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AIMS Public Health

2019, Volume 6, Issue 4: 534-545. doi: 10.3934/publichealth.2019.4.534
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Research article

Policy analysis of salt reduction in bread in Iran

  • 1.
    Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
  • 2.
    Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  • 3.
    Department of Health Services Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  • 4.
    Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • 5.
    Iran University of Medical Sciences, Tehran, Iran
  • Received: 18 October 2019 Accepted: 02 December 2019 Published: 09 December 2019

  • Given that average salt intake among Iranians is approximately 10–15 g per day particularly from sodium hidden in bread, cheese, and fast food; lowering this mineral has been followed up seriously in this country for almost 10 years (since 2009). The main objective of the present study was to provide an opportunity to recognize unwanted and unfavorable outcomes of implementing decisions and policies together with associated problems of salt reduction in bread in order to achieve national and global health promotion goals. Thus, this qualitative and retrospective policy analysis was completed to evaluate the policy of salt reduction in bread in Iran. To collect the data, the researchers traveled to six cities in different regions, wherein relevant documents were utilized added to interviews with key actors. Related websites were correspondingly searched to find reports on this policy. Moreover, the researchers referred to some organizations in-person to search documents in this area. Five group discussions were also held to obtain public opinions in this regard. Data analysis was further carried out using framework analysis. The findings revealed that allocation of the highest rates of subsidy to wheat, flour, and bread had led to elimination of competitiveness in wheat, flour, and bread supply chain in Iran. Despite the presence of proper structures as coordinators of other organizations working on public health, there was no intersectoral collaboration in terms of maintaining health of bread products and lowering salt content in this staple food. With regard to changes in priorities of the Iranian Ministry of Health and Medical Education, attempts made to improve bread quality had also failed. In addition, first-line staff (i.e. bakers) had viewed formulation and implementation of the given policy as a top-down one. Given the ambiguities in establishment of new standards, there were similarly contradictions in execution of the policy at various levels. With reference to education provided at a national level, it was concluded that some people had become more sensitive to salt reduction in bread to some extent.

    Citation: Saba Loloei, Hamed Pouraram, Reza Majdzadeh, Amirhossein Takian, Massomeh Goshtaei, Abolghasem Djazayery. Policy analysis of salt reduction in bread in Iran[J]. AIMS Public Health, 2019, 6(4): 534-545. doi: 10.3934/publichealth.2019.4.534

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  • Given that average salt intake among Iranians is approximately 10–15 g per day particularly from sodium hidden in bread, cheese, and fast food; lowering this mineral has been followed up seriously in this country for almost 10 years (since 2009). The main objective of the present study was to provide an opportunity to recognize unwanted and unfavorable outcomes of implementing decisions and policies together with associated problems of salt reduction in bread in order to achieve national and global health promotion goals. Thus, this qualitative and retrospective policy analysis was completed to evaluate the policy of salt reduction in bread in Iran. To collect the data, the researchers traveled to six cities in different regions, wherein relevant documents were utilized added to interviews with key actors. Related websites were correspondingly searched to find reports on this policy. Moreover, the researchers referred to some organizations in-person to search documents in this area. Five group discussions were also held to obtain public opinions in this regard. Data analysis was further carried out using framework analysis. The findings revealed that allocation of the highest rates of subsidy to wheat, flour, and bread had led to elimination of competitiveness in wheat, flour, and bread supply chain in Iran. Despite the presence of proper structures as coordinators of other organizations working on public health, there was no intersectoral collaboration in terms of maintaining health of bread products and lowering salt content in this staple food. With regard to changes in priorities of the Iranian Ministry of Health and Medical Education, attempts made to improve bread quality had also failed. In addition, first-line staff (i.e. bakers) had viewed formulation and implementation of the given policy as a top-down one. Given the ambiguities in establishment of new standards, there were similarly contradictions in execution of the policy at various levels. With reference to education provided at a national level, it was concluded that some people had become more sensitive to salt reduction in bread to some extent.


    加载中

    Acknowledgments


    This study was supported by Tehran University of Medical Sciences, Iran.

    Research limitations


    Despite efforts to increase the validity and the credibility of the study, the interpretations in the present study were not objective. Since subjectivity is a limitation of qualitative studies, the present study was no exception. However, policy-making on lowering salt in bread is new in Iran and further studies are required to increase the success rate of this policy in terms of improving public health.

    Conflict of interest


    The authors declare no competing interests.

