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Thursday, August 17, 2023

Debt-trap diplomacy

From Wikipedia, the free encyclopedia

Debt-trap diplomacy is a term to describe an international financial relationship where a creditor country or institution extends debt to a borrowing nation partially, or solely, to increase the lender's political leverage. The creditor country is said to extend excessive credit to a debtor country with the intention of extracting economic or political concessions when the debtor country becomes unable to meet its repayment obligations. The conditions of the loans are often not publicized. The borrowed money commonly pays for contractors and materials sourced from the creditor country.

A neologism, the term was first coined by Indian academic Brahma Chellaney in 2017 to contend that the Chinese government lends and then leverages the debt burden of smaller countries for geopolitical ends. The term "debt-trap diplomacy" has entered the official lexicon of the United States, with two successive administrations employing that term. However, some analysts have described the idea of a Chinese debt trap as a "myth" or "distraction".

Origin and background

The term was coined by Indian academic Brahma Chellaney in 2017 to describe what he called China's "predatory lending practices", which "overwhelm poor countries with unsustainable loans and force them to cede strategic leverage to China". According to Chellaney, "It's clearly part of China's geostrategic vision." Chellaney added that the Chinese government is "requiring secret negotiations and non-competitive pricing on projects in which bidding is closed and contracts must go to Chinese state-owned or state-linked companies which charge above-market prices". The idea was advanced by two Harvard University graduate students in a paper which called it Chinese "debt book diplomacy". The paper was cited by The Guardian, The New York Times and other major media outlets as academic evidence of China's intentions and spread through the media, intelligence circles and Western governments within a year.

Its original meaning has expanded to include other parts of the world. In 2018, The Guardian reported that some Belt and Road Initiative countries have begun reconsidering the project, with eight countries at risk of default. According to Jonathan Hillman, director of the Reconnecting Asia Project at the Center for Strategic and International Studies, there is more to these projects than financial strategy; "[i]t's also a vehicle for China to write new rules, establish institutions that reflect Chinese interests, and reshape 'soft' infrastructure." The term was further defined in a 2018 report by the Harvard Kennedy School's Belfer Center for Science and International Affairs, which described debt-trap diplomacy in the context of Chinese geostrategic interests.

Assessments

Media outlets

Western, Indian, and African media outlets have criticized the terms of Chinese state loans and their high interest rates. One example was a 2006 loan to Tonga to rebuild infrastructure. In 2013 and 2014, Tonga experienced a debt crisis when the Exim Bank of China (its creditor) did not write them off; the loans cost 44 percent of Tonga's gross domestic product (GDP). According to some analysts, such practices highlight China's hegemonic intentions and its challenges to state sovereignty.

In March 2022, Bloomberg News reported that despite China making the Western world uncomfortable with its large infrastructure projects in Africa, a deeper look into the evidence showed that the accusations towards China on doing debt-trap diplomacy in the continent, was "unfounded". The Economist investigation found that China, although a big lender, accounted for fewer shares of loans compared to the World Bank and commercial loans. No evidence of predatory lending practices was found.

Governments

In August 2018, a bipartisan group of 16 U.S. senators accused China of engaging in debt-trap diplomacy. In an October 2018 speech, U.S. Secretary of State Mike Pompeo said that China's loans are facilitated with bribes. A number of U.S. government documents refer to debt-trap diplomacy, including the 2020 Department of State report "The Elements of the China Challenge". According to senior U.S. government officials, Beijing "encourages dependency using opaque contracts [...] that mire nations in debt and undercut their sovereignty".

In 2021, the Trinidad and Tobago government defended its decision to accept a multi-million dollar loan from China rather than from the IMF by saying that (unlike the IMF) Beijing was not demanding any "stringent conditions" for its loans. Minister of Finance Colm Imbert said at a news conference,

The Chinese loan has a very attractive interest rate of two per cent. The IMF is 1.05 per cent, so there isn't much to choose between them. If you’re making a judgement call ... one loan, no structural adjustment, you don't have to retrench people, you don't have to de-value your currency, etc. etc. ... and then another ... you have to do all kinds of terrible things ... That's a no-brainer, obviously you’d go with the one that doesn't have any structural adjustment conditionalities associated with it, especially since the interest rates are very close, just one percent apart.

Studies

A May 2018 paper by Sam Parker and Gabrielle Chefitz from the Belfer Center for Science and International Affairs posited three strategic goals behind China's lending: "filling out a 'String of Pearls' to solve its 'Malacca Dilemma' and project power across vital South Asian trading routes; undermining and fracturing the US-led regional coalition contesting Beijing's South China Sea claims; and enabling the People's Liberation Army Navy to push through the 'Second Island Chain' into the blue-water Pacific."

A March 2018 report released by the Center for Global Development said that between 2001 and 2017, China restructured or waived loan payments for 51 debtor nations (most of the BRI's participants) without seizing state assets. In September 2018, W. Gyude Moore, a former Liberian public works minister and senior policy fellow at the Center for Global Development, said, "The language of 'debt-trap diplomacy' resonates more in Western countries, especially the United States, and is rooted in anxiety about China's rise as a global power rather than in the reality of Africa." Moore stated in 2021 that "China has been a net positive partner with most African countries."

An August 2018 China Africa Research Initiative report authored by Deborah Bräutigam, Janet Eom, and Lina Benabdallah said, "Chinese loans are not currently a major contributor to debt distress in Africa." According to the report, China was at the time "the most significant contributor to high risk of/actual debt distress" to three African countries: Zambia, Djibouti, and Congo.

In April 2019, the Rhodium Group said that China's leverage in debt was limited in power. According to a May 2019 Sydney Morning Herald article, accusations of "debt trap diplomacy" were being questioned by new research; an analysis of 40 Chinese debt re-negotiations by the Rhodium Group found "asset seizures are a very rare occurrence", and debt write-off is the most common outcome. The article also reported the views of Australian National University senior lecturer Darren Lim, who (referring to the Rhodium Group study) said that much of the leverage shifts to the borrower rather than the lender after the loan has been made. Lim also said that although the debt-trap diplomacy theory was never credible, the Trump administration embraced it. La Trobe University head of humanities and social sciences Nick Bisley said that China aimed to build political capital through the BRI, but asset seizures would not achieve that end.

An October 2019 report by the Lowy Institute said that China had not engaged in deliberate actions in the Pacific which justified accusations of debt-trap diplomacy (based on contemporaneous evidence), and China had not been the primary driver behind rising debt risks in the Pacific; the report expressed concern about the scale of the country's lending, however, and the institutional weakness of Pacific states which posed the risk of small states being overwhelmed by debt. A 2020 Lowy Institute article called Sri Lanka's Hambantota International Port the "case par excellence" for China's debt-trap diplomacy, but called the narrative a "myth" because the project was proposed by former Sri Lankan president Mahinda Rajapaksa, not Beijing. The article added that Sri Lanka's debt distress was not caused by Chinese lending, but by "excessive borrowing on Western-dominated capital markets".

Deborah Bräutigam, a professor at Johns Hopkins University, described debt-trap diplomacy as a "meme" which became popular due to "human negativity bias" based on anxiety about the rise of China. According to a 2019 research paper by Bräutigam, most of the debtor countries voluntarily agreed to the loans and had positive experiences working with China and "the evidence so far, including the Sri Lankan case, shows that the drumbeat of alarm about Chinese banks' funding of infrastructure across the BRI and beyond is overblown ... a large number of people have favorable opinions of China as an economic model and consider China an attractive partner for their development." Bräutigam and Meg Rithmire said that the theory lacked evidence, and criticized the media for promoting a narrative that "wrongfully misrepresents the relationship between China and the developing countries that it deals with." According to their research, China had never actually seized an asset from any country.

