Governance

2

Design and Conduct an Advocacy Strategy

Advocacy—activities to support and influence relevant decision-makers to take the necessary actions to promote a salt reduction strategy—will be critical throughout the design and implementation process. These activities may seek to win general support for salt reduction from the government (including commitments to reduce salt intake in the country and prioritization of salt reduction within the government agenda); it may also aim to convince government officials to support and promote a specific policy that will lead to a reduction in salt intake (e.g., adopting salt targets for packaged food, front-of-pack labeling, etc.)

Advocacy is frequently led by civil society groups or other non-profit or academic institutions. Involvement from these groups, and the constituencies they represent, expands the scale and diversity of support for sodium reduction measures; their visible backing for sodium reduction policies can counter opposition from industry and support government stakeholders to take action. Advocacy may also be conducted within the government itself; program leaders may need to convince other officials in order to obtain buy-in within the Ministry of Health; the Ministry of Health may need to obtain buy-in from other agencies such as Ministries of Trade or Finance that are traditionally less focused on health outcomes.

Before designing an advocacy strategy, ensure there is a clear definition of specific goals for sodium reduction (See Section 1C), and outline the changes that need to occur for the salt reduction strategy to move forward (See Section 1D). Once goals are defined, review findings from the situational analysis (Section 1A) to better understand the political and social contexts and identify opportunities as well as threats (e.g., SWOT analysis) for getting sodium reduction onto the current public health agenda, if it is not yet a priority. Also determine what tools and resources are available (e.g., existing data, previous sodium reduction experience and lessons learned in-country or from other countries, financial resources). In most cases, current data on sodium intake, sources, and/or content of foods is important for bringing sodium reduction into the public agenda and convincing stakeholders to take action. Identify key research gaps (refer to the situational analysis) and determine methods and actors/groups to fill these gaps.

Next, build a coalition or network of organizations interested in salt reduction or its related policies. This should start with a stakeholder analysis that examines various actors’ potential roles, level of support (or opposition), and power/influence to determine who to involve to make progress on each goal. Once allies (government bodies, civil society, NGOs, researchers, etc.) are identified and incorporated into the network, the network can meet to agree on common actions (media or political actions), amplify advocacy messages, and ensure a coherent call to action among diverse groups, such as children’s rights, sustainable food systems groups, obesity prevention organizations. Organizational priorities and agendas will vary, but working to find common long-term goals and to highlight partner achievements can encourage collaborative partnerships.

Finally, determine the target audience of the advocacy strategy. This should also derive from the results of the stakeholder analysis, in particular who has the power to make the necessary changes to achieve the identified goals (it may be a different decision-maker or group of decision-makers for each goal). Target audiences often include ministries of health, education, agriculture, and finance, food and drug administrations, and legislators.

Effective advocacy activities take into account what matters to the target audience and tailor arguments to appeal to that audience. Some audiences may find information about the negative health impacts of sodium and the health benefits of policy action compelling; others may find information about cost-effectiveness persuasive. For some decision makers, public and/or media support for the issue may also be critical (especially in the face of industry opposition). Also, consider how sodium reduction may support other policy goals, such as improving children’s health, providing nutritious school food, or supporting local agriculture. In general, it is important to anticipate and address potential concerns from stakeholders and build arguments to address them.

Once you have the building blocks in place, a comprehensive advocacy strategy can be created.This strategy can include many forms of advocacy: strong advocacy efforts include multiple complementary activities.

Advocacy activities commonly conducted by civil society and other groups include:

• Providing background research, fact sheets or policy briefs to decision-makers
• Arranging in-person meetings, phone calls, briefings or workshops with government stakeholders
• Testifying at hearings or presenting at conferences on the health harms of excess sodium and existing successful models in other countries/cities
• Generating relevant local data (e.g., data on sodium content of commonly consumed packaged food products, etc.) and designing advocacy material to inform decision-makers and/or the public about relevant data
• Conducting public awareness campaigns to build public support (using paid mass media, social media, and other channels to reach the public and other stakeholders)
• Contact journalists and/or provide journalist trainings to raise awareness about the importance of salt reduction and advocate for specific action where relevant
• Pursuing earned media coverage (e.g., newspaper or television mentions, placement of op eds in support of sodium reduction strategies)
• Identifying champions that may help get the issue into the public agenda

Advocacy activities commonly conducted by government organizations include:

• Convening workshops and presenting evidence on the need for and benefits of sodium reduction
• Sharing progress reports, publishing press releases, or participating in multi-sectoral mid-term reviews with policymakers to highlight the impact of sodium reduction interventions that are underway (progress reviews also provide an opportunity to address concerns or challenges identified during policy implementation)

3

Engage Stakeholders

Throughout the process of developing and implementing a national sodium reduction strategy, numerous types of stakeholders will be engaged (see Section 3C for examples). This section describes key steps to identifying stakeholders through a stakeholder analysis, engaging stakeholders, and building support among important stakeholder individuals and groups.

4

Mitigate Conflicts of Interest

The food industry is one of the largest in the world (and a dominant industry in many countries); it has long opposed policies and regulations that could impact its profits. Industry associations at both the global and national level represent the commercial interests of the food industry and will likely oppose policies that reduce sodium in their products. The food industry has created and funded organizations to evaluate science from an ‘industry-friendly’ perspective by creating educational programs and hiring scientists and clinicians to represent industry interests and often funds their meetings and presentations (Campbell 2021). The source of funding may not be disclosed or can be misrepresented (by using a third-party organization, such as the International Life Sciences Institute (ILSI), or funding to an academic or health organization).

Creating a structured approach for industry and people with industry ties to comment on a draft policy, without including them in policy development or final decision-making, is strongly recommended. There are several policies and/or regulations that can reduce the impact of conflicts of interest during the policy process. Best practice is to: 1) Define conflicts of interest broadly and comprehensively; 2) Require written disclosure of financial interests at regular intervals (e.g., annually) by all parties involved; 3) Include groups acting in the public and public health interest (e.g., academics, civil society, etc.) as part of the policy process; and 4) Develop strategies for mutual accountability and monitoring.