1g sodium chloride = 17.1 millimolar amounts of sodium or 393.4 mg of sodium). For the purpose of the meeting discussions and of this report, it should be noted that the word salt was used to refer to sodium and sodium chloride intake. The term limitation of dietary salt intake implies the reduction of total sodium intake from all dietary sources including, for example, additives such as monosodium glutamate and preservatives.