Review ArticleCurrent salt reduction policies across gradients of inequality-adjusted human development in the WHO European region: minding the gaps

<jats:title>Abstract</jats:title><jats:sec id="S136898001300195X_abs1" sec-type="general"><jats:title>Objective</jats:title><jats:p>To assess current salt<jats:sup>†</jats:sup>reduction policies in countries of the WHO European Region against the backdrop of varying levels of human development adjusted for income, education and health (longevity) inequalities.</jats:p></jats:sec><jats:sec id="S136898001300195X_abs2" sec-type="general"><jats:title>Design</jats:title><jats:p>Population-based, cross-sectional study, with data gathered through systematic review of relevant databases and supplementary information provided by WHO Nutrition Counterparts.</jats:p></jats:sec><jats:sec id="S136898001300195X_abs3" sec-type="general"><jats:title>Setting</jats:title><jats:p>Member States of the WHO European Region.</jats:p></jats:sec><jats:sec id="S136898001300195X_abs4" sec-type="subjects"><jats:title>Subjects</jats:title><jats:p>Inequality-adjusted Human Development Index scores were analysed against assessed levels of development and implementation of national nutrition policies and initiatives targeting population-level salt reduction.</jats:p></jats:sec><jats:sec id="S136898001300195X_abs5" sec-type="results"><jats:title>Results</jats:title><jats:p>Within the WHO European Region, Inequality-adjusted Human Development Index values among countries with no existing salt reduction initiatives (mean 0·643 (<jats:sc>se</jats:sc>0·022)) were significantly lower than among those with either partially implemented/planned salt initiatives (mean 0·766 (<jats:sc>se</jats:sc>0·017),<jats:italic>P</jats:italic>< 0·001) or fully implemented salt initiatives (mean 0·780 (<jats:sc>se</jats:sc>0·021),<jats:italic>P</jats:italic>< 0·001).</jats:p></jats:sec><jats:sec id="S136898001300195X_abs6" sec-type="conclusion"><jats:title>Conclusions</jats:title><jats:p>Where salt reduction strategies are implemented as an integral part of national policy, outcomes have been promising. However, low- and middle-income countries may face severe resource constraints that keep them from emulating more comprehensive strategies pursued in high-income countries. Care must be taken to ensure that gaps are not inadvertently widened by monitoring differential policy impacts of salt policies, particularly regarding trade flows.</jats:p></jats:sec>