Salt Reduction Initiative of the Pan American Forum for

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Salt Reduction Initiative

of the Pan American Forum for Action on NCDs

Report for the Third Meeting of the SaltSmart Consortium

28-29 October, 2014

WHO/PAHO Office, Brasilia, Brazil

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Table of Contents

Executive Summary ………………………………………………………………………………………………………………………… 1

I. Background ...................................................................................................................................... 3

II. Welcome and Agenda ..................................................................................................................... 4

III. Brazil Highlights .............................................................................................................................. 5

IV. Progress with Salt/Sodium Reduction Targets and Other Initiatives ............................................ 7

Dietary salt reduction in Barbados ..................................................................................................... 7

Proposal for a regulation to implement Chile’s "Law 20,606 on nutritional composition and

advertising of foods" and Chile’s voluntary sodium reduction strategy ........................................... 8

Costa Rica’s progress with targets and other initiatives ................................................................... 8

Consumers International – your rights, our mission ......................................................................... 9

Healthy Caribbean Coalition............................................................................................................... 9

American Heart Association Sodium Reduction Initiative .............................................................. 10

International Food and Beverage Alliance ...................................................................................... 10

V. Advancing Harmonization with Regional Targets ......................................................................... 12

The Concept Note on Target Harmonization ................................................................................... 12

Principles to Guide Target Harmonization – the Consensus Statement ......................................... 13

Proposed Regional Targets .............................................................................................................. 13

VI. Consortium Roles and Contributions in Target Dissemination, Maintenance and Monitoring .. 15

VII. Summary of Agreements and Actions to Advance Target Harmonization ................................. 18

VIII. Next Steps .................................................................................................................................. 19

APPENDIX 1: Concept Note on Target Harmonization ......................................................................... 20

APPENDIX 2: List of Participants at the Third Meeting of the SaltSmart Consortium ......................... 24

APPENDIX 3: Meeting Agenda .............................................................................................................. 27

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Executive Summary

Consistent with the SaltSmart Consortium’s Strategic Plan 2013-18 that priorized harmonization of

salt/sodium reduction targets for the Region, the Concept Note on agreeing on harmonized regional

targets for salt/sodium concentration in key food categories in the Americas, was prepared as

preparatory part of 3rd

meeting. The Note proposed regional targets (maximum values) for nine key

food categories and a process for the Consortium to agree to, maintain and monitor the targets. The

Draft Consensus Statement was also prepared to outline a set of principles to guide the Consortium

members in their working together on the proposed process.

Using the Concept Note as the basis for discussion, at the Brasilia meeting, Consortium members

were able to achieve the following objectives to advance regional harmonization of targets:

� Consortium consensus on principles to guide how it can agree on, maintain and monitor

regional targets

� Consortium agreement on proposed regional targets for key food categories

� Consortium identification of roles and contributions of each sector represented in the

Consortium in adopting, disseminating and monitoring regional targets, and how to support

country capacity building to adopt regional targets or set unique national targets

The following are the actions agreed to by Consortium members to advance with target

harmonization:

Action on the Consensus Statement

� The Consortium accepted the principles in the Consensus Statement. A small working group

will adjust the Statement based on discussions and will circulate the new version as soon as

possible.

Action on Regional Targets

� The Consortium accepted the premise on which the regional targets are based and the

proposed values. The sub-group will add a category for condiments and sauces; identify

definitions for the food categories; and highlight the lower value from the range of existing

targets for each food category.

Action on Disseminating Regional Targets

� Each Consortium member will disseminate the regional targets through their channels.

PAFNCDs will circulate the regional targets with the Policy Statement to governments in the

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Region, and will work with Consortium members to compile where the targets have been

disseminated.

Action on Monitoring Adherence to Regional Targets

� PAFNCDs will approach sub-regional food technology institutions and relevant WHO

collaborating centres to explore capacity and willingness to collect label data from industry

to serve a regional initiative. NGOs will approach the George Institute about extending the

training for its iPhone app. The food industry representatives agreed to supply label data to a

central database.

Action on Resource Mobilization

� A sub-group of the Consortium will prepare a funding proposal for nutrition label monitoring.

Participating will be Hubert Linders (CI), Adrianna Blanco (Costa Rica), Mary L’Abbé (Canada),

Maisha Hutton (Healthy Caribbean Coalition), Eduardo Nilson (MOH Brazil) and Maria Roza

Rabanal (IFBA Latin America). The basis for the proposal will be how by using a “food switch”

mobile application, the baseline salt/sodium concentrations for the key food categories can be

determined from food labels and how the values will be reassessed in two years.

With additional impetus from the American Heart Association, the Consortium also agreed to

advance further with social marketing:

Action on Social Marketing

A sub-group of the Consortium will prepare a proposal for the next full Consortium meeting that is

to articulate a way forward for social marketing. Participants will be Diana McGhie (AHA), Maisha

Hutton (HCC), Elizabeth Vargas (UNILEVER), Hasan Hutchinson (Health Canada), the PAHO/WHO

Collaborating Centre at the University of South Florida and the PAHO secretariat.

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I. Background

The global target of 30% relative reduction in salt/sodium intake is a means by which the

populations of WHO Member States can reach the recommended intake level of <2000mg sodium

per day. For the Americas Region, WHO/PAHO encourages achievement of the recommended intake

by 2020.

As of December 2013, there were formal national initiatives to reduce the overconsumption of

salt/sodium in 11 countries in the Americas – Argentina, Barbados, Brazil, Canada, Chile, Columbia,

Costa Rica, Ecuador, Mexico, Paraguay and Uruguay – plus the National Salt Reduction Initiative

(NSRI) in the US, an entity outside the national government. Eight have targets and timelines for

reduced salt/sodium in specified food categories: Brazil, Canada, Mexico and the NSRI have

exclusively voluntary targets; Argentina, Chile and Ecuador have both voluntary and regulated

components to their approaches (the regulations require warning labels on packaged products that

exceed upper limits for critical nutrients including sodium); and Paraguay has regulated the salt

content of bread.

The SaltSmart Consortium in its Strategic Plan 2013-18 agreed to advance the harmonization of

targets and timelines for reducing salt/sodium content within common food groups; and to promote

and implement reformulations to reduce the salt/sodium content in a group of agreed-upon

products, leveraging existing national and industry efforts. The Consortium recognizes that

harmonization will leverage the multisectoral efforts directed at dietary salt reduction in the Region,

benefitting national strategies to improve the quality of the food supply and food industry product

processing: countries without targets can take advantage of the targets and timelines already in

place and the lessons learned; consumers across the Region will be in a better position to achieve

the recommended intake and the associated health gains; and food companies can migrate to

harmonized formulations for same-products supplied to markets in the Americas.