Gelpern et al. (2021) analyzed 100 contracts across 24 countries and found that "Chinese contracts contain unusual confidentiality clauses that bar borrowers from revealing the terms or even the existence of the debt", "Chinese lenders seek advantage over other creditors", and "cancellation. . . clauses in Chinese contracts potentially allow the lenders to influence debtors’ domestic and foreign policies."

In June 2022, according to a report by researchers from Columbia University and the University of Oxford, "the debt-trap narrative is a function of China-US strategic and ideological rivalry rather than a reflection of African realities or perspectives." While China is Africa's biggest bilateral creditor, most of the African debt is held by private Western holders, specifically American and European investors. Chinese debt is not the most rapidly growing segment of debt, whereas African debt owned by investors from America and Europe is the fastest growing segment of African debt in the last few years. At the end of 2019, Africa's total debt was equal to US$964 billion and the total debt owed to Chinese entities was equal to US$78 billion, which is equal to about 8 per cent of the region's total debt. In response to US criticism, Chinese institutions made many goodwill gestures by postponing debt repayments worth roughly $750 million. The study said, “contrary to the debt-trap narrative, if a wave of African defaults materializes in the near future, as International Financial Institutions officials have been fearing since at least 2015, it will be catalyzed more by private-sector maneuvering and intransigence than by Chinese scheming."

London School of Economics Professor Keyu Jin writes that the claim that China leads borrowers into a debt trap is misleading. Jin observes that the majority of BRI countries' debt is owed to international organizations or private Western institutions like hedge funds, rather than to China. Jin also writes that China has written off many of its loans and also provided debt relief to borrowers.

The IMF and the World Bank

Both the International Monetary Fund (IMF) and World Bank have been accused of predatory lending practices to keep emerging economies in debt, including: demanding structural adjustment programmes as a condition for loans, often to governments who see these loans as a last resort, pressuring for privatization and exerting undue influence over central banks. The founder of the activist network Committee for the Abolition of Illegitimate Debt wrote: "The World Bank and the IMF have systematically made loans to states as a means of influencing their policies." The IMF has used geopolitical considerations, rather than exclusively economic conditions, to decide which countries received loans.

In the book Confessions of an Economic Hit Man, whistle blower John Perkins accused international lenders, including the World Bank and the IMF, of persuading leaders of underdeveloped countries to accept loans for large development projects. Working as a consultant, Perkins was involved in misrepresenting the profitability of the development projects so that they appeared to be to be self-financing.

In 2020, Oxfam reported that the IMF was "using its power" through COVID-19 pandemic relief loans to impose austerity on poor countries. IMF conditions have forced recipients to cut healthcare spending, hampering their response to the COVID-19 pandemic.

Africa

Chinese loans to Africa
Year $ (billions)
2005
2
2006
5
2007
6
2008
4
2009
6
2010
7
2011
10
2012
13
2013
18
2014
15
2015
13
2016
30

Background

African countries rapidly increased their borrowing from China between 2000 and 2014 (totaling US$94.5 billion) as they sought to end their dependence on the IMF and World Bank, which demand market liberalisation in exchange for loans. Johanna Malm wrote that Chinese loans have been an alternative to IMF loans. IMF loans are lower-cost and financed by limited government income; Chinese loans are more expensive, but secured by high-revenue projects. China is a major project stakeholder in the economies of many African countries, significantly influencing the continent's affairs. According to 2015 and 2017 World Bank records, several African countries owe large debts to China and other creditor nations. Private-sector interest rates of about 55 percent prompted some African countries to go to China, which charges about 17 percent, for loans.

According to research conducted as part of the Jubilee Debt Campaign in October 2018, African debt to China rose from $10 billion in 2010 to more than $30 billion in 2016. China loaned a total of $143 billion to African governments and state-owned enterprises between 2000 and 2017. In 2020, the African countries with the largest Chinese debt were Angola ($25 billion), Ethiopia ($13.5 billion), Zambia ($7.4 billion), the Republic of the Congo ($7.3 billion), and Sudan ($6.4 billion).

In August 2022, the Ministry of Foreign Affairs of the People's Republic of China announced that it would forgive 23 interest-free loans that matured at the end of 2021 to 17 unspecified African countries.

Alleged evidence of debt trap diplomacy

Trade between African countries and China has also affected ties between Africa and other continents, especially Europe and North America. According to Deborah Brautigam, Chinese loans are prone to misuse and have encouraged corruption and power struggles in African countries. She also published her findings in a 2020 article for Johns Hopkins’ China Africa Research Initiative, titled “Debt Relief with Chinese Characteristics". Her analysis investigated Chinese loans in Ethiopia, Angola and the Republic of Congo, and “found no ‘asset seizures’. They also found that Beijing cancelled at least $3.4 billion and had restructured or refinanced around $15 billion of debt in Africa between 2000 and 2019. And at least 26 individual loans to African nations had been renegotiated. Writing in The Atlantic, Bräutigam stated that the debt-trap narrative is “a lie, and a powerful one" and that her research shown that "Chinese banks are willing to restructure the terms of existing loans and have never actually seized an asset from any country".

Despite criticism that Chinese firms emphasize Chinese labor, Chinese-funded infrastructure projects in Africa primarily employ African workers. A 2017 McKinsey report on Sino-African economic relations found that Africans made up 89 percent of labor on the projects surveyed, and job training and local workers were regularly included in contract negotiations between the Exim Bank of China and African countries.

Britain's Debt Justice charity, formerly the Jubilee Debt Campaign, found in a 2022 study, based on World Bank figures, that more African governments' external debts were being owed to Western banks, asset managers and oil traders (35%) than to Chinese lenders (12%). It also found that interest rates charged on western private loans (5%) were almost double that of Chinese loans (2.7%) and that "the most indebted countries were less likely to have their debt dominated by China".

Of 24 African countries that spent more than 15% of government revenue servicing debt in 2021, six countries - Angola, Cameroon, Republic of Congo, Djibouti, Ethiopia and Zambia - sent over a third of debt payments to Chinese lenders. Other private creditors accounted for over a third of payments in 12 countries.

As of 2023, there have been no Chinese asset seizures in Africa.

Kenya

Between 2006 and 2017, Kenya borrowed at least KSh. 1043.77 billion ($9.8 billion) from China. Chinese debt accounts for 21 percent of Kenya's foreign debt, and 72 percent of the country's bilateral debt. China lent Kenya funds to build highways and a railway between Mombasa and Nairobi totaling over US$6.5 billion by 2020. Kenya reportedly came close to default on Chinese loans to develop its largest and most lucrative port, the Port of Mombasa, in late December 2018; there was speculation that a default could have forced Kenya to relinquish control of the port to China. However, reports have cast doubt on Chinese debt-trap threat to the port. Kenyan media have debated whether Chinese loans are worth the risk, drawing analogies with the experience of Sri Lanka and saying that these loans could jeopardize Kenyan sovereignty.

South Africa

South Africa owes an estimated four percent of its annual gross domestic product to China. The country received multiple tranches of Chinese loans, some of which have raised concerns about opaque conditions and links to corruption. This includes a controversial $2.5 billion loan from the China Development Bank to the state-owned South African electrical utility Eskom which was arranged under the Jacob Zuma government. Another $2.5 billion loan to Eskom from Huarong Energy (a private Chinese company) was found improper by the Zondo Commission of Inquiry into state corruption, prompting Eskom chairperson Jabu Mabuza to say that the company would not repay the loan due to irregularities and corruption involved in the loan process.

An additional R 370 billion ($25.8 billion) loan from the China Development Bank during the presidency of Cyril Ramaphosa was made to promote a 2018 economic stimulus package. The South African government initially described the loan as a "gift"; details of the loan were not made public, generating controversy.

The government justified the loan, saying that the interest rate was not exorbitant but could not be disclosed due to a confidentiality clause. The loan was criticized by the opposition Democratic Alliance for risking the country's fall into a "debt trap".

