Introduction by Croakey: Around the world, most people eat more salt than is good for their health; the World Health Organization says reducing sodium intake is one of the most cost-effective ways of improving health and reducing the burden of noncommunicable diseases.
Yet little progress has been made in reducing salt intakes, according to experts, who note that habits are hard to change and also that salt is a widely used ingredient in food manufacturing, with slow progress in lowering levels in packaged foods.
The George Institute for Global Health has a #SwitchTheSalt campaign, which advocates for potassium-enriched salt as a practical, scalable approach to lowering blood pressure and associated risks.
A recent workshop heard about diverse strategies being used across the globe to promote the switch to potassium-enriched salt, with a particular focus on the role of local governments and other local stakeholders. The George Institute’s Christine Smith reports.
Christine Smith writes:
Cities influence the food people eat in more ways than we often recognise, through procurement, community facilities, sporting venues, events and relationships with local food businesses.
At the recent 11th Global Conference of the Alliance for Healthy Cities in Sydney, participants joined a Switch the Salt workshop, led by The George Institute for Global Health, Nutrition Implementation Research team.
This explored how those existing levers could be used to increase uptake of potassium-enriched salt. Participants came from across Australia and Asia Pacific, bringing a mix of public health, health promotion and local government perspectives.
Reducing salt intake has been a global public health goal for more than a decade, but progress has been slow, with many countries off track to reduce population sodium intake by 30 percent and with sodium intake still more than twice the recommended level.
Potassium-enriched salt offers another way forward, by replacing some of the sodium chloride in regular salt with potassium chloride. The switch can lower blood pressure and reduce cardiovascular risk by both reducing sodium and increasing potassium intake.
The evidence is strong. The Salt Substitute and Stroke Study, involving almost 21,000 people in rural China, found 14 percent fewer strokes, 13 percent fewer major cardiovascular events and 12 percent fewer deaths among people using potassium-enriched salt compared with regular salt.
The World Health Organization took a further step, recommending that adults who choose to use table salt switch from regular salt to a lower sodium substitute containing potassium.
Australian guidance is similar, with Hypertension Australia and Heart Foundation also recommending potassium-enriched salt for people with hypertension.
This recommendation excludes those with risk of high blood potassium due to kidney disease, potassium supplements, potassium-sparing diuretics or another reason. Further advice on safe use can be found in this position statement by Hypertension Australia.
Where to start?
The question for our workshop wasn’t whether potassium-enriched salt works. It was: what it would take to use it more widely in the places where people live, eat and buy food?
Participants were asked to think about where they would start if they wanted to increase uptake of potassium-enriched salt in their own city.
Community settings and retail were prominent starting points, while particular foods such as bread and stock cubes came up as well. One participant mentioned, “bread could have a big reach because it’s something so many people eat, and they wouldn’t have to actively make the switch themselves”.
Participants also began applying these ideas to their own cities. In Kuching, for example, food festivals, markets and local retailers were identified as potential places to stock potassium-enriched salt, giving consumers greater choice.
As one participant put it, “markets and food festivals make sense for us because that’s already where people are buying and trying local food”.
What stood out was the focus on places and products that already reach large numbers of people.
The discussions pointed towards a practical starting point: identify where cities already have influence, then work with local partners to design and test an approach that fits that setting.
Making the switch possible
Awareness and use of potassium-enriched salt remain low, but implementation studies suggest acceptability may be less of a barrier than access.
A recent systematic review found low awareness and use across 29 studies from 11 countries, while acceptability and willingness to continue using reduced sodium salt were generally high. Cost, availability and taste remained practical concerns.
Real world studies show uptake can increase when people are given the opportunity to try it.
An 18-month community salt reduction program in Lithgow increased awareness and use through local businesses and community settings, while a feasibility study in Nigeria found 83 percent of household cooks had completely replaced regular salt with the intervention salt after two months.
We explored the taste question ourselves during the workshop.
Participants also took part in a blinded taste test, comparing foods made with regular salt and potassium-enriched salt before guessing which was which.
Many could pick up a slight difference in taste when the products were compared side by side, but the difference was generally seen as minor.
It was an informal exercise, but brought an important implementation question into the room: people may notice a difference, but does that difference actually matter enough to affect acceptance? One participant reflected, “I’d eat that again!”.
The discussion suggested that taste may be less of a barrier than expected, particularly when potassium-enriched salt is used in familiar foods rather than tasted in isolation.
Different government pathways
Singapore and Abu Dhabi show how governments can drive change through different levers.
Singapore has taken a partnership-led approach, working with manufacturers, suppliers, retailers and food outlets, while also using incentives to support uptake of lower sodium ingredients. By the end of 2024, more than 1,700 eateries had switched to lower sodium salt, sauces or seasonings.
Abu Dhabi has taken a more policy-led approach. In 2026, its Department of Culture and Tourism introduced requirements for potassium-enriched salt to be used in hotel restaurants, using an existing regulatory system to support implementation
The map above shows the broader range of city action already underway globally.
Abidjan and Dakar are developing nutrition standards to reduce salt consumption in public schools, Freetown is working on healthy food procurement policies for schools and hospitals, and Mumbai is focusing on public awareness of the health risks of excess salt and sugar.
For Australia, this raises a useful question: could city and other levels of government use similar incentives alongside procurement standards, partnerships and policy to make potassium-enriched salt easier and more attractive for food businesses to use?
Turning ideas into action
The workshop showed there is interest and practical opportunities to move potassium-enriched salt into everyday food environments.
For city leaders, the next step is to identify where they already have influence and where a switch could be tested.
Some clear places to start:
- Local governments can review procurement, council facilities, community events, markets and partnerships with local businesses, and identify where potassium-enriched salt could be trialled, stocked or promoted alongside regular salt.
- Food businesses and retailers can be supported to test reformulation in widely consumed foods such as bread, stock cubes, sauces and seasonings.
- Governments can consider incentives, procurement standards and other policy measures that reduce the cost and practical barriers to switching.
Cities don’t need to tackle every setting at once. A useful first step is much more concrete: identify where you already have influence, bring the right people to the table and test what can work in that setting.
• The image below shows who participated in the workshop, and where they came from.
Author details
Christine Smith is a public health nutrition researcher in the Food Policy Division, Nutrition Implementation Research team, at The George Institute for Global Health.
Her work focuses on implementation research, salt reduction and healthier food environments, including how potassium enriched salt can be translated into policy and practice.
See Croakey’s archive of articles on global health
Add Comment