Health impact assessment of a voluntary protocol to decrease salt in bread: what can we learn?

Abstract Issue Hypertension (HT) is a major and modifiable risk factor for cardiovascular diseases (CVD), which can be caused by excessive salt intake. Portugal has one of the highest mortality rate due to CVD in Europe, mainly HT. Thus, reduction intake from food products strategies advocated modify blood pressure (BP) its impact on Description problem The Portuguese population daily bread consumption. 2017 voluntary ‘Protocol' was signed between stakeholders with goal reduce content 2021. Herein, using Health Impact Assessment (HIA) approach we aimed estimate potential effect BP implementation this ‘Protocol'. two national surveys were used find average values population, while estimates calculated based upon meta-analysis data. Results It expected that could ingestion have higher effect, mostly more vulnerable populations. In fact, results showed individuals low educational level, men, aged residents South region ones benefit implementation. However, study found effects very all groups analysed, suggesting only slight health gains occur. Lessons as agreement not sufficient attain public targets devised. Following HIA framework, further complementary intersectoral integrated measures, through use compulsory fiscal policies preferably extended other highly consumed products, thus recommended. comprehensive tool assess impacts, supporting at each context design effective promote effectively prevent hypertension. Key messages systematic appropriate policy framework inform adequately political decision-making crucial Non-Communicable Diseases. Voluntary agreements should complemented measures improve efficacy aiming