The WHO's Top Ten Risk Factors

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The World Health Organization has released World Health Report 2002, one of its most ambitious projects ever (see:, and it helps underscore the fact that big, obvious health threats do far more damage than the obscure or hypothetical risk of the week. As the WHO's introduction says:

"the report identifies the top ten risks, globally and regionally, in terms of the burden of disease they cause. The ten leading risk factors globally are: underweight; unsafe sex; high blood pressure; tobacco consumption; alcohol consumption; unsafe water, sanitation, and hygiene; iron deficiency; indoor smoke from solid fuels; high cholesterol; and obesity. Together, these account for more than one-third of all deaths worldwide...The report shows that a relatively small number of risks cause a huge number of premature deaths and account for a very large share of the global burden of disease."


November 8, 2002

I can't speak for the validity of the "top ten" but am quite concerned that the WHO report systematically ignored the science on two issues regarding dietary salt.

First, the report nearly ignored entirely the worldwide campaign to iodize salt the top UNICEF health priority to protect children from mental retardation.

Second, the report's recommendations feature universal sodium restriction, though all ten studies that have examined the question of whether salt reductions lower the incidence of heart attacks and strokes have now concluded (to the shock and surprise of some anti-salt zealots) that there is no reduced incidence of cardiovascular events on lower sodium diets and some studies have identified additional risks due to the body's reaction when it senses inadequate amounts of sodium (e.g., elevated renin activity). It isn't a question of whether blood pressure should be lowered but of which mechanism is safe and effective. If sodium reduction were a pill and not a policy, it would never meet FDA standards as an approved health intervention.

Richard L. Hanneman
Salt Institute
700 N. Fairfax Street, Suite 600
Alexandria, VA 22314-2040