Abstract:
OBJECTIVE: To analyse the policy process for the South African regulation setting
upper limits for salt in thirteen commonly consumed food categories, to inform
future policy action for prevention of non-communicable diseases.
DESIGN: Semi-structured interviews (n 10) were conducted with key stakeholders
from government, academia, non-governmental organisations and the food
industry. Interviewees were asked about the content, context, process and actors
involved in developing the regulation. Data were analysed according to Walt and
Gilson’s health policy analysis triangle.
SETTING: South Africa.
PARTICIPANTS: Key actors and stakeholders in the policy process to develop the salt
regulation.
RESULTS: The regulation was a response to research establishing the effectiveness
of food supply interventions and to a shared perception that government
regulation was the quickest way to address the problem of salt overconsumption.
While the regulations were developed through a consultative process, food industry
stakeholders perceived the consultation as inadequate. Implementation is currently
underway, supported by a health promotion programme. Monitoring and
enforcement were identified as the most likely challenges due to capacity
constraints.
CONCLUSIONS: Comprehensive mandatory salt limits are an innovative approach to
food reformulation. Factors that enabled regulation included robust scientific
evidence, strong political and bureaucratic leadership, and the pragmatic use of
existing regulatory instruments. The main challenges identified were disagreement
over the appropriate nature and extent of food industry participation, and
monitoring and enforcement challenges due to capacity constraints.