Uganda

In October 2021, an investigation by the Parliament of Uganda concluded that non-public loan terms by Exim Bank of China for a $200 million expansion of Entebbe International Airport were onerous and could potentially lead to the loss of the airport in case of default. In November 2021, the Chinese embassy in Uganda rejected statements that the airport might be confiscated. A 2022 study of the loan contract by AidData stated that the airport was not at risk of seizure.

Zambia

Based on 2018 statistics in The Economist, China probably holds one-fourth to one-third of Zambia's external debt (comparable to other creditors, such as the U.S. and the World Bank. That year, Zambian lawmakers debated whether Chinese loans put Zambian sovereignty at risk. According to Africa Confidential, ZESCO (Zambia's state-owned power company) was in talks about repossession by a Chinese company. The Zambian government denied ZESCO privatization allegations. In July 2022, a committee of creditors co-chaired by China and France stated that they were committed to negotiating a restructuring of debt with Zambia under a G20 framework.

Elsewhere in Africa

  • Nigeria: China owns $3.1 billion of the country's total $27.6 billion foreign debt. The Nigerian financial publication Nairametrics warned about falling into a Chinese debt trap because of Nigeria's problems with corruption.
  • Djibouti: The country has borrowed to develop a strategic port, and Chinese loans total 77 percent of Djibouti's total debt. The country owes over 80 percent of its GDP to China, and became host to China's first overseas military base in 2017.
  • Republic of the Congo: An estimated $2.5 billion is owed to Chinese lenders; the exact figure is unknown, even by the Congolese government.
  • Egypt: China is financing the country's New Administrative Capital project. Gen. Ahmed Abdeen, who heads the Egyptian state-owned enterprise overseeing the new capital, criticized American reluctance to invest in Egypt during an interview: "Stop talking to us about human rights. Come and do business with us. The Chinese are coming—they are seeking win-win situations. Welcome to the Chinese."

Asia

Sri Lanka

Two large ships in the Hambantota International Port
Loans from China to build the Hambantota International Port have been cited as examples of debt-trap diplomacy.

In contrast to various conditions imposed by the World Bank or IMF, China has attached few conditions to its loans to Sri Lanka, requiring no policy reforms or similar structural adjustments. The use of Chinese labor on the project funded by the loan is the only condition for most Chinese loans to Sri Lanka.

Critics of Chinese foreign policy argue that loans to Sri Lanka by the Exim Bank of China to build the Hambantota International Port and the Mattala Rajapaksa International Airport are examples of debt-trap diplomacy. Contrary to critic's narratives, a 2022 Johns Hopkins University study found that there were no Chinese debt-to-equity swaps, no asset seizures, and no "hidden debt."

In 2007, the state-owned Chinese firms China Harbour Engineering Company and Sinohydro Corporation were hired to build the port for $361 million. Exim funded 85 percent of the project at an annual interest rate of 6.3 percent. After the project began losing money and Sri Lanka's debt-servicing burden increased, its government decided to lease the project to state-owned China Merchants Port on a 99-year lease for cash. The $1.12 billion lease to the Chinese company was used by Sri Lanka to address balance-of-payment issues. This raised concerns in the United States, Japan and India that the port might be used as a Chinese naval base to contain the country's geopolitical rivals, and the Chinese government might foreclose on the project.

Brahma Chellaney noted that China had gained considerable diplomatic leverage during the presidency of Mahinda Rajapaksa and enlarged its footprint in Sri Lanka. When a new government took power, Sri Lanka was on the "brink of default" and the new government had no choice but "to turn around and embrace China again". Chellaney described the Hambantota port as a strategically important natural asset with long-term value to China, even if it lacked short-term commercial viability. He said that China does not evaluate a borrower's creditworthiness, and will lend even if a loan would place a borrower in debt distress. It was later learned that Sri Lanka's debt burden was $51 billion, and 95 percent of its government revenue was going to debt servicing.

A statement issued by 182 leading economists accused private creditors - mostly Western banks & hedge funds - who hold 40% of Sri Lanka's debt of effectively taking the country hostage.

Current Sri Lankan prime minister Mahinda Rajapaksa defended the country's relationship with China and rejected the country's debt trap image, adding that "China provided concessionary loans for many infrastructure projects [during the post-conflict development]." In regards to the Hambantota Port, he added, "The Hambantota Port is not a debt trap." Rajapaksa dismissed the view that Sri Lanka was forced to enter a 99-year lease with a Chinese company because of a failure to pay the project's debts, stating that the project is commercially viable and is transforming Sri Lanka's overall port infrastructure.

Karunasena Kodituwakku, the Sri Lankan ambassador to China, said that the Chinese government did not ask the Sri Lankan government to hand over the port; the Sri Lankan government initially asked China to lease the port. Other Sri Lankan representatives have noted that it made sense for Sri Lanka to welcome Chinese investment in the port because most of its commercial shipping was from that country."

Deborah Bräutigam has disputed the usage of the term "debt-trap diplomacy". Concerning Sri Lanka, Bräutigam has noted that Chinese banks have been willing to restructure the terms of existing loans. She said that the Canadian International Development Agency financed the Canadian engineering and construction firm SNC-Lavalin's feasibility study for the port, and its study concluded in 2003 that construction of a port at Hambantota was feasible. A second feasibility report, concluded in 2006 by the Danish engineering firm Ramboll, reached a similar conclusion. According to Bräutigam, the port in Hambantota had to secure only a fraction of the cargo which went through Singapore to justify its existence. When President Maithripala Sirisena took office in 2015, Sri Lanka owed more to Japan, the World Bank, and the Asian Development Bank than to China; of the $4.5 billion in debt service Sri Lanka paid in 2017, only five percent was for Hambantota. Bräutigam was told by several Sri Lanka Central Bank governors that Hambantota (and Chinese finance in general) were not the major sources of the country's financial distress, and Bräutigam said that Sri Lanka did not default on any loans to China. Colombo had originally arranged a bailout from the IMF, but decided to raise the required funds by leasing the under-performing Hambantota Port to an experienced company as the Canadian feasibility study had recommended. Asanga Abeyagoonasekera, a Sri Lankan academic warned of a Chinese ‘strategic trap’ in Sri Lanka. Strategic-trap diplomacy term was coined by Asanga Abeyagoonasekera and published initially on 16 September 2021, assessing the Chinese Debt-trap diplomacy in Sri Lanka at an interview with Voice of America.

Chatham House published a research paper in 2020 concluding that Sri Lanka's debt distress was unconnected to Chinese lending, but resulted more from "domestic policy decisions" facilitated by Western lending and monetary policy than from Chinese government policies. The paper was skeptical of the claim that China could use Hambantota as a naval base (calling it "clearly erroneous"), and noted that Sri Lankan politicians and diplomats have repeatedly insisted that the topic was never brought up with Beijing; there has been no evidence of Chinese military activity at, or near, Hambantota since the port's lease began.

The lease was delayed for several months by concerns about possible military use and by opposition from trade unions and political parties, who called it a sellout of Sri Lankan national assets to China. Sri Lanka has indicated that it is reconsidering the lease of the Hambantota port to China.

Pakistan

Pakistan has received $42.7 billion in World Bank assistance since 1980, of which $33.4 billion are loans and $9.3 billion are grants; this has allowed the bank to exert local and national decision-making power in the country via public contracts and the appointment of State Bank of Pakistan governors. According to State Bank data, Pakistan's debt to the People's Republic of China was $7.2 billion in 2017; it increased to $19 billion by April 2018 and $30 billion by 2020, primarily due to loans to fund China–Pakistan Economic Corridor (CPEC) projects. The New York Times reported the investments' emerging military dimension in December 2018, calling it an opaque, poorly-governed debt trap. Experts have estimated that Pakistan would require nearly 40 years to pay back its debt to China. A number of scholars have said that the CPEC "subordinates Pakistan's interests to China's", and the CPEC and Pakistan's growing economic dependence on China could become a threat to Pakistan's sovereignty.