To proceed with regional target harmonization, a sub-group of the Consortium looked into five

countries in the Region where initiatives with target and timeline setting are the most advanced as

of the fall of 2014 – Argentina, Brazil, Canada, Chile and the NSRI. The experiences in these countries

supply the evidence that salt/sodium reduction targets are feasible and acceptable. Each of the

initiatives identified food categories specific to the roles of salt/sodium in formulations and

established targets with timelines to reduce the use of salt/sodium through negotiations between

public health authorities and food industries, assisted by independent food technology experts and

in some cases with inputs of consumers.

A key lesson taken from the most advanced countries is that targets that are maximum values

(upper limits) for salt/sodium concentrations in food products are the most straightforward concept

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with which governments, consumers and the food industry can work. An important finding was that

a number of broad food categories that contribute substantive amounts of salt/sodium to the diet

are common to all the countries. The sub-group combined these two aspects into a Concept Note on

agreeing on harmonized regional targets for salt/sodium concentration in key food categories in the

Americas. The Note had proposed regional targets (maximum values) for nine key food categories

and a process for the Consortium to agree to, maintain and monitor the targets. The sub-group also

prepared a Consensus Statement to confirm a set of principles to guide the Consortium members in

their working together on the proposed process.

Using the Concept Note as the basis for discussion, with this meeting, the Consortium was to

achieve the following objectives to advance regional harmonization of targets:

� Consortium consensus on principles to guide how it can agree on, maintain and monitor

regional targets

� Consortium agreement on proposed regional targets for key food categories

� Consortium identification of roles and contributions of each sector represented in the

Consortium in adopting, disseminating and monitoring regional targets, and how to support

country capacity building to adopt regional targets or set unique national targets

The meeting also provided an opportunity for countries, civil society organizations and food industry

representatives to give updates on national target setting and other relevant initiatives, and to

respond to the proposal for regional targets.

II. Welcome and Agenda

Zohra Abaakouk, Coordinator for Social Determinants of Health, Health Risks, NCDs & Mental Health

in the PAHO office in Brazil, welcomed participants. She acknowledged the importance of the

Consortium’s work in mobilizing multiple sectors towards the common goal of dietary salt/sodium

reduction. She stressed its important contribution to the prevention and control of diet-related

noncommunicable diseases.

This report briefly outlines the presentations made during the meeting and summarizes the

discussions that followed. It concludes with actions that Consortium members agreed to to

advance with target harmonization and outlines next steps with another Consortium objective

– regional social marketing. Complete presentations are posted on the PAHO website at

http://www.paho.org/hq/index.php?option=com_content&view=article&id=10203&Itemid=40

323&lang=en

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Patricia Jaime, Coordinator for Food and Nutrition in the Brazilian Ministry of Health greeted

participants on behalf of the Government of Brazil. Brazil has already demonstrated reductions in

salt/sodium content in selected food groups and reached the 2015 targets. The success underpins

Brazil’s new nutrition guidelines.

Branka Legetic welcomed participants on behalf of the WHO/PAHO and PAFNCDs and reviewed

progress with regional dietary salt reduction. In the first phase of the initiative, the Expert Group

supporting it produced several technical documents now compiled in Salt-Smart Americas – a guide

to country-level action

(http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=21554&Itemid).

Now in its second phase, the dietary salt reduction initiative in the Americas is focusing on

implementation. WHO/PAHO and the Technical Advisory Group (TAG) that now advises the initiative

are supporting three levels of countries: those most advanced that have multiple food categories

with targets and timelines; countries taking preliminary steps with single food categories, the most

common being bread; and countries that anticipate taking action.

In 2012, the SaltSmart Consortium was established on the PAFNCDs platform and produced a

Strategic Plan. At its first meeting, the Consortium priorized two of the Plan objectives: social

marketing and regional target harmonization, areas with existing capacity. At its subsequent

meeting, it explored a social marketing process.

This third meeting of the Consortium is strategic. It is a significant opportunity in that the targets

and timelines in five of the most advanced countries in the Region amount to a critical mass of

evidence of the salt content reductions that are technically feasible and acceptable to consumers.

Guided by the TAG, the Consortium using the PAFNCDs platform mechanisms is in the position to

agree to a set of regional targets for key food categories based on targets that already exist and to

disseminate them across the Region. To this end, during this meeting Consortium members will

consider a Concept Note on target harmonization and a Consensus Statement on a course of action.

III. Brazil Highlights

Brazil’s second edition of dietary guidelines (2014) – Patricia Jaime

The underpinning for Brazil’s latest dietary guidelines is that health is a basic human right

warranting support and protection, and by extension healthy diet is based on broader concepts of

food security and intersectoral health promotion. Unlike other national food guides, Brazil’s

guidelines are based on evidence that people are changing their eating patterns and as such, its key

messages emphasize behaviour:

� Make foods and freshly prepared dishes and meals the basis of the diet.

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� Be sure oils, fats, sugar and salt are used in moderation in culinary preparations.

� Limit the intake of ready-to-consume products and avoid those that are ultra-processed.

Discussion

• How will Brazil change its approach to nutrition surveillance to correspond to the new

guidelines?

To date, monitoring food consumption has involved population and administrative surveys

and nutrition surveillance. There will be a change in surveillance processes to capture the

guideline’s emphasis on behaviours e.g. new indicators will be markers specific to the eating

patterns and consumption of ultra-processed foods.

Brazil NCD Action Plan 2011-2022 – Eduardo Nilson representing Deborah Malta

The Brazilian government is committed to an NCD Action Plan with an intersectoral approach,

having engaged approximately 20 government ministries in its elaboration plus NGOs, universities,

civil society and the private sector. The key risk factors being addressed are tobacco use, harmful

use of alcohol, unhealthy diets and physical inactivity, and action areas are prevention and health

promotion, integral care and surveillance, monitoring and evaluation.

Partnerships for health promotion are based on voluntary agreements between health authorities

and e.g. food industries to reduce dietary salt intake and the media on campaigns to prevent

smoking and encourage fish consumption. Brazil has also advanced with laws on tobacco and

alcohol control and anticipates the same approach regarding e.g. food marketing, tax incentives for

healthy foods and disincentives for unhealthy foods. Priorities with health care are access to free

medicines, prevention of cervical and breast cancer, urgent care and primary health care. The next

step is involving partners in monitoring and evaluation.