    [1] Jafari M, Mohammadi M, Ghazizadeh H, et al. (2016) Feasibility and outcome of reducing salt in bread: a community trial in Southern Iran. Glob J Health Sci 8: 163. doi: 10.5539/gjhs.v8n12p163
    [2] Silow C, Axel C, Zannini E, et al. (2016) Current status of salt reduction in bread and bakery products-a review. J Cereal Sci 72: 135–145. doi: 10.1016/j.jcs.2016.10.010
    [3] Israr T, Rakha A, Sohail M, et al. (2016) Salt reduction in baked products: Strategies and constraints. Trends Food Sci Tech 51: 98–105. doi: 10.1016/j.tifs.2016.03.002
    [4] Lynch EJ, Dal Bello F, Sheehan EM, et al. (2009) Fundamental studies on the reduction of salt on dough and bread characteristics. Food Res Intl 42: 885–891. doi: 10.1016/j.foodres.2009.03.014
    [5] Antúnez L, Giménez A, Ares G (2016) A consumer-based approach to salt reduction: Case study with bread. Food Res Intl 90: 66–72. doi: 10.1016/j.foodres.2016.10.015
    [6] Karizaki VM (2017) Ethnic and traditional Iranian breads: different types, and historical and cultural aspects. J Ethn Food 4: 8–14. doi: 10.1016/j.jef.2017.01.002
    [7] Belz MC, Ryan LA, Arendt EK (2012) The impact of salt reduction in bread: a review. Crit Rev Food Sci Nutr 5: 514–524.
    [8] Tomonari T, Fukuda M, Miura T, et al. (2011) Is salt intake an independent risk factor of stroke mortality? Demographic analysis by regions in Japan. J Am Soc Hypertens 25: 456–462.
    [9] Pasqualone A, Caponio F, Pagani MA, et al. (2019) Effect of salt reduction on quality and acceptability of durum wheat bread. Food Chem 289: 575–581. doi: 10.1016/j.foodchem.2019.03.098
    [10] Avolio AP, Clyde KM, Beard TC, et al. (1986) Improved arterial distensibility in normotensive subjects on a low salt diet. Arteriosclerosis 6: 166–169. doi: 10.1161/01.ATV.6.2.166
    [11] D'Elia L, Rossi G, Ippolito R, et al. (2012) Habitual salt intake and risk of gastric cancer: a meta-analysis of prospective studies. Clin Nutr 31: 489–498. doi: 10.1016/j.clnu.2012.01.003
    [12] Quilez J, Salas-Salvado J (2012) Salt in bread in Europe: potential benefits of reduction. Nutr Rev 70: 666–678. doi: 10.1111/j.1753-4887.2012.00540.x
    [13] Ghazizadeh-Hashemi SH, Larijani B (2015) National action plan for prevention and control of non communicable diseases and the related risk factors in the Islamic Republic of Iran, 2015–2025. Tehran, Iran: Aftab e Andisheh Publ, 47–65.
    [14] World Health Organization (2011) Global status report on noncommunicable diseases 2010: Geneva. Available from: https://www.who.int/nmh/publications/ncd_report2010/en/.
    [15] World Health Organization (2010) Creating an enabling environment for population-based salt reduction strategies: report of a joint technical meeting held by WHO and the Food Standards Agency, United Kingdom, July 2010. Available from: https://apps.who.int/iris/handle/10665/44474.
    [16] Shahram Rafieifar M, Hossein Kazemeini M (2016) Strategies and opportunities ahead to reduce salt intake. Arc Iran Med 19: 729–734.
    [17] Alireza Khosravi M, Reza Malekzadeh M, Sarrafzadegan N (2012) Advocacy strategies and action plans for reducing salt intake in Iran. Arc Iran Med 15: 320–324.
    [18] Avramenko N, Tyler R, Scanlon M, et al. (2018) The chemistry of bread making: The role of salt to ensure optimal functionality of its constituents. Food Rev Intl 34: 204–225. doi: 10.1080/87559129.2016.1261296
    [19] Buse K, Dickinson C, Gilson L, et al. (2009) How can the analysis of power and process in policy-making improve health outcomes? Off J Int Hosp Fed 45: 14.
    [20] Miles MB, Huberman AM, Huberman MA, et al. (1994) Qualitative data analysis: An expanded sourcebook. Sage.
    [21] Walt G, Shiffman J, Schneider H, et al. (2008) 'Doing'health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan 23: 308–317. doi: 10.1093/heapol/czn024
    [22] Walt G (1994) Health policy: an introduction to process and power. Available from: https://repository.library.georgetown.edu/handle/10822/870131.
    [23] Fontanet I, Davidou S, Dacremont C, et al. (1997) Effect of water on the mechanical behaviour of extruded flat bread. J Cereal Sci 25: 303–311. doi: 10.1006/jcrs.1996.0087
    [24] Brinsden HC, He FJ, Jenner KH, et al. (2013) Surveys of the salt content in UK bread: progress made and further reductions possible. BMJ open 3: e002936. doi: 10.1136/bmjopen-2013-002936
    [25] Amid J (2007) The dilemma of cheap food and self-sufficiency: The case of wheat in Iran. Food Policy 32: 537–552. doi: 10.1016/j.foodpol.2006.11.001
    [26] Moynihan DP (2006) Ambiguity in policy lessons: The agencification experience. Public Adm 84: 1029–1050. doi: 10.1111/j.1467-9299.2006.00625.x
    [27] Walker L, Gilson L (2004) 'We are bitter but we are satisfied': nurses as street-level bureaucrats in South Africa. Soc Sci Med 59: 1251–1261. doi: 10.1016/j.socscimed.2003.12.020
    [28] Kilcast D, Angus F (2007) Reducing salt in foods: Practical strategies. Elsevier.
    [29] Salovaara H (2009) Technologies of salt reduction in bread: issues, problems and solutions. Salt in bread: technical, taste and other parameters for healthy eating: CCAB Seminar Brussels,
    [30] Belgium: Centre de Conferences Albert Borschette (CAAB).
    [31] 30. Dunford EK, Eyles H, Ni Mhurchu C, et al. (2011) Changes in the sodium content of bread in Australia and New Zealand between 2007 and 2010: implications for policy. Med J Aust 195: 346–349. doi: 10.5694/mja11.10673
    [32] 31. World Health Organization (2016) The SHAKE technical package for salt reduction. Available from: https://apps.who.int/iris/handle/10665/250135.
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