China and Pakistan signed a 2017 agreement to build five hydropower projects, with China investing $50 billion. According to Hassan Abbas, a Pakistani-American scholar in South Asian and Middle Eastern studies, project delays are likely to escalate costs to $98 billion. With accumulated interest of almost $5 billion per year, Pakistan would have to pay almost $200 billion over 20 years to China; scholars suggest that the debt could give China undue influence in Pakistan's affairs. Part of the agreement was scrapped by Pakistan in late 2017 due to objections to its terms.

Malaysia

China financed $22 billion in Malaysian projects during the administration of Prime Minister Najib Razak. Razak made a 31 May 2014 state visit to China, during which he was welcomed by Chinese premier Li Keqiang.

Malaysia has several Chinese Belt and Road Initiative projects under construction, including the East Coast Rail Line, Kuantan Port Expansion, Green Technology Park in Pahang, Forest City, Robotic Future City, and Samalaju Industrial Park Steel Complex.

In September 2018, Minister of Finance Lim Guan Eng cancelled two contracts, worth approximately $2.795 billion, with China Petroleum Pipeline Bureau for oil and gas pipelines. Mahathir Mohamad and Finance Minister Lim Guan Eng criticized the projects as expensive, unnecessary, superfluous, non-competitive (because open bidding was prohibited), conducted with no public oversight, and favored Chinese state-owned firms and those affiliated with Razak's United Malays National Organisation (UMNO) party at inflated prices. Residents of Malacca City said that the port was unnecessary, and the small company which received the contract had ties to the previously ruling UMNO.

About China's String of Pearls strategy in the Indian Ocean and China's motives in Malaysia and the Strait of Malacca, Malaysian Deputy Minister of Defense Liew Chin Tong said: "You look at a map and you can see the places where China is plotting ports and investments, from Myanmar to Pakistan to Sri Lanka, on toward Djibouti. What's crucial to all that? Our little Malaysia, and the Malacca Strait. I say publicly that we do not want to see warships in the Strait of Malacca or the South China Sea." The loans were later renegotiated; Mahathir Mohamad pledged support for the BRI, and was a key opening speaker at the 2019 BRI Summit in Beijing.

Maldives

People's Majlis (the Maldives parliament) speaker and former president Mohamed Nasheed said in December 2019 that the Maldives owed China $3.5 billion in loans, which included $1.5 billion in government-to-government loans, private loans, and sovereign guarantees. Nasheed said that the Chinese debt trap was an economic and human-rights issue, and an issue of sovereignty and freedom of the island nation. Nasheed has also said that project costs were inflated, and the debt on paper is far greater than the $1.1 billion actually received. Since 2008, when China began extending its operations within the Indian Ocean region, it has acknowledged the significant strategic importance of the Maldives. In order to enhance its control over the island nation, China is progressively utilizing its economic resources to exert influence on the administrative apparatus of the Maldives.

Laos

According to the World Bank, by the end of 2021, Laos's public debt had skyrocketed to 88% of gross domestic product, with Chinese creditors accounting for a 47% share of foreign debt. In addition, Laos owes 11% of its debt to China from bilateral loans. The firing of Bank of the Lao P.D.R. Governor Sonexay Sitphaxay in June 2022 hints at the economic crisis and panic.

According to Brahma Chellaney, China has taken effective control of Laos's electricity grid and, by extension, its water resources. Given the small size of Laos's economy with just seven million citizens, he finds China being able to exert enormous power over its resources.

Tajikistan

By 2008, the People's Republic of China surpassed Tajikistan's other creditors in outstanding loans; by the following year, 77 percent of Tajikistan's total loan portfolio consisted of Chinese loans. In 2011, Tajikistan's parliament agreed to cede approximately 1,000 km2 (390 sq mi) of land to China in exchange for waiving an outstanding debt amounting to hundreds of millions of dollars.

Tajikistan's 2018 debts to foreign creditors ("external debt") was estimated at $2.9 billion, of which $1.2 billion is owed to the Exim (Export-Import) Bank of China. That year, reports indicated that Xinjiang-based TBEA was granted gold-mine concessions in remuneration for TBEA costs to build a 400-megawatt power plant in Dushanbe. At the end of 2020, Tajikistan's total external debt neared $3.1 billion; of this, $1.12 billion (about 37 percent of the total) was owed to the Exim Bank of China.

Europe

China's BRI has made a number of investments in the European Union and continental Europe, including the port of Piraeus in Greece, Portugal's energy and transport sectors, and Hungarian railways. More than 12,400 freight trains travelled between China and Europe in 2020.

In April 2021, the Prime Minister of Montenegro asked the EU to help the country repay the $1 billion loan granted by the Exim Bank of China in 2014 to fund the A-1 motorway; it accounted for about 25 percent of Montenegro's external debt. Under the terms of the loan, China would receive thousands of hectares in case of non-payment. The project was called unfeasible and not economically viable in two feasibility studies by the European Bank of Reconstruction and Development and the European Investment Bank, the EU's rationale for refusing to fund it. With an estimated cost of $23.8 million per kilometre, it is one of the world's costliest highways. A paper by the China Africa Research Initiative called reporting of the land as collateral a rumor derived from mis-translation of a routine clause in the contract.

Latin America

An article on CNBC said that Chinese investment in Latin America had been burgeoning and that the project has been heavily criticized amid allegations of debt-trap diplomacy and neocolonialism. These concerns have been pronounced, especially in Venezuela and Ecuador. A 2019 study compiled by Boston University's Global Development Policy Center stated that Chinese lending has not driven Latin American countries, except possibly Venezuela, over IMF debt sustainability thresholds.

  • Argentina: Argentina has been denied access to, and oversight of, a Chinese satellite tracking station on its territory.
  • Ecuador: In March 2019, Ecuador agreed to borrow US$4.2 billion from the IMF, at a cost of 6% of its yearly GDP, while still being indebted US$6 billion to the World Bank and Inter-American Development Bank. Ecuador has agreed to sell 80-to-90 percent of its crude oil to China through 2024 in exchange for US$6.5 billion in Chinese loans.
  • Venezuela: an article published by Carnegie-Tsinghua Center for Global Policy said China's loans in Venezuela are not debt-trap diplomacy nor "creditor imperialism", but simply "lose-lose" financial mistakes in which both parties stand to lose. An article in Quartz summarized the Carnegie article; "counter to the dominant narrative about Chinese debt ensnaring other countries, the country that needs to fear excessive and unsustainable Chinese lending the most is China".

Pacific islands

In 2019, Lowy institute completed a systematic review of the evidence on whether or not China was doing debt-trap diplomacy in the Pacific Islands. Their findings were that China was not the main driver behind rising debt risks in the Pacific, nor was China the dominant creditor in the region. Only Tonga had China as a dominant creditor, but the researchers argued that this did not confer an advantageous position to China since they had to agree to defer repayments twice yet getting not much in return. They also found that Chinese lending terms were hardly predatory and that they "appear to be much more careful with loans", and concluded that "China has not been engaged in debt-trap diplomacy in the Pacific, as of yet". They also found the "overwhelming majority" of Chinese loans in the region are concessional enough to be deemed more as aid. However they also noted that the majority of the Pacific nations that are currently indebted to China, have little scope to take on more debts and recommended China to restructure their future approach to give more grant assistance, rather than more loans, to avoid overwhelming those nations with too much debts.

In March 2023, David Panuelo, president of the Federated States of Micronesia, wrote a letter accusing Beijing of bribery, spying and hostile takeovers: "Just because something is not technically legally binding doesn't mean you won't find yourself beholden to it".

