Why reducing salt is really difficult

There are two drivers for sodium in food. One is what you add and the other is what you buy in restaurants and in packaged foods. It’s different in different countries, and in different parts of countries and within different population groups. In some parts of Asia, for example, people put huge amounts of salt into their tea. In Tibet, it’s the main source of their salt — salty tea.

But the good thing is you don’t have to take it all out right away. A gradual reduction. Tastes change. You’ve got to get industry to work voluntarily to lower sodium. And you’ve got to change habits about how much salt people add at the table and to their cooking.

But not impossible

The U.K. has shown a substantial sodium reduction in food and a reduction in mortality. Wal-Mart reduced sodium by 20 to 25 percent in all their products in five years. The same product can have a quarter or four times the sodium with no difference in sales.

There are some innovations, like crackers. People learned to put sodium on the outside rather than into the batter and they could cut the amount of sodium enormously. It still tasted salty because it was salty on your palate.

The top priority

Hands down, blood pressure control is the most important thing you can do in health care. Globally, we’re at 14 percent control. U.S. is about 54, 55 percent. At the C.D.C. we did a couple of pilots; Malawi went from 0 to 35 percent in 15 months.

You can have big improvements, but you’ll only do that if you simplify treatment, if you decentralize it so people close to the patient can do it and if you use an information system that tells you how you’re doing.

All the medicines are generic. The costs that people are paying and that governments are paying are probably well over twice as much as they need to be.