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the committee expressed concern that adopting an exclusively voluntary approach in the United States may have limited success and questionable potential for long-term sustainability based on past U.S. experience. It was also noted that the regulatory structure surrounding the U.S. food supply may make regulation more feasible in the United States than in some of the other nations that have initiated sodium reduction strategies.

However, strategies carried out in other countries offer relevant themes. First, labeling initiatives are a component of all programs and are reported to be of assistance to consumers. However, labeling format and consistency has been found to be important; one UK study of the use of front-of-pack labeling found that the coexistence of a number of label formats in the market caused consumer confusion on the levels of key nutrients (British Market Research Bureau, 2009). Second, those who have worked to issue guidelines for the sodium content of foods have approached the task on the basis of food categories. The efforts undertaken by the United Kingdom in regard to food categories are particularly noteworthy and illustrative (see Appendix C). They reportedly reflect extensive dialogues with knowledgeable stakeholders and are fairly comprehensive. They have also served as the basis for the NSRI coordinated by the New York City Health Department (see Appendix G).

THE POSSIBILITY OF ECONOMIC INCENTIVES

In addition to the lessons learned from past experience, several approaches based on economic incentives have been suggested as strategies for reducing sodium intake and have an experience of use in other areas. These include agricultural subsidies for foods with lower sodium, tax incentives for production of lower-sodium foods, a salt tax on foods with higher sodium content, and a cap and trade system for salt or sodium. Although each of these possible approaches has the potential to reduce sodium intake, these may not be fine-tuned enough to reduce sodium intake or may be burdensome and costly relative to the potential reduction of sodium intake.

Agricultural Subsidies for Lower-Sodium Foods

Agricultural price supports have been provided for certain crops under periodic Farm Act legislation since the 1930s. The Farm Act legislation allows different methods of providing price and income support for agricultural commodities including direct payments, countercyclical payments, marketing assistance loans, and loan deficiency payments. Throughout the history of Farm Act legislation, covered commodities have included staple food commodities. Most recently, the Food, Conservation, and Energy Act passed in 2008 (i.e., the 2008 Farm Act) includes target prices for wheat,



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