Other countries

China has made loans to Kyrgyzstan, Laos, and Mongolia as part of the BRI. It also made a $115 million loan to Tonga to redevelop its infrastructure, and $2 billion in loans to Papua New Guinea (almost one-fourth of the country's national debt). China also has ongoing projects in Trinidad and Tobago, including a $500 million Chinese-built dry dock and a $102 million industrial park in La Brea.

Minority stress

From Wikipedia, the free encyclopedia

Minority stress describes high levels of stress faced by members of stigmatized minority groups. It may be caused by a number of factors, including poor social support and low socioeconomic status; well understood causes of minority stress are interpersonal prejudice and discrimination. Indeed, numerous scientific studies have shown that when minority individuals experience a high degree of prejudice, this can cause stress responses (e.g., high blood pressure, anxiety) that accrue over time, eventually leading to poor mental and physical health. Minority stress theory summarizes these scientific studies to explain how difficult social situations lead to chronic stress and poor health among minority individuals.

Theoretical development

Emergence

Over the past three decades, social scientists have found that minority individuals suffer from mental and physical health disparities compared to their peers in majority groups. This research has focused primarily on racial and sexual minorities. For example, Black Americans have been found to suffer elevated rates of hypertension compared to whites. Lesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals face higher rates of suicide, substance abuse, and cancer relative to non-queer people. More recent data suggest the association of minority stressors with higher rates of migraine headaches, stroke, and functional neurological disorder among LGBTQ+ people. Newer hypotheses propose that intersections of multiple minority stigmata increase experiences of stress.

Social selection hypothesis

One causal explanation for minority health disparities is the social selection hypothesis, which holds that there is something inherent to being in a minority group (e.g., genetics) that makes individuals susceptible to health problems. In general, this view has not been supported by empirical research. Instead, research suggests that environmental factors explain minority health disparities better than do genetic factors. While the social selection hypothesis is still debated, it is clear that genetic and dispositional factors do not fully explain the health disparities observed in minority groups.

Social causation hypothesis

A second hypothesis regarding the causes of minority health disparities suggests that minority group members face difficult social situations that lead to poor health. This hypothesis has received broad empirical support. Indeed, social psychologists have long recognized that minority individuals have different social experiences compared to majority individuals, including prejudice and discrimination, unequal socioeconomic status, and limited access to health care. According to the social causation hypothesis, such difficult social experiences explain health differences between minority and majority individuals.

Overview of minority stress theory

Minority stress theory extends the social causation hypothesis by suggesting that social situations do not lead directly to poor health for minority individuals, but that difficult social situations cause stress for minority individuals, which accrues over time, resulting in long-term health deficits.

When being applied to sexual and gender minorities, the term minority stress first appeared in the 1981 book Minority Stress in Lesbian Women by Virginia Rae Brooks, later known as Winn Kelly Brooks.

Minority Stress Theory, as it is currently referenced, was coined by Illan Meyer in his 1995 research study "Minority stress and mental health in gay men.". Meyer's version of minority stress theory distinguishes between distal and proximal stress processes. Distal stress processes are external to the minority individual, including experiences with rejection, prejudice, and discrimination. Proximal stress processes are internal, and are often the byproduct of distal stressors; they include concealment of one's minority identity, vigilance and anxiety about prejudice, and negative feelings about one's own minority group. Together, distal and proximal stressors accrue over time, leading to chronically high levels of stress that cause poor health outcomes. Thus, minority stress theory has three primary tenets:

  1. Minority status leads to increased exposure to distal stressors.
  2. Minority status leads to increased exposure to proximal stressors, due to distal stressors.
  3. Minority individuals suffer adverse health outcomes, which are caused by exposure to proximal and distal stressors.

These three tenets of the minority stress theory have been tested in over 134 empirical studies, most of which examined racial and sexual minority populations. Generally, the studies have confirmed that difficult social situations are associated with stress among minority individuals, and that minority stress helps to explain health disparities.

Evidence of key concepts

Minority status and distal stressors

The first tenet of minority stress theory holds that being in a minority group is associated with increased exposure to distal stressors, such as prejudice and discrimination. Indeed, despite significant improvement over the past several decades, numerous studies have confirmed that minority individuals continue to face high rates of distal stressors. For example, in large-scale national surveys, LGBTQ+ individuals report high rates of prejudice and discrimination across the lifespan. One survey found that one-fourth of LGB adults have experienced victimization related to their sexual orientation, and another found that as many as 90% of LGBTQ+ youth report hearing prejudiced remarks at school. Similarly, up to 60% of African Americans report experiencing distal stressors throughout their lives, ranging from social rejection at school to housing discrimination and employment discrimination. In one study, 37 African American respondents recalled over 100 discrete experiences with racist prejudice in a two-year period. In another study, 98% of Black participants reported experiencing at least one incidence of prejudice in the past year.

Rates of exposure to distal stressors are much higher among racial and sexual minorities than among majority individuals. For example, LGBTQ+ adults are twice as likely to recall experiencing prejudice throughout their lives compared to heterosexuals, and LGBTQ+ youth report significantly higher rates of prejudice and discrimination compared to their heterosexual and cisgender peers. In one carefully controlled study, researchers compared rates of victimization among LGBTQ+ youth and their heterosexual siblings, and they found significantly higher rates of abuse among the LGBTQ+ individuals. Comparing rates of perceived discrimination among African American and White individuals, researchers have found large differences in reports of discrimination: 30.9% of Whites reported experiencing "major discrimination" throughout their lives compared to 48.9% of African Americans. Similarly, 3.4% of Whites reported experiencing discrimination "often" in their lives, compared to 24.8% of African Americans. Thus, collectively, research suggests that minority individuals face frequent exposure to distal stressors compared to their majority group counterparts.

Minority status and proximal stressors

Proximal stressors are internal processes that are presumed to occur following exposure to distal stressors. Examples of proximal stressors include fear of rejection, rumination on previous experiences with prejudice, and distaste for one's own minority group following a prejudice event. Most research on this topic focuses on either sexual minorities or African Americans, and it is unclear whether the proximal stress processes are conceptually similar between these two groups. Thus, it is necessary to review proximal stress processes separately for sexual minority and African American populations.

Proximal stressors among sexual minorities

A growing body of research indicates that exposure to distal stressors leads to proximal stressors in sexual minority populations. While sexual minority stress and gender minority stress both use Meyer's Minority Stress Model as a framework, and share some characteristics with gender minority stress, some researchers have suggested that sexual minority stress is distinct from the minority stress experienced by transgender, gender non-conforming, and non-binary-gender individuals. For example, LGBTQ+ youth and adults who have experienced prejudice about their sexual orientation sometimes choose to conceal their sexual identity from others. Concealing such personal information causes significant psychological distress, including intrusive thoughts about the secret, shame and guilt, anxiety, and isolation from other members of the minority group. Internalized homophobia is another proximal stressor prevalent among LGBT individuals. It refers to the internalization of negative social views about homosexuality, which leads to self-hatred and poor self-regard. As predicted by minority stress theory, internalized homophobia is associated with exposure to distal stressors, insofar as it only occurs because LGB individuals are exposed to negative societal attitudes toward same-sex attraction. Rejection sensitivity represents a third proximal stress among sexual minority individuals. Rejection sensitivity refers to chronic, anxious expectations of rejection based on one's stigmatized status. Among sexual minority individuals, rejection sensitivity emerges from experiences of rejection from parents and is associated with internalized homophobia, unassertiveness, depression, and anxiety. Thus, previous experiences with prejudice are associated with proximal stress among LGBTQ+ individuals, including concealment of their sexual identity, internalized homophobia, and rejection sensitivity.

Proximal stressors among gender minorities

In comparison to cis (non-transgender) individuals, gender variant minorities face a higher rate of distal stressors, including exclusion, verbal trans bashing, as well as physical and sexual violence. The more distal stressors are sourced in family, friends, partners, neighbors, co-workers, acquaintances, strangers, and even the police, the more likely it is for gender variant people to experience proximal stress, including internalized transphobia. Internalized transphobia may initially appear as anxiety and depression, marked by a severe decrease in self-tolerance or self-empathy, yet needs to be understood diagnostically within the context of minority stress.