Brazil’s progress with food reformulation and monitoring of results – Eduardo Nilson

Monitoring whether biannual sodium reduction targets have been met has involved checking food

labels, conducting laboratory analysis of product samples and following the use of sodium-based

ingredients by food industries. Findings are that there have been reductions not only in the upper

limits of sodium content in food products but also in the average sodium levels of products. The

food companies that have signed agreements have influenced the whole market in that companies

that have not signed agreements have also reduced their sodium use. New targets are now needed

for some of the categories to achieve further reductions. There is continued monitoring of targets

for 2012 and 2013 and of population impacts through surveys.

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Discussion

• How does Brazil deal with food companies that do not achieve the targets?

Given that Brazil’s targets are voluntary, in cases where a food company does not achieve

them, public health authorities will initiate communications to discuss obstacles and work with

the company on a plan to reach the national targets. An underlying incentive for food

companies to respect voluntary targets is the understanding that authorities are willing to

consider fiscal or legal measures to ensure that targets are met.

• What mechanisms and structures are supporting Brazil is its multisectoral approach?

Brazil’s culture of democratic engagement and public consultations is underpinning its

progress. Councils are one mechanism that brings together multiple sectors e.g. one convened

on malnutrition and hunger has evolved to deal with NCDs and micronutrients. There are also

interministerial chambers; the one for food and nutrition security is responsible for an

intersectoral strategy on obesity. A challenge with the multisectoral mechanisms is monitoring

the performance of non-health sectors towards a health objective. Indicators are evolving e.g.

adding teaching of health status as an indicator in education.

IV. Progress with Salt/Sodium Reduction Targets and Other Initiatives

Three countries presented updates, responding to three prompts:

� Have main sources of salt/sodium in the diet been identified in your country population?

� Have food groups for reformulation been selected?

� Is there a monitoring system for following changes in salt/sodium in food?

Dietary salt reduction in Barbados – Trevor Hassell

The final report for the Barbados Sodium Intake Survey is expected before the end of 2014. Its

principle aim was to determine a baseline mean intake of dietary sodium in adults using 24-hour

urine sampling. Its secondary aim is to identify the main sources of dietary sodium in the diet.

Regarding NCDs, civil society is involved in preparing national/regional status reports to inform a call

for action on NCDs in the Caribbean community. There is indication of possible funding support for

specific programmes for blood pressure control and population dietary salt reduction in seven

Caribbean countries.

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Proposal for a regulation to implement Chile’s "Law 20,606 on nutritional composition and

advertising of foods" and Chile’s voluntary sodium reduction strategy – Luisa Kipreos

The public discussions on Chile’s new law are finalized. The law sets upper limits for sodium, sugars,

fats and calories per serving of selected liquid and solid food products, and requires front-of-pack

warnings when limits are exceeded. With Chileans experiencing transitions in lifestyles and

nutrition, the new law intends to assist consumers in understanding the nutrient and caloric profiles

of the food products they are purchasing and give food companies incentive to reformulate.

With bread, the basis for the now regulated sodium content was the reductions that bakeries

achieved voluntarily. For other key sources of sodium in the diet, in particular processed meats and

cheeses, the sectors are not well organized (compared to the bread sector) and responses to

voluntary targets have been weak. The new law is allowing 24 months for product reformulations

after which warning labels will be required if limits are exceeded.

Costa Rica’s progress with targets and other initiatives – Adrianna Blanco-Metzler

Costa Rica has used national household budget surveys to track the main sources of salt in the diet;

the next survey is expected in 2019-2020 and will include collection of 24-hour urine samples to

confirm sodium intake. The most recent survey has shown that a primary source of salt in the diet is

condiments that are added during home cooking. While health authorities made local producers of

condiments aware of the issue at preliminary meetings, a number of obstacles to reformulation

were identified: baseline data on sodium content are not consistently available as nutrition labeling

is not mandatory; there are no current targets to guide reformulations for condiments; and even if

targets were available, small and medium enterprises (SME) in the sector indicate that they lack the

capacity to reformulate.

Since 2012, Costa Rica has been part of an international project coordinated by the George Institute

in Australia that involves countries around the world collecting food label data for the most

common global-brand products and submitting them to a central database. These data represent a

baseline for sodium content (and other nutrients) for these products in each participating country

and allows comparison of products between countries. Data from more than 5000 labels have been

collected to date In Costa Rica. Subsequent data collection for the same products will capture

changes in the nutrient profiles.

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Three civil society organizations presented updates, responding to three prompts:

� How is your organization supporting salt/sodium reduction activities in the region?

� What is the capacity and interest of your organization to support dissemination of regional

targets?

� Does your organization have the ability to support monitoring of regional target

implementation e.g. collect label data?

Consumers International – your rights, our mission – Hubert Linders

CI is promoting a framework convention on unhealthy food control similar to the FCTC, with the goal

of making healthy foods accessible to all consumers. Specific to dietary salt/sodium reduction, CI for

Latin America working with PAHO has set up ALASS (Acción Latino-Americana de Sal y Salud), the

regional counterpart of WASH that provides information for consumers and professionals in

Spanish. CI is working on strengthening and consolidating ALASS as a network. One feature is an

interactive map with countries in the Region showing advances in salt/sodium reduction through

legislation, voluntary agreements, industry efforts and civil society findings.

It is anticipated that CI members and other civil society groups will undertake the monitoring

activities proposed in the Concept Note on target harmonization. Needed are protocols, capacity

building and resources.

Healthy Caribbean Coalition – Maisha Hutton

HCC is supporting salt reduction activities in the Caribbean through: ongoing education e.g.

publishing a weekly newsletter, posting on HCC social media and other member websites; and

supporting the annual WASH activities, the Barbados Sodium Intake Survey and the PAFNCDs

SaltSmart Consortium since its inception. HCC will also be supporting the planned civil society salt

reduction initiative to involve seven Caribbean countries.

HCC has the interest and capacity to support dissemination of regional targets; as to supporting the

monitoring of uptake of regional targets by e.g. collecting label data, HCC has the interest but not

the capacity.

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American Heart Association Sodium Reduction Initiative – Diana Vaca McGhie

AHA has three strategic priorities to reduce sodium intake at the population level: support federal

sodium targets; increase consumer demand; and coordinate scientific responses. Specific to its

consumer campaign, objectives are to increase awareness, inspire behaviour change and build an

audience of supporters. AHA is promoting “life’s simple 7” to achieve its 2020 Impact Goal – a 20%

improvement in health status relative to seven risk factors (one of which is healthy diet); and

improving cardiovascular health by 20% while reducing deaths from CVD and stroke by 20%. Sodium

intake of <1500mg/day is a feature in healthy diet. AHA’s overarching logo for the 2020 initiative is

“Life is Why”.

