Reducing salt consumption is one of the most effective ways to combat high blood pressure and prevent cardiovascular diseases (CVDs), which claim 10 000 lives every day in the WHO European Region. Yet in most countries across the Region, salt intake remains well above the recommended 5 g per day. During Salt Awareness Week 2025, WHO/Europe will underscore the urgent need for strategies that can support effective salt reduction policies.
Excessive salt intake contributes to heart attacks, strokes and other life-threatening noncommunicable diseases (NCDs). Evidence shows that reducing salt consumption by 25% through strong public health policies could prevent up to 900 000 deaths from CVDs in the Region by 2030. Tackling this issue must be a top priority, as CVDs remain the leading cause of death in the Region – responsible for 4 million deaths annually, particularly affecting men and populations in the eastern part of the Region.
Salt intake: look for the main source
At the individual level, it is very hard to control salt intake as more than 70% of the salt we consume comes from processed foods.
“Countries need tools to identify and control the major sources of salt intake. That’s why the main advice for policy-makers would be to focus on gathering data and learning what should be the main focus of action,” says Dr Maria João Gregório, who is co-leading the Regulation and Taxation Work Package at JA PreventNCD, a project that supports better NCD policies across the European Union.
Portugal’s experience: regulation and public support
As the Director of Portugal’s National Programme for Healthy Eating Promotion, Maria João has been coordinating salt-reduction policies in the country for more than 5 years and shares insights based on her experience.
Portugal became one of the first countries in the Region to implement a mandatory salt target for bread in 2009. Given bread’s central role in the Portuguese diet, the initial target of 1.4 g of salt per 100 g of bread was a strategic first step. Today, through a voluntary agreement with the baked-goods sector, Portugal has gone even further – reducing the limit to 1 g per 100 g.
A similar voluntary agreement followed for other high-salt food categories, such as popular Portuguese ready-to-eat vegetable soups.
Navigating potential barriers
“Some salt reduction polices, like taxation and mandatory reformulation are not easy to implement,” Maria João admits. Food companies are not so keen to support regulatory measures like mandatory reformulation or labelling.
Some progress only came after political pressure. In 2016, a proposed salt tax in Portugal failed to pass in parliament, which instead recommended pursuing a voluntary agreement with industry. This political dynamic led to fruitful negotiations – and shows how broader political context can influence the strategy taken.
Three policy lessons
According to Maria João, 3 essential strategies can help countries shape effective salt reduction policies.
Collect better data
“You cannot manage what you don’t measure,” she explains. Maria João advocates for 2 main tracks of data collection: regular health and food consumption data surveillance to understand current trends on the national level, and gaining access to up-to-date nutritional composition data. Often, governments do not have access to ingredients information for processed foods, and that reduces the effectiveness of policies and their evaluation.
Cooperate and exchange of best practices
“With the globalization of the food environment and considering that the challenges and the barriers are similar in many countries, our policy responses should be coordinated,” says Maria João.
Peer learning and regional collaboration are essential to overcome shared barriers, such as the lack of political will and little support from the food industry for regulatory measures.
Use public food procurement as a lever
Public institutions – schools, hospitals and prisons – buy large volumes of food. Governments can set standards for, for example, salt levels in food procured in public settings and ensure regular monitoring and evaluation to check compliance. This is a powerful tool to shape the food system and environment.
Key to success: good policy design and communication
As Co-lead of Work Package 5 within JA PreventNCD, Maria João now supports countries across the European Union (EU) in implementing effective policies to improve food environments and tackle NCDs. The project focuses on regulatory and fiscal tools, including WHO-recommended “quick buy” policies, that can deliver measurable health impact in 1–5 years, within 1 political cycle:
Front-of-pack nutrition labelling: the team is developing a harmonized framework to evaluate the impact of front-of-pack labelling on consumer behaviour, food choices and product reformulation.
Food reformulation: nutritional data is being collected and stored in an EU-level database. This will allow comparisons and tracking over time.
Portugal’s experience highlights that when policy actions are well-designed and communicated, public support is strong. For example, the country’s tax on sugar-sweetened beverages is supported by 80% of the population. A key success factor, Maria João emphasizes, was linking the policy clearly to health outcomes and reinvesting tax revenues into the national health system.
With strong public support and a good evidence base, countries of the WHO European Region can create a health-promoting food environment. “Use your data. Know your food landscape. Focus on the biggest sources of salt in the diet. Start with public food procurement. And when science is on your side, don’t be afraid to stand firm against difficulties,” says Maria João.