Proximal stressors among African Americans

Among African Americans, proximal stressors were described by early social psychological theorists. For example, Erving Goffman observed that racial minorities approach social interactions with a high degree of anxiety, because they have been discriminated against in the past. Similarly, Gordon Allport asserted that African American individuals display vigilance after exposure to prejudice, actively scanning the social environment for potential threats. Such vigilance is presumed to be taxing, sapping emotional and cognitive energy from minority individuals and thus becoming stressful. Proximal stressors also have been demonstrated among African Americans in terms of stereotype threat. Researchers have shown that, when African Americans are reminded of their racial minority status in an academic context, they face a high degree of anxiety, causing their intellectual performance to suffer.

General proximal stressors among minority individuals

The proximal stress processes reviewed above are unique to specific minority groups; for example, internalized homophobia is a proximal stressor unique to LGBTQ+ individuals who experience prejudice about their sexual and or/gender orientation/expression, and vigilance against racism is unique to racial minorities who fear future experiences with race-based discrimination. It is also possible that more general psychological processes act as proximal stressors for minority individuals. For example, exposure to prejudice may lead to rumination, which is a common psychological phenomenon characterized by a maladaptive, repetitive, and obsessive focus on a past event that leads to depressive and anxious symptoms. Several studies have shown that distal stressors are associated with such general proximal stress processes among minority individuals. In one 2010 longitudinal study, researchers found that gay men who experienced distal stressors related to their sexual orientation had an increased tendency to ruminate, which was associated with increased depressive and anxious symptoms compared to gay men who did not experience distal stressors. In another study from 2009, LGBT youth reported higher rates of rumination on days when they experienced distal stressors; rumination in turn was associated with psychological distress. Because minority individuals have been shown to face high rates of distal stressors compared to majority individuals, and because experiencing distal stressors is associated with general psychological stress processes such as rumination and anxiety, these findings highlight the more general ways in which prejudice and discrimination may affect internal stress processes among minority individuals.

Health outcomes

The bulk of minority stress research has examined the third tenet of the theory – namely, that distal and proximal stressors are associated with adverse health outcomes for minority individuals. These outcomes include both mental and physical health disparities, which differ across minority groups. Again, studies have yet to systematically determine whether minority stress is associated with different health outcomes among different minority groups. Thus, it is necessary to review associations between minority stress and health separately for LGBTQ+, African Americans, and immigrant groups, as social scientists do not know whether stress causes similar outcomes across groups. The immigrant paradox outlines health outcomes among immigrant populations.

Health outcomes among sexual minorities

LGBTQ+ individuals face higher rates of psychopathology compared to their non-LGBTQ+ peers. For example, population-based studies have shown that LGBTQ+ people are at risk for increased rates of substance abuse, suicide attempts, depression, anxiety, and somatoform disorders across the lifespan. In fact, one meta analysis found that LGBT individuals are 2.5 times more likely to have a lifetime history of mental disorder compared to heterosexuals, and 2 times more likely to have a current mental disorder. In terms of physical health, LGBTQ+ individuals are at heightened risks for some types of cancer and immune dysfunction.

Several studies have linked these negative health outcomes to distal stressors. For example, in a national survey, LGBT adults displayed higher rates of psychiatric morbidity and also reported significantly higher rates of prejudice and discrimination compared to their heterosexual peers; prejudice and discrimination fully explained the link between sexual orientation and psychiatric symptoms for LGBT respondents. In another study, level of peer victimization partially explained associations between sexual orientation and suicide risk. Perceived level of discrimination has also been shown to predict anxiety and substance abuse disorders among LGBTQ+ individuals. Multiple studies have also established an association between same-sex marriage legalization and reduced suicidality of youth and adolescents, indicating that the structural stigma embedded in denying equivalent rights to sexual minorities mediates part of the relationship between distal stressors and mental health.

Proximal stressors have also been linked to negative health outcomes for sexual minorities. For example, internalized homophobia has been linked to self-harm and eating disorders as well as sexual risk-taking behavior. Internalized homophobia has also been linked to general psychological distress, which predicts long-term mental health outcomes. Thus, both distal and proximal social stressors are associated with negative mental health outcomes among sexual minorities. A 2013 study suggests similar links between proximal stressors and physical health disparities in LGBTQ+ communities, including cardiovascular disease, asthma, diabetes, and some cancers. More recently, gender dysphoria has been suggested to represent a proximal minority stressor.

Health outcomes among African Americans

African Americans have been shown to suffer notable health disparities compared to their White peers. For example, they suffer higher rates of morbidity due to stroke, perinatal disease, and diabetes mellitus compared to Whites. They also suffer high rates of colorectal, pancreatic, and stomach cancers. In terms of mental health, African Americans report lower rates of overall life satisfaction, as well as heightened depressive symptoms and substance abuse compared to Whites.

Distal stressors have been linked to these health disparities among African Americans. For example, one study showed that perceived prejudice was associated with irregular blood pressure throughout the day, which has been linked to long-term cardiovascular disease. Exposure to racial prejudice has also been linked to negative health behaviors, such as smoking and substance abuse, which are associated with poor cardiovascular health. Indeed, a 2009 meta analysis of 36 empirical studies revealed consistent effects of prejudice and discrimination on physical health (e.g., cardiovascular disease, hypertension, diabetes) among racial minorities. That same review revealed that racial prejudice and discrimination were related to depressive symptoms and psychiatric distress in 110 empirical studies. Individual studies have shown that reports of discrimination are associated with lower reports of happiness and life satisfaction, higher psychiatric distress, and depressive symptoms. Thus, exposure to distal stressors has been linked to poor mental and physical health outcomes for African Americans.

Other studies have linked proximal stressors and health outcomes for African Americans. For example, researchers have found that African Americans have a sense of inferiority and low self-worth due to experiences with prejudice, which are associated with emotional distress. Similarly, internalized racism has been linked to psychiatric symptoms, including high rates of alcohol consumption, low self-esteem, and depression. These findings corroborate the minority stress theory by demonstrating that proximal stressors are associated with health disparities among racial minorities. Non-Hispanic Whites are more than twice as likely to receive antidepressant prescription treatments as are Non-Hispanic Blacks. The death rate from suicide for African American men was almost four times that for African American women, in 2009. However, the suicide rate for African Americans is 60% lower than that of the Non-Hispanic White population. A report from the U.S. Surgeon General found that from 1980 - 1995, the suicide rate among African Americans ages 10 to 14 increased 233%, as compared to 120% of Non-Hispanic Whites.

Criticism and limitations

Despite multiple studies indicating that minority individuals face a high degree of stress related to their minority identity, and that minority stress is associated with poor health outcomes, there are several methodological limitations and ongoing debates on this topic.

First, the minority stress concept has been criticized as focusing too narrowly on the negative experiences of minority individuals and ignoring the unique coping strategies and social support structures available to them. While theoretical writings about minority stress do note the importance of coping mechanisms for minority individuals, individual studies that use minority stress theory tend to focus on negative health outcomes rather than on coping mechanisms. In the future, it will be important for researchers to consider both positive and negative aspects of minority group membership, examining whether and why one of those aspects outweighs the other in determining minority health outcomes.

Also, few studies have been able to test minority stress theory in full. Most studies have examined one of the three links described above, demonstrating that minority individuals face heightened rates of prejudice, that minority individuals face health disparities, or that prejudice is related to health disparities. Together, findings from these three areas corroborate minority stress theory, but a stronger test would examine all three parts in the same study. While there have been a few such studies, further replication is necessary to support the presumed pathways underlying minority stress.

