566550 research-article2014
RSH0010.1177/1757913914566550Current topics & opinionsCurrent topics & opinions
Current topic & opinion
War on sodium: the case of Korean public health campaigns In Korea, the risk of excessive sodium intake is magnified due to the increasing prevalence rates of cerebro-cardiovascular system diseases such as hypertension, stroke and coronary artery disease. Accordingly, sodium intake reduction campaigns have targeted sodium reduction at the societal level instead of the individual level. Here, Hye-jin Sun takes a look at public health improvement campaigns being used in Korea.
The average daily sodium intake of Koreans is 4,791 mg, more than two times the standard (2,000 mg) recommended by the World Health Organization (WHO). As a result, the incidence rates of four major chronic diseases related to excessive sodium intake are rapidly increasing.1 The Korean sodium intake is higher compared to other countries as the diet of Koreans includes liquid cuisines (such as Jjigaes) and salted fermented foods, and there is an increased rate of eating out due to communal feeding and the high ratio of nuclear families. High sodium intake leads to increased blood pressure and an increased risk of cardiovascular system diseases such as stroke. According to the 2011 Korean national nutrition survey, the hypertension prevalence rate in populations aged 30 years and over is 30.8%, which is much higher than the prevalence rate of 13% reported in the 1990 national hypertension survey.2 In addition, medical expenses for hypertension, diabetes, heart disease and cerebrovascular disease – the four major chronic diseases due to excessive sodium intake – have increased to account for 15.1% of all medical expenses.3
for parents with a link to offices of education and public information campaigns has been implemented.5 The Korea Food and Drug Administration has implemented a series of campaign activities for designating ‘low sodium feeding weeks’ for communal feeding facilities, and for large As these problems of excessive food service and small/medium food sodium intake and chronic disease service businesses to provide foods with continue to increase, the WHO has at least 10% lower sodium content. begun an in-depth review of the These include education and public relationship between excessive sodium relation campaigns for sodium intake intake and hypertension, stroke, reduction, and distributing promotional cardiovascular disorders, stomach materials with information on how to cancer and osteoporosis.4 In Korea, the lower sodium intake.6,7 In addition, the risk of excessive sodium intake is being Korea Food and Drug Administration has magnified because the prevalence rates been actively cooperating with local of cerebro-cardiovascular system governments so that sodium reduction diseases such as hypertension, stroke campaigns can be diffused into panand coronary artery disease have been national campaigns to reach increasing. As a result, sodium intake communities through activities which reduction campaigns have targeted actively support and inform community sodium reduction at the societal level sodium reduction campaigns. instead of the individual level. This year, the Korea Food and Drug The Korea Food and Drug Administration has been implementing Administration has been implementing diverse campaigns to enhance people’s sodium intake reduction as part of awareness of sodium reduction. The disease prevention policies through Korea Food and Drug Administration dietary management. Their strategy designated the third Wednesday of every includes surveys and evaluation such as month as ‘no soup day’ as a way to actual condition surveys, standards reduce people’s intake of liquid foods with management such as the industrial a high sodium content. In addition, the world sodium content indication system Korea Food and Drug Administration has and education and public relations such implemented sodium reduction street as educational contents development campaigns for food service businesses, and campaigns. In particular, in the area held a cuisine demonstration of education and public relations, the commemorating the publication of a lowKorea Food and Drug Administration salt cuisine book and is implementing has developed textbooks, diverse sodium reduction leaflets, DVDs, Internet campaigns suitable for regional content, and has characteristics of individual campaigns implemented online local governments.8 targeting education linked with its Since eating habits or tastes children are homepage and portal actively being formed in childhood cannot be sites. As well as this, implemented to easily changed, campaigns offline education for foster proper targeting children are actively nutritionists of feeding eating habits being implemented to foster facilities in schools and proper eating habits so that
