World experts in iodine deficiency today urged renewed international commitment to help prevent loss of IQ due to fetal brain damage by facilitating access to iodized salt for the final 30 percent of world households that don't yet have it -- most of them found in just 20 countries.
At United Nations Headquarters, New York Weds. Dec. 12, the Network for Sustained Elimination of Iodine Deficiency and other issue stakeholders mark a major public health advance achieved in two decades: iodized salt now reaches 70 percent of world households, up from less than 20 percent in the early 1990s. They urge accelerated action to reach 100 percent coverage.
Thanks to successful production and marketing of iodized salt since the early 1990s, an additional 84 million annual births are now protected from the danger of significant brain damage due to iodine deficiency disorders (IDD).
However, experts report progress towards universal iodine coverage has slowed since 2002 and an estimated 1.6 billion people remain at risk of IDD. According to UNICEF, 38 million newborns worldwide remain unprotected and there are still 36 countries where fewer than half of households consume iodized salt.
Says Network Chair Alan Court, Director of the UNICEF Programme Division: "Poverty and associated health, nutrition, and social factors prevent at least 200 million children in developing countries from attaining their development potential. Among these factors the estimated impact of iodine deficiency is considered the largest and affects at least 20-25% of children in developing countries. This overwhelming evidence makes prevention of iodine deficiency a high priority which fosters children's development. The good news is that all of these disorders are easily preventable at very low cost ensuring adequate intake of iodine through the addition of a small amount of iodine to salt."
Fetal brain function damage due to iodine deficiency ranges from loss of up to10 to 15 points of IQ to severe mental retardation. In problem areas, entire school classes score lower on their educational achievement, with fewer students progressing to higher education. And, for a nation, the consequences are lower productivity, lower competitiveness in the global marketplace and higher health care costs.
To avoid suffering IDD, a human requires in a life time a total just one teaspoon of iodine -- this can be added to salt at a cost of about 10 cents worth per year. But it is necessary to ingest micro amounts of iodine on a regular basis. Consumption of iodized salt is the best form of IDD prevention and Universal Salt Iodization (USI) is the goal. The greatest need for micro amounts of iodine is in the mother's womb.
The Network for Sustained Elimination of Iodine Deficiency has assigned top priority in 2005-2010 to supporting the following countries: Afghanistan, Angola, Bangladesh, Bolivia, China, Egypt, Ethiopia, Ghana, Guatemala, Haiti, India, Indonesia, Niger, Pakistan, The Philippines, Russia, Senegal, Sudan, Ukraine, Vietnam.
The Network credits a strongly dedicated partnership, coupled with enlightened public policies, private industry action and civic sector commitment with the rapid progress towards universal iodization of edible salt. Since 1990 more than two billion people have become users of iodized salt, a remarkable feat in dietary behavior change.
Governments have pursued policies that support and sustain salt iodization and monitored progress. The salt industry and vendors produce and sell adequately iodized salt at a fair price in cities and villages. Civil society groups -- including Kiwanis International -- assist with public education about the dangers of iodine deficiency, strengthening public demand for iodized salt.
As a result:
- At least 34 countries have reached the USI goal, with 90% of households consuming iodized salt;
- At least 60 countries are well on their way towards the goal, with at least 70% of their households having access to adequately iodized salt; and
- The number of countries which face iodine deficiency as a public health problem has reduced from 110 countries in 1993 to 47 currently.
Efforts to date have involved nearly US $400 million in funds raised in large part by Kiwanis International and through contributions of the governments of Canada, the Netherlands, Australia and the US, as well as The Bill and Melinda Gates Foundation. In addition, an estimated investment of US $2 billion has been made by the salt industry.
"There is no other activity that has drawn together the productive sector of society, the government sector, civic society and the general public in a manner that iodine deficiency elimination has done," says Dr. Gerard Burrow, Chair of The International Council for Control of Iodine Deficiency Disorders (ICCIDD) and Dean Emeritus of the Yale University School of Medicine, noting that salt iodization represents the first large-scale fortification of a commodity to address a public health problem.
Households yet to be reached include the world's most marginalized -- typically poor, rural and in greatest need of IDD protection. Experts predict that the remaining distance from today to USI will be the hardest to cover. Needed is customization of the strategies successfully deployed to date in order to reach the unprotected population left, coupled with political commitment, education and awareness, and improved monitoring.
Where salt iodization has yet to occur, the main challenges include:
- Absent political commitment;
- Salt iodization legislation has not been enacted or does not extend to iodization of salt licks for animals or processed food;
- Legislation is not backed by effective enforcement and monitoring;
- Though salt iodization is a simple process, small scale producers are not supported and organized to ensure that their products are iodized;
- Consumer awareness and demand for iodized salt is lacking.
Meanwhile, the threat of IDD has re-emerged in some countries and regions. According to Alan Court, "We are warned against premature perceptions that the problem is solved where iodization has been successfully introduced."
To sustain the achievement and prevent a retreat in progress experts are calling for strong national coalitions that include officials from government, the salt industry, scientific groups and civil society.
"These coalitions must permanently oversee that high-quality iodized salt is produced and is sold in all markets, that political commitment to ending iodine deficiency is consistently renewed, and that the public remains aware of the dangers of IDD associated with accepting un-iodized salt," says M.G. Venkatesh Mannar, President of the Ottawa-based Micronutrient Initiative, a founding member of the Network.
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