Most studies of minority stress are correlational. While these studies have the advantage of using large, national datasets to establish links between minority status, stressors, and health, they cannot demonstrate causality. That is, most of the existing research cannot prove that prejudice causes stress, which causes poor health outcomes among minority individuals, because correlation does not imply causation. One way to remedy this limitation is to employ experimental and longitudinal research designs to test the impact of social stressors on health. Indeed, several studies from the 2000s made use of these more stringent tests of minority stress. Additional studies are needed to confidently state that prejudice causes poor health for minority individuals.

It is unclear whether different minority groups face different types of minority stress and different health outcomes following prejudice. Minority stress theory was originally developed to explain associations between social situations, stress, and health for LGB individuals. Still, researchers have used the same general theory to examine stress processes among African Americans, and findings have generally converged with those from LGB populations. Thus, it is possible that minority stress applies broadly to members of diverse minority groups. However, studies have yet to directly compare experiences, stress responses, and health outcomes among individuals from diverse minority groups. Systematic comparisons are necessary to clarify whether minority stress applies to all minority individuals broadly, or whether different models are required for different groups.

J. Michael Bailey, best known for his research on sexual orientation, argues that the minority stress model deserves reconsideration since it fails to take temperament and genetics into account. Bailey argues that there is a biological component to increased stress among non-heterosexual populations, and says that "it would be a shame—most of all for gay men and lesbians whose mental health is at stake—if sociopolitical concerns prevented researchers from conscientious consideration of any reasonable hypothesis".

Practical applications

Minority stress research has demonstrated that several specific processes are associated with minority health disparities. For example, existing studies highlight the differences between distal and proximal stressors, drawing attention both to socio-cultural factors (e.g., high rates of prejudice against minority individuals) and internal processes (e.g., rumination) that affect minority well-being. By separating the socio-cultural and individual aspects of minority stress, the theory suggests that practical interventions must occur at both the individual and social levels.

Social applications

On the societal level, minority stress research shows that prejudice and discrimination are common occurrences for minority individuals, and that they have damaging effects for individual well-being. This information has been used by law enforcement, policymakers, and social organizations to target and minimize the occurrence of distal stressors and, thus, to improve minority health on a large scale. For example, evidence that prejudice is associated with minority stress has been used in several amicus curiae briefs to settle important court cases regarding prejudice and discrimination against minority groups. Evidence that prejudice and discrimination are associated with minority stress that harms well-being for LGB individuals has also been invoked in the congressional debate about anti-harassment protection for LGB youth at the federal level. In the future, the minority stress concept can be used to advocate for federal funding for nationwide campaigns and interventions that aim to reduce intergroup prejudice. If successful, these programs may reduce the rate of distal stressors, significantly improving the mental and physical health of minority individuals.

Individual applications

On the individual level, minority stress research has uncovered differences in how minorities react to prejudice. For example, studies have shown that some individuals ruminate on experiences with prejudice, which is associated with anxiety and depression. Similarly, minority stress research has revealed that internalized stigma (i.e., distaste for one's own minority group) is associated with negative psychological outcomes. From these findings, clinicians have developed some interventions to decrease internalized stigma and improve well-being for minority individuals. When paired with structural interventions, these clinical applications for reducing minority stress may help to improve the pervasive health disparities observed in minority communities.

Health effects of salt

From Wikipedia, the free encyclopedia
SEM image of a grain of table salt

The health effects of salt are the conditions associated with the consumption of either too much or too little salt. Salt is a mineral composed primarily of sodium chloride (NaCl) and is used in food for both preservation and flavor. Sodium ions are needed in small quantities by most living things, as are chloride ions. Salt is involved in regulating the water content (fluid balance) of the body. The sodium ion itself is used for electrical signaling in the nervous system.

In 2020, the World Health Organization (WHO) recommended that adults consume no more than 5 grams (0.18 oz) (just under a teaspoon) of salt per day, an amount providing about 2 grams (0.071 oz) of sodium per day. The WHO further recommends that salt intake be adjusted for those aged 2 to 15 years old based on their energy requirements relative to those of adults. High sodium consumption (5 g or more of salt per day) and insufficient potassium intake (less than 3.5 grams (0.12 oz) per day) have been linked to high blood pressure and increased risk of heart disease, stroke, and kidney disease.

As an essential nutrient, sodium is involved in numerous cellular and organ functions. Several national health organizations recommend limiting sodium consumption to 2.3 g per day. However, some studies have found that sodium intake that is below 3 g per day (equivalent to about 7.5 g of salt) may increase risk for cardiovascular disease and early death.

Acute effects

Hypernatremia (high blood sodium level, above 145 mEq/L) causes thirst, and due to brain cell shrinkage may cause confusion, muscle twitching, or spasms. With severe elevation, seizures and comas may occur. Death can be caused by ingestion of large amounts of salt at a time (about 1 g per kg of body weight). Deaths have also been caused by use of salt solutions as emetics, typically after suspected poisoning.

Hyponatremia, or blood sodium levels below 135 mEq/L, causes brain cells to swell; the symptoms can be subtle and may include altered personality, lethargy, and confusion. In severe cases, when blood sodium falls below 115 mEq/L, stupor, muscle twitching or spasms, seizures, coma, and death can result.

Long-term effects

Major health organizations and recent reviews state that high consumption of salt increases the risk of several diseases in children and adults,

Excess sodium consumption increases blood pressure. Some studies suggest a "U" shaped association between salt intake and mortality, with increased mortality associated with both excessively low and excessively high salt intake. Larger reductions in salt intake lead to larger decreases in blood pressure.

Health effects associated with excessive sodium consumption include:

  • Stroke and cardiovascular disease.
  • High blood pressure: Evidence shows an association between salt intakes and blood pressure among different populations and age ranges in adults. Reduced salt intake also results in a small but statistically significant reduction in blood pressure.
  • Left ventricular hypertrophy (cardiac enlargement): "Evidence suggests that high salt intake causes left ventricular hypertrophy. This is a strong risk factor for cardiovascular disease, independently of blood pressure effects." "...there is accumulating evidence that high salt intake predicts left ventricular hypertrophy." Excessive salt (sodium) intake, combined with an inadequate intake of water, can cause hypernatremia. It can exacerbate renal disease.
  • Edema (fluid retention): A decrease in salt intake has been suggested to treat edema.
  • Kidney disease: A US expert committee reported in 2013 the common recommendation by several authorities "to reduce daily sodium intake to less than 2,300 milligrams and further reduce intake to 1,500 mg among persons who are 51 years of age and older and those of any age who are African-American or have hypertension, diabetes, or chronic kidney disease", but concluded that there was no health-outcome-based rationale for reducing intake below 2,300 mg, and did not have a recommendation for an upper limit.

A meta-analysis investigated the association between sodium intake and health outcomes, including all-cause mortality and cardiovascular disease (CVD) events. Low sodium intake level was a mean of <115 mmol (2645 mg), usual sodium intake was 115-215 mmol (2645–4945 mg), and a high sodium intake was >215 mmol (4945 mg), concluding: "Both low sodium intakes and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes".

Salt-preserved foods

The American Institute for Cancer Research (AICR) and World Cancer Research Fund International (WCRF) have stated that there is strong evidence that consuming salted foods including salt-preserved fish and salt-preserved foods in general increases risk of stomach cancer and that the high salt content of processed meat may result in damage to the stomach mucosal lining. The American Cancer Society have stated that "stomach cancer risk is increased in people whose diets include large amounts of foods preserved by salting, such as salted fish and meat and pickled vegetables."

