Healthy-heart program asks Baltimore to ease up on salt

The cooks at the Manna House soup kitchen in Baltimore routinely prepare low-salt meals, only to watch most of those sitting at the tables reach for the salt shaker.

But that ingrained habit could be broken as the Baltimore Health Department teams up with Manna House and others in an educational program to curb consumption of the mineral so closely linked to cardiovascular disease, the nation's No. 1 killer and an especially intractable problem in poorer neighborhoods. Proponents of the effort say a modest reduction in salt consumption could save 700 lives here a year.

The just-launched effort could get a boost from New York City, which last week announced a goal, supported by state and local health officials, of reducing salt used in restaurants and packaged foods by 25 percent in five years. Officials say that could save 850,000 lives annually nationwide.

Those in public health say that, over time, the multipronged, multicity effort could begin to chip away at the problem.

"The popular foods like fried fish and fried chicken are really salty, so initially we'll meet resistance," said Samuel Enos, who runs Manna House's men's health initiative. "But everyone is joining to make people aware that high salt intake causes heart disease, and eventually people will recognize it."

With health department funding, Manna House will work on education. It has also begun offering blood-pressure screenings and plan to offer them soon at local barber shops. Those who have high readings will be referred to subsidized city health care, with a goal of reducing the 20-year disparity in life expectancy between richer and poorer neighborhoods.

The city is initiating other educational programs based on the recommendations issued this fall by the Baltimore City Salt Reduction Task Force. Officials will reach others through churches and community health workers, and will initiate a program that gives awards to restaurants that offer nutritional information.

A more specific goal was set by the coalition of 40 cities and states led by New York. It seeks to reduce salt in packaged foods in 61 categories and restaurant food in 25 classes.

The entire nation should benefit because food makers and restaurants will not make different products for one city, said Sonia Angell, director of the New York Health Department's Cardiovascular Disease Prevention and Control Program. Subway restaurants and A&P stores, for example, have said they are planning changes to their products that should meet New York City's goals.

New York has been negotiating since 2008 with the industry and other stakeholders about sodium, a major component of salt. The targets are similar to ones successfully met in the United Kingdom, Angell said. For example, she said, the average amount of sodium in a serving of cereal is a third of a teaspoon, but in five years that could be reduced to a quarter of a teaspoon.

"That may not seem like much, but the benefits compound across the day and every individual will be consuming a lot less sodium," she said. "That in turn will save thousands of lives and billions in health care dollars."

The voluntary moves have won support from industry giants such as the Grocery Manufacturers Association. Locally, officials at the Restaurant Association of Maryland, which was represented on the Baltimore salt task force, agreed that reducing salt was necessary.

Changes can't happen overnight, though, said Melvin Thompson, the association's vice president of government relations. Most fast-food and casual-dining restaurants receive food prepared by suppliers, and changing recipes so quickly isn't possible. Further, he said, customers wouldn't stand for such a swift change in their favorite foods.

"That's where this becomes a challenge for our industry," he said. "We recognize that it's important to give customers what they want in terms of reduced sodium, but we need time and flexibility."

But not everyone thinks the food makers should get such time and leeway because of the severity of the situation.

The task force recommendations centering on education were a "meaningful first step," said Stephen Teret, associate dean for faculty and education in Johns Hopkins' Bloomberg School of Public Health and a salt task force member. But tougher, more "automatic" responses are necessary, he said.

Teret pointed to air bags in cars and fluoride in water as such successful approaches. He also called for more menu labeling, already required of restaurants in several other cities.

"The question is how do you get people to consume less salt," he said. "One way of approaching it is to try and educate individuals. That's good, but it only takes you so far. You need a more automatic approach."

People have just grown too accustomed to a lot of salt in their diets, he said.