Copyright © Royal Society for Public Health 2014 March 2015 Vol 135 No 2 l Perspectives in Public Health 71 SAGE Publications Downloaded from rsh.sagepub.com at UNIV OF WINNIPEG on September 1, 2015 ISSN 1757-9139 DOI: 10.1177/1757913914566550
Current topic & opinion children are not habituated to hot and salty tastes. Some local governments have installed separate public booths to display the actual sodium contents of cookies and foods that can be easily obtained by children and to distribute various kinds of promotional materials at the level of children’s eyes. Other local governments have produced promotional materials such as low-salt kimchi recipes and have supplied materials to day-care centres and kindergartens.9 An example of a case where sodium intake decreased remarkably after implementing campaigns is that of Busan regional headquarters of the National Health Insurance Corporation. The headquarters has been implementing sodium reduction campaigns in association with the Korean Pharmaceutical Association, which has attached posters to 3,055 pharmacies used by patients, particularly the elderly, of chronic
disease and has been steadily implementing customised guidance such as informing customers of the risk of excessive sodium intake during medication counselling in 213 regional hub pharmacies. In addition, the Korea Food and Drug Administration has communicated the risk of excessive sodium intake through specialised health lectures in 425 communal feeding facilities, including those in universities, has attached leaflets and posters to those facilities and has implemented low-salt diet participation campaigns. Recently, the Busan regional headquarters of the National Health Insurance Corporation analysed sodium intake after improving the eating habits of approximately 19,000 persons in 103 facilities in order to examine the effects of the campaigns. The results indicated that the past average intake of 1.37 g of salt per bowl of soup decreased by 0.49 g.10
According to the Korea Food and Drug Administration, the economic benefit of reducing the daily sodium intake to 3,000 mg should be 13 trillion Korean Won (the reduction in medical expenses at 3 trillion Won, and the benefits resulting from reduction in mortality at 10 trillion Won). 3 A series of sodium reduction– related public relations campaigns is meaningful in that it can encourage all people to participate in the practice of sodium intake reduction and can contribute to public health improvement and the decrease in the onset rate of chronic disease from excessive sodium intake.
Acknowledgements This work was supported by the National Research Foundation of Korea. Grant funded by the Korean Government (NRF2012S1A5B5A07036136).
References 1.
2.
3.
Ministry of Health and Welfare. Koreans’ salt intake is still high: Although the trend of sodium increases stopped, the intake is still at least two times of the standard recommended by the WHO. Ministry of Health and Welfare, Seoul, South Korea, 20th November 2012. Ministry of Health and Welfare. National Health and Nutrition Survey. Seoul, South Korea: Ministry of Health and Welfare, 2012. Ministry of Health and Welfare. Annual medical expenses will be reduced by 2 trillion won if daily sodium intake is reduced to 3g. Ministry of Health and Welfare, Seoul, South Korea, 21st March 2012.
4. 5.
6.
7.
Korea Food & Drug Administration. Sodium reduction policies. Yeollinmaru, 2011, 49–51. Na MY. Korea Food Drug Administration substantially began sodium intake reduction activities. Health Chosun, 10th May 2010. Available online at: www.mfds.go.kr/index. do?mid=675&seq=15150 (Last accessed 20th February 2015). Korea Food & Drug Administration. Sodium intake reducing campaign series (1): 361 communal feeding facilities voluntarily participated in sodium reduction. Korea Food & Drug Administration, Seoul, South Korea, 23rd May 2011. Korea Food & Drug Administration. Sodium intake reducing campaign series (3): Small/medium food
72 Perspectives in Public Health l March 2015 Vol 135 No 2 Downloaded from rsh.sagepub.com at UNIV OF WINNIPEG on September 1, 2015
service business oriented campaigns were implemented. Korea Food & Drug Administration, Seoul, South Korea, 18th July 2011. 8. Park SH. ‘No Soup Day’ designed to cut salt intake. The Korea Herald, 13th March 2013, pp. 1–2. 9. Science Times. ‘Sodium reduction campaigns’ diffused throughout the country: Foods eaten out and communal feedings are more problematic than meals at home. Science Times, 30th October 2012, pp. 1–4. 10. Ha YS. National Health Insurance Corporation, the effects of sodium reduction campaigns were ‘great’. News Eye, 19th August 2012.