Food industry representatives responded to three prompts:

� On 15 September 2014, IFBA renewed its worldwide commitment to health and wellness. How

does the commitment apply to salt/sodium reduction in the Americas Region?

� What would be your organization’s contribution to encouraging other food companies and food

sectors to adopt regional targets?

� What would be the role of the food and beverage industry in supporting the monitoring process

for regional targets?

International Food and Beverage Alliance – Maria Roza Rabanal

IFBA members made their first collective commitment to the WHO Global Strategy on Diet, Physical

Activity and Health (2004) in 2008. Members enhanced their commitment to WHO in September

2014 in response to the 2011 UN Political Declaration of the High-level Meeting on the Prevention

and Control of NCDs and WHO’s Global Action Plan (2013-2020) for NCD prevention and control.

Specific to sodium, each IFBA member will be announcing an approach to sodium reduction if

applicable to the company’s portfolio. To date, one of Mondelez’s stated actions has been 10%

reduction in sodium in its current food portfolio.

Alliance of Food and Beverage Associations in Latin America (ALAIAB) – Strategy to Strengthen the

Food and Beverage Industry in Latin America – Diego Hekimian

ALAIAB is a relatively new entity; its board of directors was elected and organizing statutes

approved in May 2014. Association members are currently in 14 countries. Key objectives are to

expand membership and to strengthen the image and positioning of food and beverage industries

throughout the Region. The Alliance frames industry respect for voluntary agreements for sodium

reduction as consistent with one of its values – to contribute to society and governments. Examples

are the agreements made by COPAL in Argentina and ABIA in Brazil along with those made by

product-specific trade associations in both countries.

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Discussion

• How will IFBA’s renewed worldwide commitment to health and wellness, declared in

September 2014, relate to salt/sodium reduction in the Region?

By the end of 2014, each IFBA member will make public its specific commitments to improving

the nutrient profiles of its food products. Commitments like these need to go beyond IFBA to

include small and medium enterprises in as many countries as possible.

• Monitoring the salt/sodium content of breads from small local bakeries is posing a challenge in

Brazil as none of the establishments label their products. How does Chile monitor small bakery

breads?

To fulfill the requirements of the new regulation, public health authorities have taken samples

from artisanal bakeries for analysis. Currently there is capacity for product analysis in the

Metropolitan area; the Ministry of Health and the Public Health Institute are working to set up

four other centres in the country to analyze samples.

• Why has Chile set a two-year window for the food industry to complete reformulations?

After two years the new law will be enforced. During the two years, public health authorities

will be encouraging food sectors as needed to reformulate.

• What is the extent of the controversy in Central and South America around the science

supporting dietary salt reduction?

In Brazil, the salt industries represented by the Salt Institute are fuelling the controversy. Brazil

is countering with data supplied by e.g. WASH.

In North America the food industry is resourcing a continuation of the controversy despite

having publicly agreed to voluntary salt/sodium reductions. Food companies must have an

internal consistency regarding the issue.

• How is the AHA working with CDC and the FDA?

AHA is promoting a more aggressive target for sodium intake (<1500mg Na/day) than the

other institutions. AHA’s added value is in its increasing support to consumers and elevating

the urgency of salt/sodium reduction policies needed at federal and state levels.

• What is the capacity of civil society for product monitoring?

Food formulations differ depending on the country. In very general terms, countries in the

“south” have less healthy foods than in the “north”. But no matter the region, civil society

organizations can undertake product monitoring e.g. the WASH initiative, by taking advantage

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of available instruments and mechanisms e.g. the George Institute application. Nevertheless

they need resources; they have limited capacities.

V. Advancing Harmonization with Regional Targets

The Concept Note on target harmonization – Norm Campbell and Mary L’Abbé, WHO/PAHO TAG,

Consortium sub-group on target harmonization

The Concept Note outlines four steps for the Consortium to advance regional harmonization of

targets: confirm the role of regional targets, agree on target values, promote and disseminate them

and monitor progress. At this meeting the Consortium is in a position to take the first two steps –

agree on the role of regional targets, confirmed through a Consensus Statement, and agree on

proposed regional target values based on existing targets for common key food categories. For the

latter two steps – dissemination of regional targets and monitoring their adoption – the Consortium

will examine the options presented in the Concept Note and decide on how to take these two steps

forward.

This meeting is an opportunity to build on the initiatives in the Region that are the most advanced

with targets and timelines for salt/sodium reduction. Their approaches and experiences have

already been distilled in the Guide for Setting Targets and Timelines to Reduce the Salt Content of

Food, published by PAHO in 2013, directed at countries that intend to set unique national targets. In

broader terms, the Guide is to foster collaboration and harmonization of approaches, and support

expansion and consistency of targets.

The targets that have been agreed to in countries can be further disseminated. Referring to the

maximum target values that a number of countries have set for key food categories, this Consortium

can by consensus agree to regional harmonized targets – maximum values (upper limits) for specific

food categories to guide countries that to date have not established their own targets.

The starting points for this meeting are therefore a Concept Note on target harmonization – setting

regional targets; a Consensus Statement that sets out the principles by which the Consortium can

agree to, maintain and monitor regional targets; and a table of proposed regional harmonized

maximum targets adapted from Appendix 1 in the Guide (Targets and timelines for food categories

common in Argentina, Brazil, Canada, Chile and the NSRI (updated in October 2014)).

In the table of proposed targets that the Consortium will consider, the food categories selected

were identified as major sources of salt/sodium in two or more countries, and maxima targets were

preferred from among the target types that the various countries have chosen. Fundamental to

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basing harmonized regional targets on existing targets is that the latter have been set after

extensive consultations.

Discussion

• The regional targets proposed are maximum values. Four countries in the Region have

maximum values for multiple food categories (Argentina, Brazil, Canada and Chile). Where at

least two of the countries have a maximum value for a common food category, the highest

value was taken as the regional target.

• Regional targets, as upper limits, can only influence foods that are outliers at the high end,

whose salt/sodium content is higher than the regional target.

• Maximum values for food categories are more readily understood and accepted than averages

or sales-weighted-averages, and between countries, are most readily transferable for common

food categories. Regional maxima are a reasonable first step with target harmonization for the

Region.

• The extent of similarity or difference among products in a food category determines whether

sub-categories are needed. Definitions for the food categories will be clarified.

