SRCP Current Activities

The Fund for Public Health in New York City ($395,000) is working with higher learning institutions and hospitals to implement food and nutrition standards and other sodium reduction strategies in their cafeterias and cafes. Partner sites have committed to adopting the New York City Food Standards for Cafeterias/Cafés (Cafeteria Standards), which seek to increase the availability of healthier foods and beverages in the retail setting. Eleven of the 25 standards address sodium by increasing the availability of fresh produce, promoting healthy eating through advertising, and reducing calories and sodium.

To facilitate this strategy, the New York City Department of Health and Mental Hygiene (Health Department) is providing tailored technical assistance in the form of site visits and assessments, menu reviews, nutrition analysis, and action plans. The Health Department is also working with two large national food distributors on Good Choice, a tool that makes it easier for distributors to highlight healthier products that meet the NYC Food Standards and for customers to buy lower-sodium foods.

Richmond University Medical Center has worked to adopt the Cafeteria Standards, by removing all high-sodium soups (more than 480 mg sodium per 8 oz) and five entrees (more than 700 mg sodium per serving) from their menu cycle. They have also made environmental changes, including removing high-calorie and high-sodium items from the checkout area and replacing them with fresh fruits and healthier snacks. Good Choice is now available to New York State agencies and Los Angeles and San Diego Counties.

The Health and Hospital Corporation of Marion County ($290,250) has committed to reducing sodium in food served at two large government worksites with cafeterias, a convenience store, a coffee shop and at two entities that provide meals to older adults and vulnerable children. Marion County is partnering with the sites and their food service operators to reduce sodium in foods purchased and served by:

• Assessing their sodium content.
• Finding healthier alternatives and changing recipes and menus.
• Implementing nutrition guidelines.
• Applying lower-sodium cooking techniques and training.
• Assessing consumer purchasing practices and acceptance of meals.
• Implementing environmental or behavioral opportunities for change such as providing venue-specific nutrition information.

By year 3, the government worksites achieved a 13% increase in the number of lower-sodium foods purchased by the food service operators. A majority of the participating worksite entities have implemented nutrition standards and practices to reduce sodium and offered healthier food options at the same or lower cost than less healthy options. All of the entities have highlighted lower-sodium options by making the food more visible or using promotional signage, and they all have educated customers about sodium.

The meal programs serving older adults and vulnerable children have achieved a 15% increase in the number of lower-sodium products used and a 24% decrease in the average sodium in foods served. A key strategy to reduce sodium is purchasing lower-sodium products used in several meals. Site and food service staff have received sodium education, and program participants have done taste tests to ensure they liked the new foods.

The Los Angeles County Department of Public Health ($395,000) leads the Los Angeles County Sodium Reduction Initiative (LACSRI) in partnership with the County of San Diego Health and Human Services Agency. The main goal of LACSRI has been to implement comprehensive nutrition standards (e.g., calorie and sodium limits for meals and snacks served and sold) and other healthy food procurement practices in three venues: hospitals, higher learning institutions, and senior meal programs. As of 2019, they have collaborated with 14 large-scale food purchasing institutions.

Additionally, LACSRI has cultivated cross-sector partnerships with diverse public-private stakeholders. As part of this effort, LACSRI is also collaborating with the New York City Department of Health and Mental Hygiene to expand the Good Choice food distributor recognition program in Los Angeles and San Diego Counties. The LACSRI team designed and launched a new consumer education campaign called Eat Your Best, Less Salt, More Plants to support institutional and community efforts to reduce sodium in food services venues operated by LACSRI partners. Program successes include the addition of four new grain-based salads averaging less than 50 mg of sodium per serving and four new grab-and-go wraps averaging less than 600 mg of sodium per serving at a children’s hospital in Los Angeles. At another private sector hospital, achievements included replacing six high-sodium ingredients such as canned tomatoes, resulting in an average sodium decrease of 58%.

The New York State Department of Health ($395,000) and three partner organizations were selected to work in four New York counties (Erie, Niagara, Onondaga, and Rockland) to implement food service guidelines. This program seeks to help children in early care and education centers to become accustomed to the taste of lower-sodium foods so they can avoid high blood pressure in adulthood. The program also focuses on students enrolled in colleges and universities in the four counties. In addition to their work with local partners, the program works with the New York City Department of Health and Mental Hygiene to identify foods that meet comprehensive nutrition criteria created by New York City, including those for sodium. Strategies include:

• Gradually reducing sodium targets for different food categories.
• Identifying lower-sodium products with distributors.
• Training staff at food venues on techniques and changes to products, recipes, or portion sizes to lower sodium content.
• Using behavior-change approaches to increase demand for or access to lower-sodium foods.