RSH0010.1177/1757913914566550Current topics & opinionsCurrent topics & opinions
Current topic & opinion
War on sodium: the case of Korean public health campaigns In Korea, the risk of excessive sodium intake is magnified due to the increasing prevalence rates of cerebro-cardiovascular system diseases such as hypertension, stroke and coronary artery disease. Accordingly, sodium intake reduction campaigns have targeted sodium reduction at the societal level instead of the individual level. Here, Hye-jin Sun takes a look at public health improvement campaigns being used in Korea.
The average daily sodium intake of Koreans is 4,791 mg, more than two times the standard (2,000 mg) recommended by the World Health Organization (WHO). As a result, the incidence rates of four major chronic diseases related to excessive sodium intake are rapidly increasing.1 The Korean sodium intake is higher compared to other countries as the diet of Koreans includes liquid cuisines (such as Jjigaes) and salted fermented foods, and there is an increased rate of eating out due to communal feeding and the high ratio of nuclear families. High sodium intake leads to increased blood pressure and an increased risk of cardiovascular system diseases such as stroke. According to the 2011 Korean national nutrition survey, the hypertension prevalence rate in populations aged 30 years and over is 30.8%, which is much higher than the prevalence rate of 13% reported in the 1990 national hypertension survey.2 In addition, medical expenses for hypertension, diabetes, heart disease and cerebrovascular disease – the four major chronic diseases due to excessive sodium intake – have increased to account for 15.1% of all medical expenses.3
for parents with a link to offices of education and public information campaigns has been implemented.5 The Korea Food and Drug Administration has implemented a series of campaign activities for designating ‘low sodium feeding weeks’ for communal feeding facilities, and for large As these problems of excessive food service and small/medium food sodium intake and chronic disease service businesses to provide foods with continue to increase, the WHO has at least 10% lower sodium content. begun an in-depth review of the These include education and public relationship between excessive sodium relation campaigns for sodium intake intake and hypertension, stroke, reduction, and distributing promotional cardiovascular disorders, stomach materials with information on how to cancer and osteoporosis.4 In Korea, the lower sodium intake.6,7 In addition, the risk of excessive sodium intake is being Korea Food and Drug Administration has magnified because the prevalence rates been actively cooperating with local of cerebro-cardiovascular system governments so that sodium reduction diseases such as hypertension, stroke campaigns can be diffused into panand coronary artery disease have been national campaigns to reach increasing. As a result, sodium intake communities through activities which reduction campaigns have targeted actively support and inform community sodium reduction at the societal level sodium reduction campaigns. instead of the individual level. This year, the Korea Food and Drug The Korea Food and Drug Administration has been implementing Administration has been implementing diverse campaigns to enhance people’s sodium intake reduction as part of awareness of sodium reduction. The disease prevention policies through Korea Food and Drug Administration dietary management. Their strategy designated the third Wednesday of every includes surveys and evaluation such as month as ‘no soup day’ as a way to actual condition surveys, standards reduce people’s intake of liquid foods with management such as the industrial a high sodium content. In addition, the world sodium content indication system Korea Food and Drug Administration has and education and public relations such implemented sodium reduction street as educational contents development campaigns for food service businesses, and campaigns. In particular, in the area held a cuisine demonstration of education and public relations, the commemorating the publication of a lowKorea Food and Drug Administration salt cuisine book and is implementing has developed textbooks, diverse sodium reduction leaflets, DVDs, Internet campaigns suitable for regional content, and has characteristics of individual campaigns implemented online local governments.8 targeting education linked with its Since eating habits or tastes children are homepage and portal actively being formed in childhood cannot be sites. As well as this, implemented to easily changed, campaigns offline education for foster proper targeting children are actively nutritionists of feeding eating habits being implemented to foster facilities in schools and proper eating habits so that