Principles to Guide Target Harmonization – the Consensus Statement – Branka Legetic

The Consensus Statement has both the principles to guide the Consortium in accepting harmonized

regional targets and a “call to action”. With harmonization in the Consortium’s Strategic Plan and

with a working version of proposed regional targets in hand, agreement on the principles in the

Consensus Statement will move this objective forward.

Proposed Regional Targets – Mary L’Abbé

The principles to guide the Consortium’s agreement to regional targets are consistent with the

principles that countries applied to determine their national targets:

– Countries priorized food categories that contributed significant amounts to salt/sodium

intakes. The proposed food categories for target harmonization are among the categories

selected by at least two of the four countries with maximum target values (upper limits). For

most of the food categories, the categories are broad and the targets have a relative

consistency in the Americas.

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– Countries set their targets through extensive consultations, with advice that the targets

were technically feasible and that they respected the characteristics and roles of

salt/sodium for the food categories. Choosing the highest value from the range of maximum

targets to be a regional target for a food category is the least stringent approach to

harmonization.

- The timeline target year of 2016 is consistent with the proposed two-year approach for

review.

Discussion

• Other Regions are taking similar approaches. The EU community has 15 common food

categories with maximum values; countries are to choose five categories that are priorities in

national contexts. Across the EU, out of the 15 categories, five are most consistently selected.

For the Pacific Islands where targets do not exist, maximum values were determined from

external sources and will be re-visited over time.

• Regional targets can be useful to transnational food companies to guide the formulations of

same-food portfolios. They can potentially facilitate common market activities related to

standardizing food imports and exports. Within countries, because regional targets are

maximum values, compliance amongst SME should be easier than with other types of targets.

• For Paraguay, the regional targets will be useful as guides for national industries and if

accepted at MERCOSUR, will make imported products also compliant. Paraguay’s legislation on

salt/sodium content of bread has already taken effect; bread has been evaluated at 509mg

Na/100g, below the proposed regional target.

• Chile has demonstrated that for bread, 400 mg Na/100g – a substantially lower target value

than the proposed regional target – is also feasible. The lower values in the ranges for the food

categories are equally legitimate targets for the categories.

• Columbia is in the process of setting targets and timelines. The utility of the regional targets is

clear – there is no need for national targets to be above the highest maximum values already

set.

• Governments and food companies can use the existing targets as “reference values”. Each of

the food categories has a range of maximum targets. The national target for a food category

should be less than the highest value in the range but countries can be more ambitious.

Regional targets do not preclude countries from setting lower more stringent targets. The

lowest values in the ranges are in fact the current optimal targets that governments and food

industries should be aiming for.

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• For the Caribbean, regional targets are practical, realistic and relevant, and coming from

WHO/PAHO, also legitimate. Small countries can be inspired to act when there is action and

good examples elsewhere. Agreement on regional targets is a test for the Consortium as they

will be useful for the Region.

• Regional targets are relevant in the context of MERCOSUR, specifically the working group on

food and nutrition security that is preparing its action plan. With the key broad food

categories having been defined with industry in a number of countries, all based on the role of

salt/sodium in formulations, they accommodate the differences in details within a category

that may be found in different countries. Selecting the current highest maximum value from

the range of maxima to be the regional target for a food category gives governments and the

food industry flexibility and confidence to adopt it or a lower target from the range as all the

values have been demonstrated as feasible.

• These initial regional values are a feasible option as national targets for countries that lack

data or capacity to establish unique national targets. This way the number of countries in the

Region active in reducing salt/sodium intake can grow. As countries gradually achieve their

respective maximum targets or the regional targets, the ranges of maximum values for food

categories will shift downwards and a new set of lower regional targets can be established.

Over time, the benefits of lower salt/sodium intake will be equitably distributed across the

Region.

• A key food category that needs to be addressed and assigned regional targets is condiments

and sauces. These are added during home cooking and are an important and increasing source

of salt/sodium in Costa Rica and generally in Central America.

VI. Consortium Roles and Contributions in Target Dissemination, Maintenance and

Monitoring

Discussion

• How best to reach countries without targets?

The Guide for Setting Targets and Timelines for Reducing the Salt Content of Food (2013) is the

primary resource for countries that intend to determine unique national targets. The regional

targets proposed now must nevertheless be disseminated as widely as possible as they are

relevant to countries with and without the data and capacity to set unique targets. Regional

values should be central in meetings with relevant food industry sectors.

16

Civil society can use its networks and community channels to raise awareness of the targets

e.g. ALASS accounts for 15 countries in the Region. Regional targets can be supplied first to the

associations in ALASS as the norms they are to respect and promote. These associations can

then disseminate them further, and the ALASS network itself is expected to grow.

Dissemination needs to also reach societies of health professionals.

The regional targets should be disseminated to the entities that endorsed the original Policy

Statement on salt/sodium reduction and otherwise, should be disseminated along with the

Policy Statement as broadly as possible. The PAFNCDs and the Consortium can encourage

them to use and/or disseminate them within their respective countries and networks.

The Latin American alliance of food and beverage associations (ALAIAB) is prepared to

participate in disseminating and monitoring the regional targets among its members.

• How best to monitor adherence to regional targets?

The ALAS website can be a platform for making public the reformulation pledges that food

companies make in countries.

In Brazil, the government, food industries and civil society are all collecting nutrient profile

data. Government laboratories examine label data and ANVISA the health surveillance agency

conducts chemical analyses. Government data are considered “official” as they are based on

label information and chemical analyses.

The issue at hand is the collection of data in countries that do not have the capacity to collect

label information or to chemically analyze food products. Nutrition labels may not be

mandatory and laboratory analyses require rigorous methodologies to be reliable.

Monitoring must be feasible and sustainable, and account for all the countries in the Region.

Baselines for salt/sodium concentrations for the key food categories must be determined now

and the concentrations reassessed every two years to check if regional targets are taking hold.

The food industry considers label data (+/- allowed margins of error) to be more reliable than

data from chemical analyses. Because of a lack of standardization in practices, different

laboratories have been found to produce different values for nutrient concentrations.

To enforce its law on maximum sodium concentrations per food category, Argentina has

designated specific laboratories to conduct analyses of samples for each food category, this

way addressing the issue of standardization.

17

The food industry can supply label data. Outstanding are selection of independent institution

(possibly one of WHO Collaborative centers) that would receive and process the data, the

mechanisms for supplying and receiving the data and extent of their analysis. Needed are

criteria to select an institution to collect label data – using a simple and flexible approach to

apply only to the key food categories with regional targets. The institution must be willing to

be a partner in piloting a process and have the capacity to scale up. Resources will need to be

mobilized.