The Onondaga County Health Department engaged food service management staff, chefs, and dieticians in an interactive, hands-on, chef-led training to demonstrate ways to decrease sodium in recipes that are regularly offered in their cafeterias. Within 1 year of the training, all partnering sites replaced their products with lower-sodium alternatives and many altered recipes to be lower in sodium using the techniques they had learned.

The Oregon Health Authority, Public Health Division ($395,000) works with partners to lower sodium in meals served by three of the largest government purchasers of food in Oregon: the Oregon Department of Corrections (DOC), Oregon Department of Education, and Oregon State Hospital. Oregon also collaborates with Oregon State University’s Food Innovation Center to conduct consumer sensory testing related to lower-sodium products and build the statewide demand for, and therefore supply of, lower-sodium foods. A partnership between the Oregon DOC and the Oregon Health Authority (OHA) led to a 17% reduction in the amount of sodium in meals served between 2016 and 2019 to adults in custody at the state’s 14 correctional institutions. DOC’s food services staff and inmates serve more than 16 million meals a year. With a food budget of just $2.55 per adult in custody per day, the DOC, in consultation with OHA, lowered sodium in meals by purchasing and substituting low-sodium versions of food products and revising recipes and food preparation techniques.

The Philadelphia Department of Public Health (PDPH) ($395,000) engages seven city departments to implement the Philadelphia Nutrition Standards (Standards) and Asian buffet restaurants to decrease sodium in their dishes. Temple University’s Center for Asian Health and the Greater Philadelphia Chinese Restaurant Association organize assessments and trainings for restaurants’ food procurement and preparation. With city departments, the PDPH collects menus, conducts nutrition analyses, and provides recommendations to help departments comply with the Standards; rewrites bids and requests for proposals for compliance with Standards; and engages current or potential vendors to increase the availability of lower-sodium products. Successes include a 5.5% reduction in sodium from 2017 to 2018 in the menu for Riverview Home, an adult care facility and increased purchases of lower sodium chicken and beef broth for homeless shelters. The Department of Prisons replaced over 50% of items with lower-sodium alternatives and changed nearly 60% of recipes to reduce sodium, an average reduction of 463 mg daily. PDPH partners with Drexel University’s Food Lab (DFL) and local manufacturers to reformulate high-sodium products (e.g., breads, rolls) while maintaining quality, safety, shelf life, consumer acceptance, and cost. DFL developed a lower-sodium hoagie roll recipe and approached a local baking company to manufacture the roll. The reformulated roll is now available for city departments to purchase and, in April 2019, the baking company replaced the School District of Philadelphia’s hoagie roll order with the new lower-sodium formula, which resulted in a reduction of 140 mg of sodium in each of the 1.68 million rolls purchased annually, removing 1,294 lb of salt from school lunches.

Public Health–Seattle and King County ($339,700), together with University of Washington Center for Public Health Nutrition, partners with seven school districts, one large statewide food bank distributor, and local emergency food coalitions comprising 41 food pantries. Work with schools has included providing chef consultation and technical assistance to four districts, providing chef trainings, developing or modifying recipes, adding flavor stations with spices, and convening seven districts as the School Nutrition Services Learning Network to implement behavioral economic strategies. Several school districts are directly involving their students in this work through taste testing and recipe development. As a result of procurement changes and recipe modifications, average sodium content in schools decreased in cold sandwiches (35% reduction), rice-based entrees (28% reduction), grab-and-go meals (24% reduction), and Mexican-inspired entrees (13% reduction). Slightly more than half of all school meals served in two districts were affected by lower-sodium ingredients in one 6-week sample in 2018.

The health department works with the emergency food organizations to help local food pantries develop and implement nutrition-based standards. These standards guide procurement, distribution, and food environment decision-making. They also help local food pantries implement behavioral economics changes such as marketing and product placement. Successes from 2016 to 2019 include adoption of nutrition standards by the statewide food banks and one local emergency food coalition, as well as implementation of behavioral economics strategies in more than 15 food pantries.

University of Arkansas for Medical Sciences (UAMS) ($394,999) engages schools and meal distribution programs to carry out comprehensive sodium reduction strategies. UAMS partnered with two Northwest Arkansas school districts with 34 schools to implement Smarter Lunchrooms strategies. Smarter Lunchrooms strategies are based in behavioral economics principles and nudge students to choose and eat healthier foods. UAMS Northwest trained school nutrition staff in four categories: Focus on the Fruit, Vary the Vegetables, Highlight the Salad, and Move More White Milk. From baseline of this initiative to year 2, sodium was reduced by 8.2% per entrée offered and 5.3% per entrée served. UAMS Northwest plans to expand partnerships to more school districts in the Northwest Arkansas region. Plans include continuing the Smarter Lunchrooms strategies, developing more nutrition education resources, and conducting several more trainings for staff, including salad and whole grain bar trainings.