Copyright © Royal Society for Public Health 2014 March 2015 Vol 135 No 2 l Perspectives in Public Health 71 SAGE Publications Downloaded from rsh.sagepub.com at UNIV OF WINNIPEG on September 1, 2015 ISSN 1757-9139 DOI: 10.1177/1757913914566550
Current topic & opinion children are not habituated to hot and salty tastes. Some local governments have installed separate public booths to display the actual sodium contents of cookies and foods that can be easily obtained by children and to distribute various kinds of promotional materials at the level of children’s eyes. Other local governments have produced promotional materials such as low-salt kimchi recipes and have supplied materials to day-care centres and kindergartens.9 An example of a case where sodium intake decreased remarkably after implementing campaigns is that of Busan regional headquarters of the National Health Insurance Corporation. The headquarters has been implementing sodium reduction campaigns in association with the Korean Pharmaceutical Association, which has attached posters to 3,055 pharmacies used by patients, particularly the elderly, of chronic
disease and has been steadily implementing customised guidance such as informing customers of the risk of excessive sodium intake during medication counselling in 213 regional hub pharmacies. In addition, the Korea Food and Drug Administration has communicated the risk of excessive sodium intake through specialised health lectures in 425 communal feeding facilities, including those in universities, has attached leaflets and posters to those facilities and has implemented low-salt diet participation campaigns. Recently, the Busan regional headquarters of the National Health Insurance Corporation analysed sodium intake after improving the eating habits of approximately 19,000 persons in 103 facilities in order to examine the effects of the campaigns. The results indicated that the past average intake of 1.37 g of salt per bowl of soup decreased by 0.49 g.10
According to the Korea Food and Drug Administration, the economic benefit of reducing the daily sodium intake to 3,000 mg should be 13 trillion Korean Won (the reduction in medical expenses at 3 trillion Won, and the benefits resulting from reduction in mortality at 10 trillion Won). 3 A series of sodium reduction– related public relations campaigns is meaningful in that it can encourage all people to participate in the practice of sodium intake reduction and can contribute to public health improvement and the decrease in the onset rate of chronic disease from excessive sodium intake.
Acknowledgements This work was supported by the National Research Foundation of Korea. Grant funded by the Korean Government (NRF2012S1A5B5A07036136).
References 1.
2.
3.
Ministry of Health and Welfare. Koreans’ salt intake is still high: Although the trend of sodium increases stopped, the intake is still at least two times of the standard recommended by the WHO. Ministry of Health and Welfare, Seoul, South Korea, 20th November 2012. Ministry of Health and Welfare. National Health and Nutrition Survey. Seoul, South Korea: Ministry of Health and Welfare, 2012. Ministry of Health and Welfare. Annual medical expenses will be reduced by 2 trillion won if daily sodium intake is reduced to 3g. Ministry of Health and Welfare, Seoul, South Korea, 21st March 2012.
4. 5.
6.
7.
Korea Food & Drug Administration. Sodium reduction policies. Yeollinmaru, 2011, 49–51. Na MY. Korea Food Drug Administration substantially began sodium intake reduction activities. Health Chosun, 10th May 2010. Available online at: www.mfds.go.kr/index. do?mid=675&seq=15150 (Last accessed 20th February 2015). Korea Food & Drug Administration. Sodium intake reducing campaign series (1): 361 communal feeding facilities voluntarily participated in sodium reduction. Korea Food & Drug Administration, Seoul, South Korea, 23rd May 2011. Korea Food & Drug Administration. Sodium intake reducing campaign series (3): Small/medium food
72 Perspectives in Public Health l March 2015 Vol 135 No 2 Downloaded from rsh.sagepub.com at UNIV OF WINNIPEG on September 1, 2015
service business oriented campaigns were implemented. Korea Food & Drug Administration, Seoul, South Korea, 18th July 2011. 8. Park SH. ‘No Soup Day’ designed to cut salt intake. The Korea Herald, 13th March 2013, pp. 1–2. 9. Science Times. ‘Sodium reduction campaigns’ diffused throughout the country: Foods eaten out and communal feedings are more problematic than meals at home. Science Times, 30th October 2012, pp. 1–4. 10. Ha YS. National Health Insurance Corporation, the effects of sodium reduction campaigns were ‘great’. News Eye, 19th August 2012.