To be explored is an opportunity to apply the George Institute iPhone method to more broadly

collect brand-label data. A regional initiative to collect data combined with the George

Institute project would significantly add value to label data collection on a global scale.

18

VII. Summary of Agreements and Actions to Advance Target Harmonization

Action on the Consensus Statement

The Consortium accepted the principles in the Consensus Statement. Small working group will

adjust the Statement based on discussions and will circulate the new version as soon as possible.

Action on Regional Targets

The Consortium accepted the premise on which the regional targets are based and the proposed

values. The working group will add a category for condiments and sauces; identify definitions for

the food categories; and highlight the lower value from the range of existing targets for each

food category. A new table of targets will be circulated.

Action on Disseminating Regional Targets

Each Consortium member will disseminate the regional targets through its channels. PAFNCDs

will circulate the regional targets with the Policy Statement to governments in the Region, and will

work with Consortium members to compile where the targets have been disseminated.

Action on Monitoring Adherence to Regional Targets

PAFNCDs will approach sub-regional food technology institutions and relevant WHO

collaborating centres to explore capacity and willingness to collect label data from industry to

serve a regional initiative. NGOs will approach the George Institute about extending the training

for its iPhone app. The food industry representatives agreed to supply label data to a central

database.

Action on Resource Mobilization

A sub-group of the Consortium will prepare a funding proposal for nutrition label monitoring.

Participating will be Hubert Linders (CI), Adrianna Blanco (Costa Rica), Mary L’Abbé (Canada),

Maisha Hutton (Healthy Caribbean Coalition), Eduardo Nilson (MOH Brazil) and Maria Roza Rabanal

(IFBA Latin America). The basis for the proposal will be how baseline salt/sodium concentrations

for the key food categories can be determined from food labels and how the values will be

reassessed in two years.

19

VIII. Next Steps

To Advance Further with Social Marketing – Diana McGhie, American Heart Association (AHA)

AHA has been testing messages on dietary sodium reduction aimed at consumers. The messages

may be adaptable to e.g. the English Caribbean working with the Healthy Caribbean Coalition. AHA’s

instruments and methods may also inform social marketing initiatives for Central and South

American countries. The WHO collaborating centre on social marketing at the University of South

Florida will be engaged.

Specific formative research will be necessary on which to base a social marketing process. Messages

need to be culturally appropriate and aligned to the knowledge, attitudes and behaviours of

consumers in defined markets. The Consortium will need to harness the marketing expertise of the

food industry.

Action on Social Marketing

A sub-group of the Consortium will prepare the proposal for the next meeting of the

Consortium to articulate a way forward for social marketing. Participants will be Diana

McGhie (AHA), Maisha Hutton (HCC), Elizabeth Vargas (UNILEVER), Hasan Hutchinson (Health

Canada), the PAHO/WHO Collaborating Centre at the University of South Florida and the PAHO

secretariat.

20

APPENDIX 1: Concept Note on Target Harmonization

Concept Note – Agreeing on regional targets for the salt/sodium concentrations in

key food categories in the Americas

Definitions

Key food categories – the most common food categories selected for reformulation of salt/sodium

content that have been identified in at least two of the five initiatives in the Americas with the most

comprehensive reformulation schedules – Argentina, Brazil, Canada, Chile and the NSRI. Food

category definitions are taken from the Harmonized Commodity Description and Coding System (HS)

of the Customs Tariff. Where HS codes do not apply, or if preferred, the category definitions

established by countries can be used.

Maximum value – the upper limit for salt/sodium concentration for a food category or product

accepted by public health authorities and food companies to be technologically feasible and

acceptable to consumers, yet sufficient to achieve a public health impact

Regional target for salt/sodium concentration – the highest value for salt/sodium concentration

per 100g of food product taken from the range of existing maximum values/upper limits per food

category set by countries in the Americas. Where the regional target for a food category has already

been met, the lower value in the range of existing maximum targets should become the

reformulation target.

Background

The first Consortium meeting was held in 2012 where members agreed to several main lines of

work. At a second meeting, members accepted a Five-year Strategic Plan (2013 to 2018). Of the five

objectives in the Plan, they chose to begin with two: social marketing and harmonization of targets.

A sub-group of members agreed to work on each of the objectives. Also during the second meeting,

members drafted a creative brief for a social marketing campaign.

With 12 countries in the Region having initiatives to reduce the overconsumption of salt, and

expecting the number to grow, given that salt intake reduction is among the WHO global indicators

key to reducing NCDs, it is timely for the Consortium to address target harmonization. The intention

is to support the harmonization of targets for food groups common to multiple countries, leveraging

on existing national targets in order to support the broader application of such targets throughout

the region. Achieving this objective will benefit both national public nutrition initiatives and the food

21

industry: countries that intend to set targets for reformulations, but may not have the resources to

do so individually, can take advantage of the investments made and lessons learned by others to

establish targets and timelines; and food companies can migrate to harmonized formulations for

same-products supplied to markets in the Region.

PAHO TAG has prepared a Guide to assist countries in setting their own targets.1 For countries that

lack the capacity to do so and to advance the Consortium’s objective on harmonization in the

Region, TAG has compiled the targets and timelines for nine food categories common in five

countries – Argentina, Brazil, Canada, Chile and the NSRI. In these countries, food categories for

reformulation and targets were agreed upon through negotiations between public health

authorities and the food industry, with assistance from independent food technology experts, and in

some cases inputs of consumers.2

What are most feasible to transfer from the five countries above to those that intend to have

reformulations are the targets that are maximum salt/sodium concentrations per 100g of food

product. Targets based on maxima are not only a straightforward concept for the food industry and

consumers, the process of deriving and re-deriving the targets and ongoing monitoring, given the

downward shift expected in maxima as reformulations proceed, is more feasible using maxima than

averages or sales-weighted averages.

The identification of key food categories and corresponding regional targets for them, however,

does not preclude countries from deriving sales weighted averages or averages as additional targets

for the salt/sodium content of foods nor from setting targets for other food categories or

establishing more stringent national targets, either voluntary or mandatory. Regional targets

nevertheless will support expansion and consistency of salt/sodium reduction efforts into a broader

number of countries, leveraging multisectoral efforts in this area.

The process below is proposed to advance the agreeing upon regional targets for key food

categories. For each step and its outcomes, there are roles and contributions for each of the sectors

represented in the Consortium – countries, the food industry, civil society, TAG and PAFNCDs.