Possible effects of microplastic contamination

Microplastic contamination in sea salt has been confirmed in all areas of the world, ranging from zero to 1,674 particles per kilogram. The most common particles are polypropylene, followed by polyethylene and nylon. Microplastic particles per kg sea salt tend to be higher when sourced from Asian countries. Salt sourced from India ranged from 115 to 560 particles/kg. Sea salt sourced from China reported more than 400/kg. Microplastics also accrue in shellfish grown or harvested in regions with microplastic contamination of seawater, and are a significant contributor to human exposure. The extent to which humans are exposed to microplastics in foods and beverages can be assessed via measuring microplastics content in feces, but the health effects, if any, are poorly understood.

Dietary recommendations

Recommended intakes of salt are usually expressed in terms of sodium intake as an Adequate Intake (AI) and a Tolerable upper intake level (Upper Limit or UL). Salt (as sodium chloride) contains 39.3 percent of sodium by weight.

Country Description Sodium intake
mg per day
Salt intake
mg per day
Authority Remarks
United Kingdom The Reference Nutrient Intake (RNI) defined for a typical adult RNI: 1600 RNI: 4000 Scientific Advisory Committee on Nutrition (SACN) (2003) However, average adult intake is two and a half times the RNI. SACN states, "The target salt intakes set for adults and children do not represent ideal or optimum consumption levels, but achievable population goals." The Food Safety Authority of Ireland endorses the UK targets.
Canada An Adequate Intake (AI) and Upper Limit (UL) recommended for persons aged 4 years or more. AI: 1200–1500
UL: 1900–2300
AI: 3000–3750
UL: 5500–5750
Health Canada (2017) "Canadians are consuming too much sodium without understanding the risks to their health. Canadians should lower their sodium intakes, as part of maintaining a healthy lifestyle, to reduce the risk of high blood pressure, stroke and heart and kidney disease." (2017)
Australia and New Zealand An Adequate Intake (AI) and an Upper Level of intake (UL) defined for adults AI: 460–920
UL: 2300
AI: 1150–2300
UL: 5750
NHMRC (2006) Not able to define a recommended dietary intake (RDI)
United States An Adequate Intake (AI) and Upper Limit (UL) defined for adults. A different UL defined for the special group comprising people over 51 years of age, African Americans and people with hypertension, diabetes, or chronic kidney disease (regardless of age). UL: 2300
UL for special group: 1500
UL: 5750
UL for special group: 3750
Department of Agriculture and Department of Health and Human Services (2010) The Food and Drug Administration itself does not make a recommendation, but refers readers to the dietary guidelines given by this authority.

As of 2009 the average sodium consumption in 33 countries was in the range of 2,700 to 4,900 mg/day. This ranged across many cultures, and together with animal studies, this suggests that sodium intake is tightly controlled by feedback loops in the body. This makes recommendations to reduce sodium consumption below 2,700 mg/day potentially futile. Upon review, an expert committee that was commissioned by the Institute of Medicine and the Centers for Disease Control and Prevention reported that there was no health outcome-based rationale for reducing daily sodium intake levels below 2,300 milligrams, as had been recommended by previous dietary guidelines; the report did not have a recommendation for an upper limit of daily sodium intake.

The United States Centers for Disease Control and Prevention (CDC) states that excess sodium can increase blood pressure and the risk for heart disease and stroke in some individuals. Therefore, health authorities recommend limitations on dietary sodium. The United States Department of Health and Human Services recommends that individuals consume no more than 1500–2300 mg of sodium (3750–5750 mg of salt) per day.

Although sea salt is sometimes promoted as being healthier than table salt, both forms have the same sodium content.

Labeling

UK: The Food Standards Agency defines the level of salt in foods as follows: "High is more than 1.5 g salt per 100 g (or 0.6 g sodium). Low is 0.3 g salt or less per 100 g (or 0.1 g sodium). If the amount of salt per 100 g is in between these figures, then that is a medium level of salt." In the UK, foods produced by some supermarkets and manufacturers have 'traffic light' colors on the front of the packet: red (high), amber (medium), or green (low).

USA: The FDA Food Labeling Guide stipulates whether a food can be labeled as "free" "low," or "reduced/less" in respect of sodium. When other health claims are made about a food (e.g., low in fat, calories, etc.), a disclosure statement is required if the food exceeds 480 mg of sodium per 'serving'.

Campaigns

Australia

In Australia, the "Drop the Salt! Campaign" aimed to reduce the consumption of salt by Australians to 6g per day over the course of five years ending in 2012.

South Africa

In 2016, South Africa was the first country to legislate the maximum amount of salt in processed food. The legislation was aimed at addressing the fact that 60% of salt in the diet was contributed to by processed foods, with 65% of all ethnic groups consuming sodium in excess of 6g/day, and 40% of young adults in excess of 9g/day.

United Kingdom

Consensus Action on Salt and Health (CASH) established in the United Kingdom in 1996, actively campaigns to raise awareness of the alleged harmful health effects of salt. The 2008 focus includes raising awareness of high levels of salt hidden in sweet foods that are marketed towards children. In 2004, Britain's Food Standards Agency started a public health campaign called "Salt – Watch it", which recommends no more than 6 g of salt per day; it features a character called Sid the Slug and was criticised by the Salt Manufacturers Association (SMA). The Advertising Standards Authority did not uphold the SMA complaint in its adjudication. In March 2007, the FSA launched the third phase of their campaign with the slogan "Salt. Is your food full of it?" fronted by comedian Jenny Eclair.

United States

Federal programs

Since 2010, as part of the Sodium Reduction in Communities Program (SRCP), the United States Centers for Disease Control and Prevention funded local communities across the United States to implement a variety of policy, systems, and environmental change strategies focused on increasing access to lower sodium in foods in a variety of settings such as hospitals, congregate meal sites, and university settings.

Voluntary initiatives

In January 2010, New York City launched the National Salt Reduction Initiative (NSRI). It was the only coordinated, voluntary effort to reduce sodium in the United States, an effort supported by the Institute of Medicine as an interim goal in advance of federal action on sodium reduction.

As of 2013, over 90 state and local health authorities and health organizations had signed on as partners of the NSRI. Together, the NSRI partnership encouraged food manufacturers and chain restaurants to voluntarily commit to NSRI sodium reduction targets for 2012 and 2014. The NSRI aimed to reduce sodium in the food supply by 25 percent in five years and reduce population sodium intake by 20 percent in the same time, thereby reducing risk for heart attacks and strokes.

Taxation

In the United States, taxation of sodium has been proposed as a method of decreasing sodium intake and thereby improving health in countries where typical salt consumption is high. Taking an alternative view, the Salt Institute, a salt industry body based in North America, is active in promoting the use of salt, and questioning or opposing the recommended restrictions on salt intake.

Dietary reduction

A low sodium diet reduces the intake of sodium by the careful selection of food. The use of a salt substitute can provide a taste offsetting the perceived blandness of low-salt food; potassium chloride is widely used for this purpose. The World Health Organization (WHO) recommends daily potassium intake of not less than 3,510 mg. Government interventions such as food product reformulation and food procurement policy have the potential to reduce the population salt intake.

Studies found that excessively low sodium intake, below about three grams (3,000 mg) of salt per day, is associated with increased mortality and higher risk for cardiovascular disease.

A 2020 Cochrane systematic review concludes that for white people with hypertension, reducing salt intake results in a decrease of about 4 mmHg (about 3.5%) of their blood pressure; for people with normal blood pressure, the decrease was negligible. Weak evidence indicated that these effects might be a little greater in black and Asian people. This review also indicates potential negative side effects on hormones and lipid levels, so that decreasing salt intake is not necessarily recommended for people with normal blood pressure.

In people with chronic kidney disease, including those on dialysis, there is high-certainty evidence that dietary salt restriction may help to lower systolic and diastolic blood pressure, as well as albuminuria. The risk of hypotensive symptoms, such as dizziness, may also increase in some people, with moderate certainty. It is unclear whether this affects the dosage required for anti-hypertensive medications. The effect of salt restriction on extracellular fluid, oedema, and total body weight reduction is also uncertain.

Introduction to entropy

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