1 Guide for setting targets and timelines to reduce the salt content of food, 2013,

http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=21493&Itemid=

2 Targets and timelines for food categories in common in Argentina, Brazil, Canada, Chile and the

National Salt Reduction Initiative in the United States,

http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=25647+&Itemid=99

9999&lang=pt

22

Proposed process to agree upon, maintain and monitor regional targets

Codes of conduct on transparency, full disclosures and declarations of conflicts of interest will be

applied as needed.

Step Outcomes

Roles and contributions

1) Confirm the

role of regional

targets in target

harmonization in

the Region

Consortium consensus on principles to guide

agreement on and dissemination, maintenance

and monitoring of regional targets

All Consortium members agree to the Consensus Statement

2) Agree upon

regional targets

A harmonized maximum value for salt/sodium

concentration per key food category or food

product as mg Na per 100g for a given year

Plan for progressively lower regional targets for

the salt/sodium concentration of common staple

foods

All Consortium members:

• confirm the key food categories/ products

• confirm the maximum target per key food

category/product

• identify a schedule for revisiting the regional targets

• identify options for monitoring adherence to the

established targets

3) Promote and

disseminate

regional targets

Consortium members endorse the regional targets

as a means to advance harmonization and

participate in encouraging uptake by food

companies supplying key products in the Region,

particularly in markets without national targets

Civil society entities endorse the regional targets

and participate in their promotion and monitoring

PAFNCD circulates the regional targets

PAFNCD/PAHO/TAG support countries to build capacities

necessary to set regional targets

4) Demonstrate

and report on

progress towards

meeting the

targets

Publication of food industry pledges to the targets

Up-to-date food composition databases

Verified label data

MONITORING

Options for data collection

• industry voluntarily and regularly provides food

composition data on products in the key categories to

an independent institution

• industry voluntarily and regularly provides label data

on products in the key categories to an independent

institution

23

Public awareness of food company performance

• an independent institution collects product samples

and label data

• civil society entities collect label data

EVALUATION

Options for verification of label data

• an independent entity chemically analyzes a sub-set of

products for label accuracy

• civil society entities monitor accuracy of label data

REPORTING ON ADHERENCE TO TARGETS

• PAFNCD using results of data analyses reports

publically on adherence

• Civil society entities report publically on adherence

Assumptions

• composition data supplied and / or label data collected

• an independent entity conducts chemical and / or label analysis

• ongoing collection of maximum values per food categories / products

• as maxima adjust downwards, regional targets adjusted accordingly

• capacities and resources for the initiative maintained

24

APPENDIX 2: List of Participants at the Third Meeting of the SaltSmart Consortium

28-29 October 2014

WHO/PAHO Office in Brasilia, Brazil

Lorena Andrea Allemandi

Director

Area of Healthy Nutrition Policy

Inter-American Heart Foundation, Argentina

(FIC Argentina)

Scalabrini Ortiz 2470 4 H

1425 Ciudad Autónoma de Buenos Aires

Telephone: 54-11-4831-2238

Email: [email protected]

Norm Campbell MD FRCPC

Libin Cardiovascular Institute of Alberta

University of Calgary

3280 Hospital Drive NW

Calgary Alberta

T2N 4Z6

Telephone: 403-210-7961


Abraham Miranda,

Health Attache

Embassy of USA

Telephone: 55 61 3312 7697

Cellphone: 55 61 8224 8700

Email:[email protected]

Trevor Hassell

Chair, National Barbados NCD Committee

Cnr River Road & Spruce Street,

St. Michael, Barbados, BB11155

Telephone: 246 435 7486


Diego Hekimian

Vice President

Department of Institutional Affairs COPAL

Alianza Latinoamericana de Asociaciones de la

Industria de Alimentos y Bebidas (ALAIAB)

Telephone: 54 5533 5000 int 5197


Maisha Hutton

Executive Director

Healthy Caribbean Coalition


Patricia Jaime

Coordinator of Food and Nutrition

Ministry of Health, Brazil


Luisa Kipreos

Department of Eating and Nutrition

Chilean Ministry of Health

Telephone: 2 25740474 -2 25740493


Mary R. L'Abbe

Earle W. McHenry Professor and

Chair, Department of Nutritional Sciences,

Faculty of Medicine, University of Toronto

FitzGerald Building, 150 College St, Rm 315

Toronto, ON Canada M5S 3E2

Telephone: 416-978-7235

Cellphone: 416-605-1902


Hubert Linders

Project Coordinator, fundraising officer

Consumers International

The Global Campaigning Voice for Consumers

Juan Antonio Ríos 58, 7th floor

Santiago, Chile

Telephone:56 2 2632 2084

Cellphone:56 2 9101 5522


Diana Vaca Mcghie

Global Strategies & Programs

American Heart Association

25

1150 Connecticut Avenue, Suite 300

Washington D.C. 20036

Telephone: 202-785-7917

Cellphone: 202-230-9074


Adriana Blanco-Metzler

Researcher, Instituto Costarricense de

investigación

y Enseñanza en Nutrición y Salud

INCIENSA

Tres Rios, San José, Costa Rica


Claudia Patricia Moreno Barrera

Promoting an Prevention Department

Ministry of Health and Social Protection

Colombia

Telephone: 3305000 ext 1246


Eduardo Augusto Fernandes Nilson

Vice coordinator of Food and Nutrition

Ministry of Health


Susana Sanchez

Directora de Nutrición y Programas

Alimentarios

Instituto Nacional de Alimentación y Nutrición

Telephone: 595 21-294073

Cellphone: 595 981-249685


Juliana Faria

R & D Manager

Grupo Bimbo

Rua Errico Verissimo, 342

Sau Paulo/05560-900

Brasil

Telephone: 55 11 21 77 9195


Maria Rosa Rabanal

Scientific, Regulatory Affairs and Nutrition

Manager for Southern Cone and H&W LA

Mondelez

Buenos Aires, Argentina


Elizabeth Vargas

Nutrition and Health Regional Leader - Latin

America

Unilever Brasil

Itaim Bibi | São Paulo | 04543-011

Av. Pres. Juscelino Kubitschek, 1309

Telephone: +55 11 3568 8321

Cellphone: +55 11 98927-7756


ABIA Brazil representatives:

Daniella Cunha (Director of Institutional

Relationships)

Edmund Klotz (President)

Ignez Novaes de Goes (Technical Manager)

SECRETARIAT:

Branka Legetic

PAHO-WHO Regional Advisor & Unit Chief

Noncommunicable Diseases and Disabilities

Department of Noncommunicable Diseases and

Mental Health

Telephone: 202 974 3892

Cellphone: 202-316-6459


Barbara Legowski

Temporary Advisor

17 Loch Isle Road

Ottawa, ON K2H 8G5, Canada

Telephone: 613 726 2625


Silva, Dra. Ana Carolina Feldenheimer

Advisor in Nutrition issues

PAHO office Brazil


Zohra Abaakouk

Coordinator

26

Social Determinants of Health, Health Risks,

NCDs & Mental Health

PAHO office Brazil


27

APPENDIX 3: Meeting Agenda

SALTSMART CONSORTIUM

The Multi-stakeholders Committed to Reducing the Overconsumption of Dietary Salt in the Americas

28-29 October 2014, WHO/PAHO Office, Brasilia, Brazil

Acknowledging progress with dietary salt reduction in the Region

Advancing harmonization – agreeing on regional targets for the salt/sodium content

in key food categories

Background

As of December 2013, 11 countries in the Pan American Region have formal national initiatives to

reduce the overconsumption of salt – Argentina, Barbados, Brazil, Canada, Chile, Columbia, Costa Rica,

Ecuador, Mexico, Paraguay and Uruguay – plus in the United States, the National Salt Reduction

Initiative (NSRI) is an entity outside the national government. Eight have targets and timelines for

sodium in specified food categories: Brazil, Canada, Mexico and the NSRI have exclusively voluntary

targets; Argentina, Chile and Ecuador have both voluntary and regulated components to their

approaches (the regulations require warning labels on packaged products that exceed upper limits for

critical nutrients including sodium); and Paraguay has regulated the salt content of bread. Given that salt

intake reduction is among the WHO global targets key to reducing NCDs, national initiatives to reduce

the overconsumption of salt are expected to grow.

The SaltSmart Consortium in its Strategic Plan 2013-18 agreed to advance the harmonization of targets

and timelines for reducing salt/sodium content within common food groups; and to promote and

implement reformulation actions to reduce salt/sodium in a group of agreed-upon products, leveraging

existing national and industry efforts. A sub-group of Consortium members that agreed to work on this

objective is now proposing a process to this end. Harmonization will benefit both the food industry and

national public nutrition initiatives: food companies and particularly multinationals can migrate to

standard formulations for same-products supplied to markets in the Region; and countries that intend

to set targets for reformulations can take advantage of the investments made by others to establish

targets and timelines.

In five countries – Argentina, Brazil, Canada, Chile and the NSRI in the US – targets and timelines for

reformulation were derived through negotiations with the food industry and with assessments by

independent food technology experts, and in some cases consumers. The proposal to harmonize targets

is referring to the targets set in these five countries as they demonstrate that the scheduled

reformulations are feasible and acceptable.

28

This Meeting

With this meeting, the Consortium will agree on principles as well as propose maximum values for

regional targets and the process to disseminate them, and monitor adherence to them. The basis for

discussions is the Concept Note on agreeing on regional targets for salt/sodium concentration in key

food categories in the Americas.

The meeting is also an opportunity to highlight other advances in the Region addressing dietary salt

reduction.

Objectives for Day 1: Updates and highlights; introduction to harmonization – consensus on regional

targets

1. Updates and highlights from Brazil

2. Other country updates

3. Food industry and trade association updates; September 2014 IFBA commitments – impacts in the

Americas region

4. Civil society updates

5. Consortium consensus on basis for regional targets

Objectives for Day 2: Agreeing on regional targets; outlining a process to disseminate targets and

monitor adherence

1. Identification of roles and contributions of Consortium members in adopting, disseminating and

monitoring regional targets, and how to support country capacity building to adopt or set targets

2. Next steps

AGENDA

Tuesday 28 October

8:15-8:45 REGISTRATION

8:45-9:00

WELCOME AND INTRODUCTIONS

Brazil MOH

PWR, WHO/PAHO representative to Brazil

9:00-9:15

AGENDA

• Review of objectives and agenda

• Introduction of participants

29

Branka Legetic, WHO/PAHO

9:15-10:00

10:00-10:15

BRAZIL HIGHLIGHTS

• New Food Guide

Patricia Jaime, Brazil MOH

• National plan addressing noncommunicable diseases

Deborah Malta, Brazil MOH

• Progress on food reformulations and monitoring of results

Eduardo Nilson, Brazil MOH

• Q&A

10:15-10:45 BREAK

10:45-11:15

11:15-11:45

11:45-12:15

12:15-12:45

PROGRESS ON TARGETS AND OTHER INITIATIVES

� Country panel – Barbados, Canada, Costa Rica

� Civil society panel – Consumers International, Healthy Caribbean Coalition,

American Heart Association

� Industry and trade associations panel September 2014 IFBA commitments –

Mondelez, ALAIAB, UNILEVER

� Q&A

12:45-2:00 LUNCH

2:00-2:40

2:40-3:10

ADVANCING HARMONIZATION WITH REGIONAL TARGETS

� Presenting the Concept

Norman Campbell, Co-chair TAG and Mary L’Abbé, TAG

• Discussion

Rosa Maria Rabanal, Mondelez, moderator

3:10-3:40 BREAK

30

3:40-3:50

3:50-4:30

CONSENSUS ON PRINCIPLES

� Presentation of the Consensus Statement


� Discussion and agreement on the Consensus Statement

Diana Vaca McGhie, AHA, moderator

4:30 ADJOURN

Wednesday 29 October

8:30-8:45 WELCOME BACK

� Review of Day 1, objectives for Day 2


8:45-9:15

9:15-10:30

PROPOSED REGIONAL TARGETS

� Presentation of regional targets for key food categories

Mary L’Abbé, TAG

� Break out groups

10:30-11:00 BREAK

11:00-12:30 � Plenary - groups report back

Adriana Blanco, Costa Rica, moderator

� Agreement on regional targets

12:30-2:00 LUNCH

2:00-2:15

ROLES AND CONTRIBUTIONS IN TARGET DISSEMINATION, MAINTENANCE AND

MONITORING

� Presentation of elements in dissemination and maintenance of regional targets

and monitoring of adherence to targets

Eduardo Nilson, Brazil MOH

� Break out groups

31

2:15-3:00

3:00-4:00

� Plenary – groups report back

Trevor Hassel, HCC, moderator

� Confirmation of roles and contributions

Elizabeth Vargas, UNILEVER

4:00-4:15 BREAK

4:15-5:00 NEXT STEPS

� Next meeting

5:00 ADJOURN

Documents

Salt Reduction Initiative of the Pan American Forum for